Impacto de la diabetes mellitus en el manejo del paciente quemado

Abstract

The abundant complications inherent to diabetes mellitus (DM) mark it as a greatly relevant condition in hospitalizations for any other cause. Specifically, the preexistence of DM in patients hospitalized for burns represent a therapeutic challenge, since they tend to have a worse prognosis, longer time of hospitalization, greater risk of infection of the burns, and greater risk of mortality than non-diabetic patients. It has been demonstrated that burns generate a stress response that leads to hyperglycemia, even in non-diabetic patients, due to the acute increase in hormones such as epinephrine and cortisol, as well as the reduction in the peripheral uptake of glucose. This, in addition to the preexistence of DM, importantly increases the risk of developing acute complications of DM, and thus the risk of mortality. In both patients with and without DM, it has been shown that controlling the hyperglycemia induced by burns entails a better prognosis and lower mortality. The objective of this review is to assess the mechanisms linking DM and burns, and how these mechanisms modify the management of diabetic burn patients.