Adrenaline-induced hyperglycaemia — FRCA Primary MCQ

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ModeratePharmacologyAdrenaline-induced hyperglycaemiaFRCA Primary

A ventilated patient in ICU receives an inotrope after emergency laparotomy. Twelve hours later the glucose is 13 mmol/L despite no history of diabetes. Which infusion is most likely to explain this finding?

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Reveal the answer and explanation

Correct answer: D — Adrenaline

Adrenaline stimulates β2- and α1-adrenoceptors, promoting hepatic glycogenolysis, gluconeogenesis and reduced peripheral glucose uptake. Noradrenaline is a tempting answer because it is a common ICU vasopressor, but it has less β2-mediated metabolic effect. Dobutamine and milrinone mainly augment inotropy, whereas vasopressin acts through V1 receptors. The clinical pearl is that catecholamine choice can materially affect glucose and lactate interpretation after major surgery.

Reference: Peck, Hill & Williams Pharmacology for Anaesthesia and Intensive Care; RCoA Primary FRCA Syllabus