Norepinephrine

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An event is serious (based on the ICH definition) when the patient outcome is:

• * death

• * life-threatening

• * hospitalisation

• * disability

• * congenital anomaly

• * other medically important event

A 57-year-old man experienced hyperglycaemia during vasopressive therapy with norepinephrine.

The man, who had obstructive sleep apnea, asthma and type 2 diabetes, was hospitalised in Switzerland due to aggravation of his dyspnea. He had been receiving metformin for his diabetes. Three weeks prior to the current presentation, he presented for dry cough and received amoxicillin/clavulanic-acid and clarithromycin for 5 days. After 24 hours of presentation, he was intubation due to acute respiratory distress syndrome. Vasopressive therapy with norepinephrine infusion at an initial dose of 0.22 µg/kg/min was initiated on day 1 of hospitalisation. His SARS-CoV-2 by RT-qPCR assay was positive. On day 2 of hospitalisation, an increase in plasma glucose was observed. By day 3, a rapidly progressive requirement of insulin aspart was noted. Despite receiving high doses of insulin, an increased plasma glucose level was noted. He received norepinephrine 0.28 µg/kg/min (on day 2 and day 3), 0.21 µg/kg/min (on day 4), 0.20 µg/kg/min (on day 5), 0.16 µg/kg/min (on day 6), 0.04 µg/kg/min (on day 7) and 0.02 µg/kg/min (on day 8). He had also received concurrent hydrocortisone for 3 days (day 6−day 8). Laboratory investigation on day 2−day 8 showed a plasma glucose level from 227−290 mg/dL. On day 9 of hospitalisation (after completion of course of norepinephrine), a decrease in plasma glucose level was noted with subsequent decrease in insulin requirement. Thereafter, his infusion rate was rapidly decreased to avoid hypoglycaemia. On day 13, he was extubated and on the following day he was shifted to intermediate care unit. On day 15, his plasma glucose level 122 mg/dL. He was shifted to regular hospital room insulin treatment was switched to insulin-suspension-isophane. Based on the presentation, his hyperglycaemia was considered to be secondary to SARS-CoV-2 infection and vasopressive therapy with norepinephrine.