Rapid Administration of Insulin in Sepsis

Inclusion criteria

• Suspected or confirmed infection;
• Any two of four criteria of systemic inflammatory response:

• Temperature > 100.4° or < 96.8° F
• Heart rate > 90 beats/minute
• Respiratory rate > 20 breaths/min. or PaCO2 < 32 mm Hg
• WBC >12,000 or < 4000 cells/µL or > 10% bands
• Initiation of quantitative resuscitation protocol in the ED;
• Requirement of high dose vasopressors (defined as a cumulative vasopressor index = 4) to treat shock

Exclusion criteria

• Age <18 years;
• Pregnancy;
• Any primary diagnosis other than sepsis;
• Established Do Not Resuscitate status or advanced directives restricting aggressive care or treating physician deems aggressive care unsuitable;
• Known hyperkalemia (serum potassium >5.5);
• Dialysis-dependent renal failure;
• Anticipated requirement for immediate surgery (within 24 hours);
• Active participation in another interventional study;
• Transferred from another hospital setting with sepsis therapy initiated;
• Inability to obtain informed consent;
• Cardiopulmonary resuscitation (chest compression or defibrillation) prior to enrollment;
• Active malignancy currently under treatment (chemo- or radiation therapy);
• Known systemic allergy to insulin;
• History of periodic paralysis associated with carbohydrate loading;
• Receiving continuous intravenous inotropic support (including dobutamine, milrinone, amrinone, and levosimendan).