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Basic and clinical assessment of initial distribution volume of glucose in hemodynamically stable pediatric intensive care patients.

Ishihara H, Hashiba E, Okawa H, Saito J, Kasai T, Tsubo T - J Intensive Care (2014)

Bottom Line: Initial distribution volume of glucose (IDVG), which is not associated with significant modification of glucose metabolism, has been proposed as an indicator of the central extracellular fluid volume status in adults.Mean indexed IDVG (IDVGI) of the first measurement in 55 children was 144 ± 22 (SD) mL/kg, which was associated with a plasma glucose disappearance rate (Ke-glucose) of 0.094 ± 0.033/min.Two-point IDVG is preferable to 1-point IDVG for approximated IDVG.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Kuroishi-Kousei Hospital, 9-1 Tateishi, Kuroishi-shi, Aomori 036-0351 Japan.

ABSTRACT

Background: Initial distribution volume of glucose (IDVG), which is not associated with significant modification of glucose metabolism, has been proposed as an indicator of the central extracellular fluid volume status in adults. However, data on IDVG in children are lacking. This study examined pharmacokinetic data on IDVG in children and compared IDVG with other clinical variables.

Methods: In total, 128 daily data sets from 60 consecutive pediatric intensive care patients (body weight ≥8.0 kg), consisting mostly of children undergoing cardiovascular surgery, were studied. Either 1 or 2 g of glucose based on body weight (approximately 0.1 g/kg) was administered. IDVG could not be determined from ten data sets from eight children because of body movement-associated glucose fluctuation during measurement. In the remaining 113 data sets from 55 children, IDVG was determined by applying the one-compartment model. Approximated IDVG based on the incremental plasma glucose level at 3 min postinjection (1-point IDVG), and approximated IDVG based on incremental plasma glucose levels at 3 and 5 min postinjection (2-point IDVG), were also calculated. Postoperative daily IDVG and the relationship between IDVG and cardiac output or circulating blood volume (CBV) were evaluated when data were available.

Results: Convergence was assumed in each glucose clearance curve. Mean indexed IDVG (IDVGI) of the first measurement in 55 children was 144 ± 22 (SD) mL/kg, which was associated with a plasma glucose disappearance rate (Ke-glucose) of 0.094 ± 0.033/min. Bias and precision were smaller between 2-point IDVG and standard IDVG than between 1-point IDVG and standard IDVG (-0.02 ± 0.13 L versus 0.07 ± 0.20 L, p <0.001). Postoperative IDVGI in 37 children after cardiovascular surgery increased daily on postoperative days 1-2 (p ≤0.011). Linear correlations were observed between IDVGI and indexed cardiac output (r = 0.588, n = 28, p <0.001) and between IDVGI and indexed CBV (r = 0.547, n = 25, p = 0.0047).

Conclusions: IDVG is a potential marker of fluid volume status in children, even though body movement-associated glucose fluctuation is a major limitation. Two-point IDVG is preferable to 1-point IDVG for approximated IDVG.

No MeSH data available.


Related in: MedlinePlus

Flow chart of data collection and evaluation. *Data for the first measurement from each patient. pts = patients; CO = cardiac output; CBV = circulating blood volume.
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Fig1: Flow chart of data collection and evaluation. *Data for the first measurement from each patient. pts = patients; CO = cardiac output; CBV = circulating blood volume.

Mentions: Each glucose decay curve was initially examined to determine whether a consistent decrease in incremental plasma glucose concentrations was observed throughout the 7-min period after glucose injection. Ten data sets (7.8%) from eight children failed to show a consistent decrease, which did not permit pharmacokinetic analysis for determining IDVG. Three of these eight children also had data sets associated with a consistent decrease. Thus, the remaining 118 data sets from 55 children, including 8 data sets from the 3 children, were available for analysis in this study (Figure 1). The following pharmacokinetic analysis and clinical assessment were performed.Figure 1


Basic and clinical assessment of initial distribution volume of glucose in hemodynamically stable pediatric intensive care patients.

Ishihara H, Hashiba E, Okawa H, Saito J, Kasai T, Tsubo T - J Intensive Care (2014)

Flow chart of data collection and evaluation. *Data for the first measurement from each patient. pts = patients; CO = cardiac output; CBV = circulating blood volume.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4358717&req=5

Fig1: Flow chart of data collection and evaluation. *Data for the first measurement from each patient. pts = patients; CO = cardiac output; CBV = circulating blood volume.
Mentions: Each glucose decay curve was initially examined to determine whether a consistent decrease in incremental plasma glucose concentrations was observed throughout the 7-min period after glucose injection. Ten data sets (7.8%) from eight children failed to show a consistent decrease, which did not permit pharmacokinetic analysis for determining IDVG. Three of these eight children also had data sets associated with a consistent decrease. Thus, the remaining 118 data sets from 55 children, including 8 data sets from the 3 children, were available for analysis in this study (Figure 1). The following pharmacokinetic analysis and clinical assessment were performed.Figure 1

Bottom Line: Initial distribution volume of glucose (IDVG), which is not associated with significant modification of glucose metabolism, has been proposed as an indicator of the central extracellular fluid volume status in adults.Mean indexed IDVG (IDVGI) of the first measurement in 55 children was 144 ± 22 (SD) mL/kg, which was associated with a plasma glucose disappearance rate (Ke-glucose) of 0.094 ± 0.033/min.Two-point IDVG is preferable to 1-point IDVG for approximated IDVG.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Kuroishi-Kousei Hospital, 9-1 Tateishi, Kuroishi-shi, Aomori 036-0351 Japan.

ABSTRACT

Background: Initial distribution volume of glucose (IDVG), which is not associated with significant modification of glucose metabolism, has been proposed as an indicator of the central extracellular fluid volume status in adults. However, data on IDVG in children are lacking. This study examined pharmacokinetic data on IDVG in children and compared IDVG with other clinical variables.

Methods: In total, 128 daily data sets from 60 consecutive pediatric intensive care patients (body weight ≥8.0 kg), consisting mostly of children undergoing cardiovascular surgery, were studied. Either 1 or 2 g of glucose based on body weight (approximately 0.1 g/kg) was administered. IDVG could not be determined from ten data sets from eight children because of body movement-associated glucose fluctuation during measurement. In the remaining 113 data sets from 55 children, IDVG was determined by applying the one-compartment model. Approximated IDVG based on the incremental plasma glucose level at 3 min postinjection (1-point IDVG), and approximated IDVG based on incremental plasma glucose levels at 3 and 5 min postinjection (2-point IDVG), were also calculated. Postoperative daily IDVG and the relationship between IDVG and cardiac output or circulating blood volume (CBV) were evaluated when data were available.

Results: Convergence was assumed in each glucose clearance curve. Mean indexed IDVG (IDVGI) of the first measurement in 55 children was 144 ± 22 (SD) mL/kg, which was associated with a plasma glucose disappearance rate (Ke-glucose) of 0.094 ± 0.033/min. Bias and precision were smaller between 2-point IDVG and standard IDVG than between 1-point IDVG and standard IDVG (-0.02 ± 0.13 L versus 0.07 ± 0.20 L, p <0.001). Postoperative IDVGI in 37 children after cardiovascular surgery increased daily on postoperative days 1-2 (p ≤0.011). Linear correlations were observed between IDVGI and indexed cardiac output (r = 0.588, n = 28, p <0.001) and between IDVGI and indexed CBV (r = 0.547, n = 25, p = 0.0047).

Conclusions: IDVG is a potential marker of fluid volume status in children, even though body movement-associated glucose fluctuation is a major limitation. Two-point IDVG is preferable to 1-point IDVG for approximated IDVG.

No MeSH data available.


Related in: MedlinePlus