Acute metabolic changes in critical care and cardiac care: Role of potassium, glucose and lactate

This thesis describes the relation of potassium, glucose and lactate with outcome in critical care and cardiac care and computer-assisted regulation of glucose and potassium in the intensive care.
In patient with acute myocardial infarction it is important to identify those who have the highest risk for adverse outcome. Several markers can be used for this purpose. This thesis demonstrates that hyperglycemia predicts short-term prognosis associated with a larger infarct size whereas HbA1c predicts long-term outcome resulting from a higher baseline risk.
Managing glucose levels in critically ill patients is part of routine clinical care, also in patients without diabetes. This thesis describes several aspects of glucose control in the intensive care and the implementation of a computer-assisted glucose regulation protocol.
Atrial fibrillation is a common complication after cardiac surgery. The GRIP-COMPASS trial compares two potassium targets (both within the normal range) and the effect on post-operative atrial fibrillation in patients after cardiac surgery. There was no difference in the incidence of atrial fibrillation between the two groups. Patients who developed AF/AFL were more likely to develop a cerebral vascular accident (CVA) or to die during hospitalization.