INS and obesity due to melanocortin 4 receptor deficiency: Forced activation of hypothalamic IKKβ/NF-κB interrupts central insulin/leptin signaling and action, while its suppression significantly protects against obesity and glucose intolerance [69] Hyperglycemia in the ICU has been linked with worse outcomes [70], moreover, NF-κB activity is significantly elevated in adults and children with severe sepsis [71].The impaired insulin signaling and activation of NF-κB prompts us to hypothesize that SAE could also result in metabolic and hydroelectrolyte imbalance.