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Endocrine Critical CareIntensive insulin therapy van den Berghe G, Wilmer A, Hermans G, et al. Intensive insulin therapy in the medical ICU. N Engl J Med. 2006; 354:449-61. RCT of 1200 MICU patients found those randomized to intense therapy had reduced risk of acute renal injury and shorter duration of ICU stay, but no difference in mortality. Of note, patients with ICU stays < 3 days had higher mortality than controls while those with stays > 3 days had reduced mortality with intensive control. http://www.ncbi.nlm.nih.gov/pubmed/16452557?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus Brunkhorst FM, Engel C, Bloos F, et al. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med 2008;358:125-139. This multicenter 2-by-2 factorial trial of 537 patients was stopped early due to elevated rates of severe hypoglycemia in the intensive control arm (17.0% vs. 4.1% in non-intensive arm, p < .001). No differences in 28-day mortality were observed. http://www.ncbi.nlm.nih.gov/pubmed/18184958?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum Overview Goldberg PA, Inzucchi SE. Critical issues in endocrinology. Clin Chest Med. 2003;24:583-606, vi. This article provides a review of the treatment of several important endocrine emergencies, including diabetic hyperglycemic states, adrenal insufficiency, myxedema coma, thyroid storm, and pituitary apoplexy. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=14710692&query_hl=19&itool=pubmed_DocSum | |||||||||
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