Rapid Administration of Insulin in Sepsis

Inclusion Criteria:

1. Suspected or confirmed infection;

2. 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
3. Initiation of quantitative resuscitation protocol in the ED;
4. Requirement of high dose vasopressors (defined as a cumulative vasopressor index = 4) to treat shock

Exclusion Criteria:

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