SlideShare una empresa de Scribd logo
1 de 28
Hyperglycemia and the Critically Ill Patient Tony Gerlach, PharmD, BCPS The Ohio State University Medical Center
Objectives ,[object Object],[object Object],[object Object]
Effects of Insulin ,[object Object],[object Object],[object Object],[object Object],[object Object]
Glucose control in Healthy People with out Diabetes Insulin Release Glucagon Decrease Glucose Intake
Causes of Hyperglycemia:  Glucose Intake ,[object Object],[object Object],[object Object],[object Object],[object Object]
Causes of Hyperglycemia: Stress Response ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Causes of Hyperglycemia: Medications And Disease ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Epidemiology of Hypoglycemia in the ICU ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Long-term Glycemic Control and Postoperative Infection Complications %  Arch Surg 2006;141:375-80. ** Statistically Significant
Hyperglycemia and Mortality Mayo Clin Proc. 2003;78:1471-8 . %
Hyperglycemia, Infectious Complication and Mortality in Trauma Patients J Trauma 2004;56:1058-62. %
Effects of Hyperglycemia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sternal Wound Infections in Diabetics undergoing Cardiac Surgery Ann Thorac Surg 1999;67:352-62 %  ** Statistically Significant
Intensive Insulin Therapy and Outcomes in SICU Patients N Engl J Med 2001;345:1359-67. %  ** Statistically Significant
Intensive Insulin Therapy and Outcomes in Mixed ICU Patients Mayo Clin Proc 2004;79:992-1000 * Statistically Significant
Intensive Insulin Therapy and Outcomes in MICU Patients N Engl J Med 2006;354:449-61 %  * Statistically Significant
Blood Glucose and Insulin Requirements during ICU Stay Crit Care Med 2003;31:359-66 mg/dL Units/h per cal/kg
Early versus Late Intensive Insulin Therapy in ICU Patients ** Statistically Significant Inten Care Med 2008;34:881-7
Hyperglycemia and mortality in VA ICU patients ,[object Object],[object Object],[object Object],[object Object],[object Object],ADA 2006 Scientific Sessions Medscape July 23, 2006
GluControl Study ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],SCCM 2007 Scientific Sessions Medscape February 2007
What is the Optimal Glucose Range? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Optimal Glucose Target ,[object Object],[object Object],[object Object]
OSUMC Insulin Infusion Protocol ,[object Object],[object Object],[object Object],[object Object],[object Object]
OSUMC Insulin Infusion Protocol ,[object Object],[object Object],[object Object],[object Object],[object Object]
OSUMC Experience ** Statistically Significant %
Source of Dextrose ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
OSUMC Nursing Hypoglyecmia Policy ,[object Object],[object Object],[object Object],[object Object],[object Object]
Final Thoughts ,[object Object],[object Object],[object Object],[object Object],[object Object]

Más contenido relacionado

La actualidad más candente

Glycemic Control - Diabetes Mellitus
Glycemic Control - Diabetes Mellitus Glycemic Control - Diabetes Mellitus
Glycemic Control - Diabetes Mellitus Areej Abu Hanieh
 
Management of inpatient hyperglycemia
Management of inpatient hyperglycemiaManagement of inpatient hyperglycemia
Management of inpatient hyperglycemiaDr. Armaan Singh
 
ueda2013 management of hyperglycaemia-d.mohamed
ueda2013 management of hyperglycaemia-d.mohamedueda2013 management of hyperglycaemia-d.mohamed
ueda2013 management of hyperglycaemia-d.mohamedueda2015
 
Diaa ewais.ada diabetes hospital management
Diaa ewais.ada diabetes hospital managementDiaa ewais.ada diabetes hospital management
Diaa ewais.ada diabetes hospital managementEmad Hamed
 
Nice Sugar Study - Glycemic control in the ICU
Nice Sugar Study - Glycemic control in the ICUNice Sugar Study - Glycemic control in the ICU
Nice Sugar Study - Glycemic control in the ICUshivabirdi
 
Intensive Insulin Therapy In The Medical ICU
Intensive Insulin Therapy In The Medical ICUIntensive Insulin Therapy In The Medical ICU
Intensive Insulin Therapy In The Medical ICUMuhammad Badawi
 
managing diabetes in critically ill hospitalized patients
managing diabetes in critically ill hospitalized patientsmanaging diabetes in critically ill hospitalized patients
managing diabetes in critically ill hospitalized patientssumitverma88
 
Numbers to Remember, Important Numbers not to be missed
Numbers to Remember, Important Numbers not to be missedNumbers to Remember, Important Numbers not to be missed
Numbers to Remember, Important Numbers not to be missedUsama Ragab
 
Iv insulin infusion therapy
Iv insulin infusion therapyIv insulin infusion therapy
Iv insulin infusion therapyEmad Hamed
 
Ibrahim elebrashy.insulin therapy
Ibrahim elebrashy.insulin therapyIbrahim elebrashy.insulin therapy
Ibrahim elebrashy.insulin therapyEmad Hamed
 
Diabetes of stout people
Diabetes of stout peopleDiabetes of stout people
Diabetes of stout peopleUsama Ragab
 
Inpatient Diabetes Management - How to Control Hyperglycemia inhsopital
Inpatient Diabetes Management - How to Control Hyperglycemia inhsopitalInpatient Diabetes Management - How to Control Hyperglycemia inhsopital
Inpatient Diabetes Management - How to Control Hyperglycemia inhsopitalUsama Ragab
 
Drug induced Dysglycemia
Drug induced DysglycemiaDrug induced Dysglycemia
Drug induced DysglycemiaUsama Ragab
 
Perioperative hyperglycemia management
Perioperative hyperglycemia managementPerioperative hyperglycemia management
Perioperative hyperglycemia management143348383
 

La actualidad más candente (17)

Glycemic Control - Diabetes Mellitus
Glycemic Control - Diabetes Mellitus Glycemic Control - Diabetes Mellitus
Glycemic Control - Diabetes Mellitus
 
Management of inpatient hyperglycemia
Management of inpatient hyperglycemiaManagement of inpatient hyperglycemia
Management of inpatient hyperglycemia
 
ueda2013 management of hyperglycaemia-d.mohamed
ueda2013 management of hyperglycaemia-d.mohamedueda2013 management of hyperglycaemia-d.mohamed
ueda2013 management of hyperglycaemia-d.mohamed
 
Diaa ewais.ada diabetes hospital management
Diaa ewais.ada diabetes hospital managementDiaa ewais.ada diabetes hospital management
Diaa ewais.ada diabetes hospital management
 
Nice Sugar Study - Glycemic control in the ICU
Nice Sugar Study - Glycemic control in the ICUNice Sugar Study - Glycemic control in the ICU
Nice Sugar Study - Glycemic control in the ICU
 
ICN Vic - glucose control in diabetics
ICN Vic - glucose control in diabeticsICN Vic - glucose control in diabetics
ICN Vic - glucose control in diabetics
 
Intensive Insulin Therapy In The Medical ICU
Intensive Insulin Therapy In The Medical ICUIntensive Insulin Therapy In The Medical ICU
Intensive Insulin Therapy In The Medical ICU
 
managing diabetes in critically ill hospitalized patients
managing diabetes in critically ill hospitalized patientsmanaging diabetes in critically ill hospitalized patients
managing diabetes in critically ill hospitalized patients
 
Numbers to Remember, Important Numbers not to be missed
Numbers to Remember, Important Numbers not to be missedNumbers to Remember, Important Numbers not to be missed
Numbers to Remember, Important Numbers not to be missed
 
Insulin in icu 2
Insulin in icu 2Insulin in icu 2
Insulin in icu 2
 
Iv insulin infusion therapy
Iv insulin infusion therapyIv insulin infusion therapy
Iv insulin infusion therapy
 
Ibrahim elebrashy.insulin therapy
Ibrahim elebrashy.insulin therapyIbrahim elebrashy.insulin therapy
Ibrahim elebrashy.insulin therapy
 
Diabetes of stout people
Diabetes of stout peopleDiabetes of stout people
Diabetes of stout people
 
Inpatient Diabetes Management - How to Control Hyperglycemia inhsopital
Inpatient Diabetes Management - How to Control Hyperglycemia inhsopitalInpatient Diabetes Management - How to Control Hyperglycemia inhsopital
Inpatient Diabetes Management - How to Control Hyperglycemia inhsopital
 
Drug induced Dysglycemia
Drug induced DysglycemiaDrug induced Dysglycemia
Drug induced Dysglycemia
 
Landmark trials in diabetes
Landmark trials in diabetesLandmark trials in diabetes
Landmark trials in diabetes
 
Perioperative hyperglycemia management
Perioperative hyperglycemia managementPerioperative hyperglycemia management
Perioperative hyperglycemia management
 

Destacado

Nice sugar nejm 2009
Nice sugar nejm 2009Nice sugar nejm 2009
Nice sugar nejm 2009Aivan Lima
 
Profile Neuro Care
Profile Neuro CareProfile Neuro Care
Profile Neuro CareMazher Haq
 
Gis ing.
Gis ing.Gis ing.
Gis ing.tyfngnc
 
Immunodeficiency states
Immunodeficiency statesImmunodeficiency states
Immunodeficiency statessambo zailani
 
Anemia in critical illness
Anemia in critical illnessAnemia in critical illness
Anemia in critical illnesssesegreti1
 
Red cell transfusions in the critically ill compatible
Red cell transfusions in the critically ill compatibleRed cell transfusions in the critically ill compatible
Red cell transfusions in the critically ill compatibleBharath T
 
Interpretation of renal diagnostic tests
Interpretation of renal diagnostic testsInterpretation of renal diagnostic tests
Interpretation of renal diagnostic testsChristos Argyropoulos
 
Prevention of GIT bleeding in the icu
Prevention of GIT bleeding in the icuPrevention of GIT bleeding in the icu
Prevention of GIT bleeding in the icufaheta
 
Hyperglycemia for dm educators March 2016
Hyperglycemia for dm educators March 2016Hyperglycemia for dm educators March 2016
Hyperglycemia for dm educators March 2016Mohammad Othman Daoud
 
Management of Diabetes in Hemodialysis Patients
Management of Diabetes in Hemodialysis PatientsManagement of Diabetes in Hemodialysis Patients
Management of Diabetes in Hemodialysis PatientsMNDU net
 
Hypoglycemia and ulcus and ck dduty report 13 jan 2016
Hypoglycemia and ulcus and ck dduty report 13 jan 2016Hypoglycemia and ulcus and ck dduty report 13 jan 2016
Hypoglycemia and ulcus and ck dduty report 13 jan 2016Soroy Lardo
 
Icu admission, discharge criteria and triage
Icu admission, discharge criteria and triageIcu admission, discharge criteria and triage
Icu admission, discharge criteria and triagefakhfas
 

Destacado (15)

Hyperglycemia
HyperglycemiaHyperglycemia
Hyperglycemia
 
Nice sugar nejm 2009
Nice sugar nejm 2009Nice sugar nejm 2009
Nice sugar nejm 2009
 
Profile Neuro Care
Profile Neuro CareProfile Neuro Care
Profile Neuro Care
 
Acute hyperglycemia and cardiac events
Acute hyperglycemia and cardiac eventsAcute hyperglycemia and cardiac events
Acute hyperglycemia and cardiac events
 
Gis ing.
Gis ing.Gis ing.
Gis ing.
 
Immunodeficiency states
Immunodeficiency statesImmunodeficiency states
Immunodeficiency states
 
Anemia in critical illness
Anemia in critical illnessAnemia in critical illness
Anemia in critical illness
 
Red cell transfusions in the critically ill compatible
Red cell transfusions in the critically ill compatibleRed cell transfusions in the critically ill compatible
Red cell transfusions in the critically ill compatible
 
Interpretation of renal diagnostic tests
Interpretation of renal diagnostic testsInterpretation of renal diagnostic tests
Interpretation of renal diagnostic tests
 
Management of head trauma in icu
Management of head trauma in icuManagement of head trauma in icu
Management of head trauma in icu
 
Prevention of GIT bleeding in the icu
Prevention of GIT bleeding in the icuPrevention of GIT bleeding in the icu
Prevention of GIT bleeding in the icu
 
Hyperglycemia for dm educators March 2016
Hyperglycemia for dm educators March 2016Hyperglycemia for dm educators March 2016
Hyperglycemia for dm educators March 2016
 
Management of Diabetes in Hemodialysis Patients
Management of Diabetes in Hemodialysis PatientsManagement of Diabetes in Hemodialysis Patients
Management of Diabetes in Hemodialysis Patients
 
Hypoglycemia and ulcus and ck dduty report 13 jan 2016
Hypoglycemia and ulcus and ck dduty report 13 jan 2016Hypoglycemia and ulcus and ck dduty report 13 jan 2016
Hypoglycemia and ulcus and ck dduty report 13 jan 2016
 
Icu admission, discharge criteria and triage
Icu admission, discharge criteria and triageIcu admission, discharge criteria and triage
Icu admission, discharge criteria and triage
 

Similar a Hyperglyceminin Icu Md2008

perioperative-management.ppt
perioperative-management.pptperioperative-management.ppt
perioperative-management.pptDrVANDANA17
 
Diabetic ketoacidosis: a case study
Diabetic ketoacidosis: a case studyDiabetic ketoacidosis: a case study
Diabetic ketoacidosis: a case studyLyndon Woytuck
 
ueda2012 ada diabetes hospital management-d.diaa
ueda2012 ada diabetes hospital management-d.diaaueda2012 ada diabetes hospital management-d.diaa
ueda2012 ada diabetes hospital management-d.diaaueda2015
 
Neonatal hypoglycemia
Neonatal hypoglycemia Neonatal hypoglycemia
Neonatal hypoglycemia drnarendragoel
 
ENDOCRINE EMERGENCY.pptx
ENDOCRINE EMERGENCY.pptxENDOCRINE EMERGENCY.pptx
ENDOCRINE EMERGENCY.pptxMalarmathiM1
 
glycemic_control_in_the_hospitalized_patient_august_2019.ppt
glycemic_control_in_the_hospitalized_patient_august_2019.pptglycemic_control_in_the_hospitalized_patient_august_2019.ppt
glycemic_control_in_the_hospitalized_patient_august_2019.pptssuser2127042
 
Perioperative Management of Diabetes Mellitus
Perioperative Management  of Diabetes MellitusPerioperative Management  of Diabetes Mellitus
Perioperative Management of Diabetes MellitusSakkar Chowdhury
 
Diabetes Mellitus management in OPD
Diabetes Mellitus management in OPDDiabetes Mellitus management in OPD
Diabetes Mellitus management in OPDnium
 
Peri-operative Hyperglycemia in OT
Peri-operative Hyperglycemia in OT Peri-operative Hyperglycemia in OT
Peri-operative Hyperglycemia in OT Saptaparni Hazra
 
Perioperative Diabetes mellitus management
Perioperative Diabetes mellitus managementPerioperative Diabetes mellitus management
Perioperative Diabetes mellitus managementDharmraj Singh
 
Thyroid crisis
Thyroid crisisThyroid crisis
Thyroid crisisEM OMSB
 
Management of diabetes emergencies''
Management of diabetes emergencies''Management of diabetes emergencies''
Management of diabetes emergencies''Musa Ezekiel
 
umpierrezInpatientnonicuGuidelines1.ppt
umpierrezInpatientnonicuGuidelines1.pptumpierrezInpatientnonicuGuidelines1.ppt
umpierrezInpatientnonicuGuidelines1.pptDanielCy4
 
Anesthesia considration for DIABETES MELLITUS
Anesthesia considration for DIABETES MELLITUSAnesthesia considration for DIABETES MELLITUS
Anesthesia considration for DIABETES MELLITUSibrahimelkathiri1
 
Risk Factors Associated With Severe Hypoglycemia in Older Adults With Type 1 ...
Risk Factors Associated With Severe Hypoglycemia in Older Adults With Type 1 ...Risk Factors Associated With Severe Hypoglycemia in Older Adults With Type 1 ...
Risk Factors Associated With Severe Hypoglycemia in Older Adults With Type 1 ...دكتور ابراهيم العويطي
 

Similar a Hyperglyceminin Icu Md2008 (20)

Inpatient Management of Hyperglycemia
Inpatient Management of HyperglycemiaInpatient Management of Hyperglycemia
Inpatient Management of Hyperglycemia
 
perioperative-management.ppt
perioperative-management.pptperioperative-management.ppt
perioperative-management.ppt
 
Diabetic ketoacidosis: a case study
Diabetic ketoacidosis: a case studyDiabetic ketoacidosis: a case study
Diabetic ketoacidosis: a case study
 
Hyperglycemia in ccm
Hyperglycemia in ccmHyperglycemia in ccm
Hyperglycemia in ccm
 
NICE SUGAR
NICE SUGARNICE SUGAR
NICE SUGAR
 
ueda2012 ada diabetes hospital management-d.diaa
ueda2012 ada diabetes hospital management-d.diaaueda2012 ada diabetes hospital management-d.diaa
ueda2012 ada diabetes hospital management-d.diaa
 
Neonatal hypoglycemia
Neonatal hypoglycemia Neonatal hypoglycemia
Neonatal hypoglycemia
 
Nice-Sugar
Nice-SugarNice-Sugar
Nice-Sugar
 
ENDOCRINE EMERGENCY.pptx
ENDOCRINE EMERGENCY.pptxENDOCRINE EMERGENCY.pptx
ENDOCRINE EMERGENCY.pptx
 
glycemic_control_in_the_hospitalized_patient_august_2019.ppt
glycemic_control_in_the_hospitalized_patient_august_2019.pptglycemic_control_in_the_hospitalized_patient_august_2019.ppt
glycemic_control_in_the_hospitalized_patient_august_2019.ppt
 
Perioperative Management of Diabetes Mellitus
Perioperative Management  of Diabetes MellitusPerioperative Management  of Diabetes Mellitus
Perioperative Management of Diabetes Mellitus
 
Diabetes Mellitus management in OPD
Diabetes Mellitus management in OPDDiabetes Mellitus management in OPD
Diabetes Mellitus management in OPD
 
Peri-operative Hyperglycemia in OT
Peri-operative Hyperglycemia in OT Peri-operative Hyperglycemia in OT
Peri-operative Hyperglycemia in OT
 
Perioperative Diabetes mellitus management
Perioperative Diabetes mellitus managementPerioperative Diabetes mellitus management
Perioperative Diabetes mellitus management
 
Thyroid crisis
Thyroid crisisThyroid crisis
Thyroid crisis
 
Management of diabetes emergencies''
Management of diabetes emergencies''Management of diabetes emergencies''
Management of diabetes emergencies''
 
umpierrezInpatientnonicuGuidelines1.ppt
umpierrezInpatientnonicuGuidelines1.pptumpierrezInpatientnonicuGuidelines1.ppt
umpierrezInpatientnonicuGuidelines1.ppt
 
DIABETIC_KETO_ACIDOSIS.pptx
DIABETIC_KETO_ACIDOSIS.pptxDIABETIC_KETO_ACIDOSIS.pptx
DIABETIC_KETO_ACIDOSIS.pptx
 
Anesthesia considration for DIABETES MELLITUS
Anesthesia considration for DIABETES MELLITUSAnesthesia considration for DIABETES MELLITUS
Anesthesia considration for DIABETES MELLITUS
 
Risk Factors Associated With Severe Hypoglycemia in Older Adults With Type 1 ...
Risk Factors Associated With Severe Hypoglycemia in Older Adults With Type 1 ...Risk Factors Associated With Severe Hypoglycemia in Older Adults With Type 1 ...
Risk Factors Associated With Severe Hypoglycemia in Older Adults With Type 1 ...
 

Último

Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟ 9332606886 ⟟ Call Me For G...
Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟  9332606886 ⟟ Call Me For G...Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟  9332606886 ⟟ Call Me For G...
Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟ 9332606886 ⟟ Call Me For G...narwatsonia7
 
Model Call Girls In Chennai WhatsApp Booking 7427069034 call girl service 24 ...
Model Call Girls In Chennai WhatsApp Booking 7427069034 call girl service 24 ...Model Call Girls In Chennai WhatsApp Booking 7427069034 call girl service 24 ...
Model Call Girls In Chennai WhatsApp Booking 7427069034 call girl service 24 ...hotbabesbook
 
Top Rated Hyderabad Call Girls Chintal ⟟ 9332606886 ⟟ Call Me For Genuine Se...
Top Rated  Hyderabad Call Girls Chintal ⟟ 9332606886 ⟟ Call Me For Genuine Se...Top Rated  Hyderabad Call Girls Chintal ⟟ 9332606886 ⟟ Call Me For Genuine Se...
Top Rated Hyderabad Call Girls Chintal ⟟ 9332606886 ⟟ Call Me For Genuine Se...chandars293
 
Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...
Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...
Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...GENUINE ESCORT AGENCY
 
Best Rate (Patna ) Call Girls Patna ⟟ 8617370543 ⟟ High Class Call Girl In 5 ...
Best Rate (Patna ) Call Girls Patna ⟟ 8617370543 ⟟ High Class Call Girl In 5 ...Best Rate (Patna ) Call Girls Patna ⟟ 8617370543 ⟟ High Class Call Girl In 5 ...
Best Rate (Patna ) Call Girls Patna ⟟ 8617370543 ⟟ High Class Call Girl In 5 ...Dipal Arora
 
Call Girls Ahmedabad Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Ahmedabad Just Call 9630942363 Top Class Call Girl Service AvailableCall Girls Ahmedabad Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Ahmedabad Just Call 9630942363 Top Class Call Girl Service AvailableGENUINE ESCORT AGENCY
 
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...jageshsingh5554
 
Manyata Tech Park ( Call Girls ) Bangalore ✔ 6297143586 ✔ Hot Model With Sexy...
Manyata Tech Park ( Call Girls ) Bangalore ✔ 6297143586 ✔ Hot Model With Sexy...Manyata Tech Park ( Call Girls ) Bangalore ✔ 6297143586 ✔ Hot Model With Sexy...
Manyata Tech Park ( Call Girls ) Bangalore ✔ 6297143586 ✔ Hot Model With Sexy...vidya singh
 
VIP Hyderabad Call Girls Bahadurpally 7877925207 ₹5000 To 25K With AC Room 💚😋
VIP Hyderabad Call Girls Bahadurpally 7877925207 ₹5000 To 25K With AC Room 💚😋VIP Hyderabad Call Girls Bahadurpally 7877925207 ₹5000 To 25K With AC Room 💚😋
VIP Hyderabad Call Girls Bahadurpally 7877925207 ₹5000 To 25K With AC Room 💚😋TANUJA PANDEY
 
Top Rated Bangalore Call Girls Mg Road ⟟ 9332606886 ⟟ Call Me For Genuine S...
Top Rated Bangalore Call Girls Mg Road ⟟   9332606886 ⟟ Call Me For Genuine S...Top Rated Bangalore Call Girls Mg Road ⟟   9332606886 ⟟ Call Me For Genuine S...
Top Rated Bangalore Call Girls Mg Road ⟟ 9332606886 ⟟ Call Me For Genuine S...narwatsonia7
 
Call Girls Visakhapatnam Just Call 8250077686 Top Class Call Girl Service Ava...
Call Girls Visakhapatnam Just Call 8250077686 Top Class Call Girl Service Ava...Call Girls Visakhapatnam Just Call 8250077686 Top Class Call Girl Service Ava...
Call Girls Visakhapatnam Just Call 8250077686 Top Class Call Girl Service Ava...Dipal Arora
 
Top Rated Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
Top Rated  Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...Top Rated  Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
Top Rated Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...chandars293
 
Russian Call Girls Service Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...
Russian Call Girls Service  Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...Russian Call Girls Service  Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...
Russian Call Girls Service Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...parulsinha
 
Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...
Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...
Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...Anamika Rawat
 
Call Girls Vadodara Just Call 8617370543 Top Class Call Girl Service Available
Call Girls Vadodara Just Call 8617370543 Top Class Call Girl Service AvailableCall Girls Vadodara Just Call 8617370543 Top Class Call Girl Service Available
Call Girls Vadodara Just Call 8617370543 Top Class Call Girl Service AvailableDipal Arora
 
Top Rated Bangalore Call Girls Richmond Circle ⟟ 9332606886 ⟟ Call Me For Ge...
Top Rated Bangalore Call Girls Richmond Circle ⟟  9332606886 ⟟ Call Me For Ge...Top Rated Bangalore Call Girls Richmond Circle ⟟  9332606886 ⟟ Call Me For Ge...
Top Rated Bangalore Call Girls Richmond Circle ⟟ 9332606886 ⟟ Call Me For Ge...narwatsonia7
 
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...khalifaescort01
 
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any Time
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any TimeTop Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any Time
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any TimeCall Girls Delhi
 
Top Rated Bangalore Call Girls Majestic ⟟ 9332606886 ⟟ Call Me For Genuine S...
Top Rated Bangalore Call Girls Majestic ⟟  9332606886 ⟟ Call Me For Genuine S...Top Rated Bangalore Call Girls Majestic ⟟  9332606886 ⟟ Call Me For Genuine S...
Top Rated Bangalore Call Girls Majestic ⟟ 9332606886 ⟟ Call Me For Genuine S...narwatsonia7
 
Call Girls Shimla Just Call 8617370543 Top Class Call Girl Service Available
Call Girls Shimla Just Call 8617370543 Top Class Call Girl Service AvailableCall Girls Shimla Just Call 8617370543 Top Class Call Girl Service Available
Call Girls Shimla Just Call 8617370543 Top Class Call Girl Service AvailableDipal Arora
 

Último (20)

Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟ 9332606886 ⟟ Call Me For G...
Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟  9332606886 ⟟ Call Me For G...Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟  9332606886 ⟟ Call Me For G...
Top Rated Bangalore Call Girls Ramamurthy Nagar ⟟ 9332606886 ⟟ Call Me For G...
 
Model Call Girls In Chennai WhatsApp Booking 7427069034 call girl service 24 ...
Model Call Girls In Chennai WhatsApp Booking 7427069034 call girl service 24 ...Model Call Girls In Chennai WhatsApp Booking 7427069034 call girl service 24 ...
Model Call Girls In Chennai WhatsApp Booking 7427069034 call girl service 24 ...
 
Top Rated Hyderabad Call Girls Chintal ⟟ 9332606886 ⟟ Call Me For Genuine Se...
Top Rated  Hyderabad Call Girls Chintal ⟟ 9332606886 ⟟ Call Me For Genuine Se...Top Rated  Hyderabad Call Girls Chintal ⟟ 9332606886 ⟟ Call Me For Genuine Se...
Top Rated Hyderabad Call Girls Chintal ⟟ 9332606886 ⟟ Call Me For Genuine Se...
 
Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...
Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...
Pondicherry Call Girls Book Now 9630942363 Top Class Pondicherry Escort Servi...
 
Best Rate (Patna ) Call Girls Patna ⟟ 8617370543 ⟟ High Class Call Girl In 5 ...
Best Rate (Patna ) Call Girls Patna ⟟ 8617370543 ⟟ High Class Call Girl In 5 ...Best Rate (Patna ) Call Girls Patna ⟟ 8617370543 ⟟ High Class Call Girl In 5 ...
Best Rate (Patna ) Call Girls Patna ⟟ 8617370543 ⟟ High Class Call Girl In 5 ...
 
Call Girls Ahmedabad Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Ahmedabad Just Call 9630942363 Top Class Call Girl Service AvailableCall Girls Ahmedabad Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Ahmedabad Just Call 9630942363 Top Class Call Girl Service Available
 
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
VIP Service Call Girls Sindhi Colony 📳 7877925207 For 18+ VIP Call Girl At Th...
 
Manyata Tech Park ( Call Girls ) Bangalore ✔ 6297143586 ✔ Hot Model With Sexy...
Manyata Tech Park ( Call Girls ) Bangalore ✔ 6297143586 ✔ Hot Model With Sexy...Manyata Tech Park ( Call Girls ) Bangalore ✔ 6297143586 ✔ Hot Model With Sexy...
Manyata Tech Park ( Call Girls ) Bangalore ✔ 6297143586 ✔ Hot Model With Sexy...
 
VIP Hyderabad Call Girls Bahadurpally 7877925207 ₹5000 To 25K With AC Room 💚😋
VIP Hyderabad Call Girls Bahadurpally 7877925207 ₹5000 To 25K With AC Room 💚😋VIP Hyderabad Call Girls Bahadurpally 7877925207 ₹5000 To 25K With AC Room 💚😋
VIP Hyderabad Call Girls Bahadurpally 7877925207 ₹5000 To 25K With AC Room 💚😋
 
Top Rated Bangalore Call Girls Mg Road ⟟ 9332606886 ⟟ Call Me For Genuine S...
Top Rated Bangalore Call Girls Mg Road ⟟   9332606886 ⟟ Call Me For Genuine S...Top Rated Bangalore Call Girls Mg Road ⟟   9332606886 ⟟ Call Me For Genuine S...
Top Rated Bangalore Call Girls Mg Road ⟟ 9332606886 ⟟ Call Me For Genuine S...
 
Call Girls Visakhapatnam Just Call 8250077686 Top Class Call Girl Service Ava...
Call Girls Visakhapatnam Just Call 8250077686 Top Class Call Girl Service Ava...Call Girls Visakhapatnam Just Call 8250077686 Top Class Call Girl Service Ava...
Call Girls Visakhapatnam Just Call 8250077686 Top Class Call Girl Service Ava...
 
Top Rated Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
Top Rated  Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...Top Rated  Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
Top Rated Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
 
Russian Call Girls Service Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...
Russian Call Girls Service  Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...Russian Call Girls Service  Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...
Russian Call Girls Service Jaipur {8445551418} ❤️PALLAVI VIP Jaipur Call Gir...
 
Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...
Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...
Jogeshwari ! Call Girls Service Mumbai - 450+ Call Girl Cash Payment 90042684...
 
Call Girls Vadodara Just Call 8617370543 Top Class Call Girl Service Available
Call Girls Vadodara Just Call 8617370543 Top Class Call Girl Service AvailableCall Girls Vadodara Just Call 8617370543 Top Class Call Girl Service Available
Call Girls Vadodara Just Call 8617370543 Top Class Call Girl Service Available
 
Top Rated Bangalore Call Girls Richmond Circle ⟟ 9332606886 ⟟ Call Me For Ge...
Top Rated Bangalore Call Girls Richmond Circle ⟟  9332606886 ⟟ Call Me For Ge...Top Rated Bangalore Call Girls Richmond Circle ⟟  9332606886 ⟟ Call Me For Ge...
Top Rated Bangalore Call Girls Richmond Circle ⟟ 9332606886 ⟟ Call Me For Ge...
 
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
 
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any Time
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any TimeTop Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any Time
Top Quality Call Girl Service Kalyanpur 6378878445 Available Call Girls Any Time
 
Top Rated Bangalore Call Girls Majestic ⟟ 9332606886 ⟟ Call Me For Genuine S...
Top Rated Bangalore Call Girls Majestic ⟟  9332606886 ⟟ Call Me For Genuine S...Top Rated Bangalore Call Girls Majestic ⟟  9332606886 ⟟ Call Me For Genuine S...
Top Rated Bangalore Call Girls Majestic ⟟ 9332606886 ⟟ Call Me For Genuine S...
 
Call Girls Shimla Just Call 8617370543 Top Class Call Girl Service Available
Call Girls Shimla Just Call 8617370543 Top Class Call Girl Service AvailableCall Girls Shimla Just Call 8617370543 Top Class Call Girl Service Available
Call Girls Shimla Just Call 8617370543 Top Class Call Girl Service Available
 

Hyperglyceminin Icu Md2008