Retirar Siempre Paulatinamente la NP

¿Es Necesario Retirar Siempre Paulatinamente la NP?

No (Grado A).

Comentarios:

Desde que Dudrick popularizó la NP y hasta hace poco tiempo se recomendaba que la NP fuera disminuida poco a poco antes de retirarla por completo para prevenir la hipoglucemia. Sin embargo, se ha demostrado que aun después de NP prolongada, las células beta permanecen sensibles a los cambios en los niveles de glucosa y que la adaptación de los niveles de glucosa y de la secreción de insulina se hace muy rápidamente153.

Estudios concretos sobre este asunto han mostrado que al ocurrir la suspensión abrupta de la NP que contenga glucosa en cantidad de 3,7 g/kg por día, la glucosa del plasma vuelve a los niveles que tenía antes de la infusión en los siguientes 60 minutos, sin ningún síntoma de hipoglucemia154,155. No hay diferencias en los valores promedio de glucosa o de hormonas claves (como epinefrina, norepinefrina, insulina, glucagón, hormona del crecimiento y cortisol) cuando la suspensión de la NP se hace abruptamente o en forma gradual156.

En un estudio aleatorizado que comparó la suspensión abrupta de la NP con la gradual, no se encontró diferencia en el valor mínimo de glucosa sanguínea. Ninguno de los pacientes tuvo cambios significativos en la escala de valoración de hipoglucemia157.

Conflictos de intereses

Los conflictos de intereses han sido presentados y están archivados en ESPEN (espenjournals@espen.org).

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