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Standard Septic Shock Treatments Ineffective
Date:1/9/2008

erapy or a modified Ringer's lactate solution versus a pentastarch solution. Pentastarch is a synthetic fluid replacement substance.

The idea behind intensive insulin therapy originally came from a study of cardiac surgical patients that found when blood sugar was kept in the normal, healthy range, mortality was reduced, according to Saravolatz. "The immune system doesn't work well if blood sugar is too high," he explained.

In this study, however, the German researchers found that intensive insulin therapy didn't produce a statistically significant reduction in death rates but did increase the risk of serious adverse events, such as critically low blood sugar (hypoglycemia). In the intensive insulin group, 17 percent had severe hypoglycemia compared to just 4 percent of those on standard insulin therapy.

Additionally, the researchers found that pentastarch was associated with higher rates of kidney failure than Ringer's lactate.

"The use of intensive insulin therapy placed critically ill patients with sepsis at increased risk for serious adverse events related to hypoglycemia," said one of the study's lead authors, Dr. Frank Brunkhorst, a senior physician in internal and intensive care medicine at the Clinic for Anesthesiology and Intensive Care at Friedrich Schiller University of Jena in Germany.

And, he added, "As used in this study, [pentastarch] was harmful, and its toxicity increased with accumulating doses."

Saravolatz said: "This is a fascinating study that has the potential to really change what we're doing. This study will relieve some of the intense efforts to get blood sugar lower. I'm not saying we'll let people have blood sugars of 200 or 300, but this study will have an impact.

"And, this study shows that pentastarch really is potentially harmful," he said, adding that for most patients with septic shock, "salt water (saline) and the right antibiotics are probably all we nee
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