ENDOCRINAL DISORDERS AND EMERGENCIES IN CRETICAL ILL PATEINTS IN INTENSIVE CARE UNIT

Abstract

Diabetes mellitus is a multi-system disease with both biochemical and anatomical consequences. It is a chronic disease of carbohydrate, fat, and protein metabolism caused by the lack of insulin. In type 1 diabetes, insulin is functionally absent because of the destruction of the beta cells of the pancreas. Type 1 DM occurs most commonly in juveniles but can occur in adults, especially in those in their late 30s and early 40s. Unlike people with type 2 DM, those with type 1 DM generally are not obese and may present initially with diabetic ketoacidosis (DKA) (Carroll Mf. et al., 2005). Type 2 diabetes mellitus is a group of disorders characterized by hyperglycemia and associated with microvascular (ie, retinal, renal, possibly neuropathic), macrovascular (ie, coronary, peripheral vascular), and neuropathic (ie, autonomic, peripheral) complications. Unlike type 1 diabetes mellitus, patients are not absolutely dependent upon insulin for life, even though many of these patients are ultimately treated with insulin(Barker Dj.,2004) . Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state are the most common and most serious diabetic emergencies. Most of these occur in patients with known diabetes. It has long been assumed that DKA is pathogonomic of type 1 diabetes mellitus, but it is now recognised that DKA can occur in type 2 diabetes (Umpierrez GE. et al., 2004). Hypoglycaemia is a biochemical diagnosis defined as blood glucose level of <2.5 mmol/l, but is believed by patients, friends and family as a group of symptoms. Most of hospital admissions are due to insulin treatment of type 1 or 2 diabetes mellitus, although sulphonylurea drugs can also cause hypoglycaemic episodes (Shorr RI. et al., 2002). However, most hypoglycaemia episodes are managed by patients and by the ambulance services (Sampson MJ. et al., 2006).