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Posted: June 27th, 2023
NPO Status and Rates of Hypoglycaemia
NPO status, or nothing by mouth, is a medical instruction that restricts oral intake of food and fluids for patients who are undergoing certain procedures or treatments. NPO status is often necessary to prevent aspiration, vomiting, or interference with anesthesia. However, NPO status also carries some risks, especially for patients with diabetes who are prone to hypoglycaemia, or low blood sugar. Hypoglycaemia can cause symptoms such as dizziness, confusion, weakness, and seizures, and can lead to serious complications if not treated promptly. Therefore, it is important to monitor and manage blood glucose levels in patients with diabetes who are on NPO status.
According to a systematic review by Umpierrez et al. (2018), the incidence of hypoglycaemia in hospitalized patients with diabetes ranges from 4% to 56%, depending on the definition, measurement method, and patient population. The risk factors for hypoglycaemia include older age, renal impairment, insulin therapy, and prolonged fasting. The authors recommend that patients with diabetes who are on NPO status should receive basal insulin or basal-bolus insulin regimens, rather than sliding-scale insulin or premixed insulin, to prevent wide fluctuations in blood glucose levels. They also suggest that blood glucose should be checked every 4 to 6 hours in patients on NPO status, and more frequently in those with unstable glucose levels or receiving intravenous insulin.
Another study by Egi et al. (2010) compared the outcomes of critically ill patients with and without diabetes who were on NPO status and received enteral nutrition or parenteral nutrition. The authors found that hypoglycaemia occurred in 5.7% of patients with diabetes and 3.1% of patients without diabetes, and that hypoglycaemia was associated with increased mortality and length of stay in both groups. The authors concluded that tight glycaemic control may not be beneficial for critically ill patients on NPO status, and that a moderate target range of 7.8 to 10 mmol/L may be more appropriate.
In summary, NPO status is a common and necessary intervention for many patients with diabetes, but it also increases the risk of hypoglycaemia. Therefore, careful monitoring and adjustment of blood glucose levels and insulin therapy are essential to prevent adverse outcomes. Further research is needed to determine the optimal glycaemic targets and management strategies for different patient populations and clinical settings.
Works Cited
Egi, Moritoki, et al. “Hypoglycemia and outcome in critically ill patients.” Mayo Clinic Proceedings 85.3 (2010): 217-224.
Umpierrez, Guillermo E., et al. “Management of hyperglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline.” The Journal of Clinical Endocrinology & Metabolism 103.1 (2018): 8-38.
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