A 32-year-old man is admitted to the hospital after sustaining a head injury and fractures of both femurs in a motor vehicle collision. CT scan of the head reveals a left-sided extradural hematoma. He has no history of chronic illness and takes no medications. The patient receives intravenous fluid boluses and blood transfusions and is taken to the operating room for fracture repair and removal of the hematoma. On the first postoperative day, laboratory results show high plasma glucose and lactate levels. Which of the following is the primary contributor to this patient's elevated blood glucose levels?

Question

A 32-year-old man is admitted to the hospital after sustaining a head injury and fractures of both femurs in a motor vehicle collision.  CT scan of the head reveals a left-sided extradural hematoma.  He has no history of chronic illness and takes no medications.  The patient receives intravenous fluid boluses and blood transfusions and is taken to the operating room for fracture repair and removal of the hematoma.  On the first postoperative day, laboratory results show high plasma glucose and lactate levels.  Which of the following is the primary contributor to this patient's elevated blood glucose levels?

Quizplus · Accepted Answer

Eductional Objective: Stress hyperglycemia is transiently elevated blood glucose levels in the context of severe illness (eg, sepsis, burns, major hemorrhage) in patients without preexisting diabetes mellitus.  Cortisol and catecholamines released in response to severe metabolic stress act on the liver to increase glycogenolysis and gluconeogenesis.

A 32-Year-Old Man Is Admitted to the Hospital After Sustaining