Hyperglycemia is common in critically ill patients and has been associated with poor outcomes. The effect of hypothermia, whether induced or spontaneous, on insulin resistance and hyperglycemia is not well understood and sometimes overlooked. In cardiac surgery hypothermia impairs blood glucose homeostasis and insulin sensitivity ⁽¹⁾. However, the impact of therapeutic hypothermia on blood glucose levels and insulin requirements is unknown ⁽¹⁾. 

Keywords: Therapeutic Hypothermia, Hyperglycemia.

1. Cueni-Villoz N, Devigili A, Delodder F, Cianferoni S, Feihl F, Rossetti AO, et al. Increased blood glucose variability during therapeutic hypothermia and outcome after cardiac arrest. Critical care medicine. 2011;39(10):2225-31.
2. Nielsen NM, Sunde K, Hovdenes J, et al. The Hypothermia Network. Adverse events and their relation to mortality in out-of-hospital cardiac arrest patients treated with therapeutic hypothermia. Crit Care Med 2011;39:57–64.
3. Hyperglycemia as an Effect of Cardiopulmonary Bypass: Intra-operative Glucose Management Samira Najmaii, MS; Daniel Redford, et al. 2006;38:168–173
4. Mallet ML. Pathophysiology of accidental hypothermia. QJM. 2002; 95:775–85.
5. Zydlewski AW, Hasbargen JA. Hypothermia-induced hypokalemia. Mil Med. 1998;163:719–21.
6. Plavinik FL, Rodrigues CI, Zanella MT, et al. Hypokalemia, glucose intolerance, and hyperinsulinemia during diuretic therapy. Hypertension. 1992;19:II26–9.
7. Lazar HL, McDonnell M, Chipkin SR, et al.: The Society of Thoracic Surgeons practice guideline series: Blood glucose management during adult cardiac surgery. Ann Thorac Surg 2009; 87: 663-9
8. Malatinsky J, Vigas M, Jezova D, et al. The effects of open heart surgery on growth hormone, cortisol and insulin levels in man. Hormone levels during open heart surgery. Resuscitation 1984;11(1-2):57-68.
9. Allison SP, Prowse K, Chamberlain MJ. Failure of insulin response to glucose load during operation and after myocardial infarction. Lancet 1967;1(7488):478-481.
10. Abe T. Influence of cardiac surgery using cardio-pulmonary bypass on metabolic regulation. Jpn Circ J 1974;38(1):13-21.
11. Kuntschen FR, Galletti PM, Hahn C. Glucose-insulin interactions during cardiopulmonary bypass. Hypothermia versus normothermia. J Thorac Cardiovasc Surg 1986;91:451-459.
12. Lehot JJ, Piriz H, Villard J, et al. Glucose homeostasis: comparison between hypoth-ermic and normothermic cardiopulmonary bypass. Chest 1992;102:106-111
13. Porte D Jr, Graber AL, Kuzuya T, et al. The effect of epinephrine on immunoreactive insulin levels in man. J Clin Invest 1966;45(2):228-236.
14. Nagaoka H, Innami R, Watanabe M, et al. Preservation of pancreatic beta cell function with pulsatile cardiopulmonary bypass. Ann Thorac Surg 1989;48:798-802
15. Rogers AT, Zaloga GP, Prough DS, et al. Hyperglycemia during cardiac surgery: central vs peripheral mechanisms [abstract]. Anesth Analg 1990;70:S328
16. Kuntschen FR, Galletti PM, Hahn C. Glucose-insulin interactions during cardiopulmonary bypass. Hypothermia versus normothermia. J Thorac Cardiovasc Surg 1986;91:451-459.
17. Ridley PD, Ratcliffe JM, Alberti KGMM, et al. The metabolic consequences of a “washed” cardiopulmonary bypass pumppriming fluid in children undergoing cardiac operations. J Thorac Cardiovasc Surg 1990;100:528-537.
18. Zydlewski AW, Hasbargen JA. Hypothermia-induced hypokalemia. Mil Med. 1998;163:719–21.
19. Plavinik FL, Rodrigues CI, Zanella MT, et al. Hypokalemia, glucose intolerance, and hyperinsulinemia during diuretic therapy. Hypertension. 1992;19:II26–9. 172 S. NAJMAII ET AL
20. Rogers AT, Zaloga GP, Prough DS, et al. Hyperglycemia during cardiac surgery: central vs peripheral mechanisms [abstract]. Anesth Analg 1990;70:S328.

Tuhinsubhra Medda

BSc Perfusion Technology, Dept of Cardiothoracic & Vascular Surgery,

R G Kar Medical College, Kolkata