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 diabetic stroke patient in ER  



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Author14 Posts
  #1

1. Regarding diabetic stroke patient:

a. high blood suger should be lowered quickly.
b. high blood suger should be lowered slowely, if any.
c. high blood suger should not be managed during the
acute phase of stroke, regardless of blood suger level.
d. no relation exists between stroke and diabetes.

please explain your point of view.. :wink:




  #2

i go for b
in pt with diabetes, an aggressive treatment is need when there is complication--- coma (HHNK or DKA)
if that is not present, i think the pt should be treated for the stroke (priority) and hyperglicemia corrected slowly, if any.


  #3

since here its Diabetic stroke B seems the best answer.


  #4

it was a question in the exam yesterday, however the question was not so clear, some answered with (a) and others with (b), others with (c), that is how much clear the question should be.

good luck


  #5

I also go for b because too rapid correction may cause electrolyte and acid-base change, which will make things worse. Thanks.


  #6

Can somebody help with the answer to this one? I think this is the kind of question that they are hitting on in the USMLE CK right now!! A GREAT question, but one that is very difficult to find the answer to.

Somebody help if at all possible. I can't find diabetic stroke management anywhere!!! sad It's bugging me like crazy!!!


  #7

standard recommendations are that glucose levels be maintained in a reasonable range less than 180-200 mg/dL, but no present data indicate that normalization of the blood sugar level reduces the incidence of stroke :-)

So, my answer is C


  #8

i'm not sure about it but i think that once stroke has occured lowering the blood sugar won't help the stroke any.
stroke would have occured b/c of microvascular causes right? so once the damage is done how can lowering the blood sugar help in managing the stroke?
it will help in managing the diabetes sure but not the stroke.
correct me if i'm wrong.


  #9

I think, if we leave alone sugar in acute stroke, in spite of poor condition of patient, we'll lost the patient because deabetic coma or etc., and thats why we need to reduce blood sugar level, but do not treat deabetes mellitus.
I think so, may be I'm wrong.


  #10

Some more info about this theme:

Recently, it has been pointed at an importance of early detection of hyperglycaemia in ischemic brain accidents, because hyperglycaemia seriously affects ischemic brain tissue. Apart from other things, it leads to impairment of motor functions. A specialist providing care to diabetics must consider and start treatment of all the risk factors. Under ideal conditions, every diabetic should be excellently compensated and have normal blood pressure values, low concentrations of LDL cholesterol, and should be treated with ACE inhibitor at the same time as with acetylsalicylic acid and clopidogrel.

No reduction in short-term mortality risk was observed in patients treated with intravenous (IV) glycerol. However, an increase in short-term mortality risk was observed in the patients who were concurrently treated with IV corticosteroids. Similarly, treatment with mannitol did not reduce the risk of short-term mortality; however, concurrent treatment with IV corticosteroids did not show a significant rise in short-term mortality risk. When treatment with IV glycerol and mannitol was considered together, the treatment did not decrease short-term mortality risk, while concurrent therapy with corticosteroids was associated with an increase in short-term mortality risk. CONCLUSION: This study does not support the use of IV osmotic agents such as glycerol or mannitol in the prevention of short-term mortality in older patients with acute ischaemic stroke. Furthermore, our data suggest a possible harmful effect of IV corticosteroids on short-term mortality risk.

So after this info, correct answer is D?


  #11

A major remaining question is the potential role of aggressive glucose control for reducing macrovascular event rates in patients with diabetes.

Thats all folk!!! :-)


  #12

is stroke not a stressful condition and if yes, does it increase the insulin requirement to prevent the pt from going into ketoacidosis!


  #13

Great point Babu!! I think the ansnwer is correcting slowly while managing the stroke at the same time.

What do you all think? smiling face


  #14

I think answer is (B)

Reason-

Diabetes usually causes small vessel disease and complicates in lacunar infarcts (small lesion ,massive damage).Hence certain amount od increased anion gap is expected and hence metabolic acidosis.

Further ,to complicate the situation ,metabolic acidosis deteriorates cerebral edema and hence increases ICP leading to hypotension.

A rapid correction of blood sugar may lead to hypoglycemia,further aggravating hypotension/shock due to loss of intravascular volume expanding effect of hyperglycemia.The patient then enters a vicious cycle.

Bottom line-DON'T GO FAST.





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