• Continuous Intravenous Insulin Weight Based Dose-Related Hypoglycemia in Critically Ill Patients

      Erstad, Brian; Patanwala, Sid; Frey, Paul; Lee, Yong Gu; Paddock, Holly; Erstad, Brian; Patanwala, Sid; College of Pharmacy, The University of Arizona (The University of Arizona., 2014)
      Specific Aims: To evaluate the association of weight-based insulin dose with hypoglycemia in critically ill patients receiving continuous intravenous insulin infuions. To determine whether higher weight-based doses of insulin were associated with a higher incidence of hypoglycemia Methods: This was a retrospective, case-control study conducted at a tertiary care, academic medical center. Adult (>18 years) patients admitted to the intensive care unit (ICU) receiving intravenous (IV) regular insulin infusions for the management of hyperglycemia between 1 January 2008 and 30 March 2013 were included. Medical records were retrospectively reviewed. Each patient with hypoglycemia was matched with a non-hypoglycemic control subject, based on age range and sex. Laboratory data, patient demographics, hypoglycemic events, insulin infusion data, SOFA scores, length of hospital and ICU stay, and patient outcomes were collected and evaluated. Main Results: Sixty-one patients experienced a hypoglycemic event and were matched with 61 non-hypoglycemic control subjects for statistical analysis. With the exception of ethnicity (p = 0.041) as a demographic predictor of hypoglycemia; age, sex, weight, height, and BMI were not significant. The starting insulin infusion rate and the total number of insulin units per day administered were not found to be associated with hypoglycemia, p=0.107 and p=0.357, respectively. Conclusion: This study failed to show significance in the total units per day of insulin and the incidence of hypoglycemia. There was no statistical significance in BMI between case and control groups, thus no clear conclusion can be made associating hypoglycemia with weight-based insulin dosing.
    • Psychological and Genetic Predictors of Pain Sensitivity

      Patanwala, Sid; Snyder, Eric; Li, May; Walsh, Keith; Patanwala, Sid; Snyder, Eric; College of Pharmacy, The University of Arizona (The University of Arizona., 2013)
      Specific Aims: To assess influence of PCS and FPQ-III on pain tolerance as well as SNPs TRPA1(rs11988795), COMT (rs4646312, rs6269) and FAAH(rs 932816, rs4141964, rs2295633). Methods: A Pain Catastrophizing Scale (PCS) and Fear of Pain Questionnaire (FPQ-III) were completed by a total of 89 healthy adults. A genetic analysis from cheek swabs was performed for single nucleotide polymorphisms(SNPs) within genes: TRPA1, COMT, and FAAH. A cold-pressor test involving the non-dominant hand inserted in circulating water kept at 1-3 degrees Celsius was used and the duration of time subjects were able to leave their hand in the water (pain tolerance) was measured as the primary outcome. Linear regression analysis was used to identify predictors of pain tolerance. Main Results: The subjects were 58% female, the majority were Caucasian (51%) with 26% Asian, 14% Hispanic and 9% other. The mean pain tolerance was 121 ± 66 seconds and regression analysis showed female sex (p=0.001), Asian race (p=0.001), PCS score (<0.001) and FPQ-III score (p=0.014) were associated with decreased pain tolerance while the SNPs were not.      Conclusion: Psychological factors and patient demographics are associated with pain tolerance but the single nucleotide polymorphisms evaluated were not. Future pain studies should utilize a psychological assessment to adjust for this as a confounder.