Hiperglicemia post-ictus

Otman Fernández Concepción, Miguel Ángel Buergo Zuaznábar, Melvin López Jiménez

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OBJETIVOS: Revisar las evidencias disponibles sobre la frecuencia y mecanismos de producción de la hiperglicemia postictus (HPI), así como aquellas que relacionan la HPI con el riesgo de evolución desfavorable y la eficacia de alternativas de tratamiento para esta entidad.

DESARROLLO: Entre el 43% y el 68% de los pacientes que sufren un ictus tienen un aumento en los niveles de glicemia. Del 16% al 24% de éstos no son diabéticos conocidos. La gran mayoría de estos pacientes tienen una regulación anormal de la glucosa, 16,4% reciben un nuevo diagnóstico de diabetes mellitus, y el 23,1% tienen una PTG alterada. La HPI tiene dos picos: uno en las primeras ocho horas y otro entre el tercer y quinto día. La HPI se asocia a muerte y evolución desfavorable, sobre todo la hiperglicemia persistente; además, aumenta el riesgo de transformación hemorrágica tras la trombólisis. El punto de corte para iniciar tratamiento con insulina no está claro, estudios han definido 7,2 mmol/L o 8,7 mmol/L; sin embargo, las guías clínicas sugieren 10 mmol/L debido al riesgo de hipoglicemia con estrategias más agresivas.

Palabras clave

Diabetes mellitus; Glicemia; Hiperglicemia post–ictus; Ictus

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