Abstract
Blood or plasma glucose concentration can be measured accurately and rapidly. However, after a glucose challenge metabolism may modify glucose kinetics, so that glucose has not been used as an indicator for dilution volumetry. To test the hypothesis that the initial distribution volume of glucose (IDVG) reflects cardiac output rather than glucose metabolism in the critically ill, the relationship between IDVG and thermodilution cardiac output was evaluated at 27 points in 13 non-surgical, critically ill patients without congestive heart failure. The IDVG was calculated from incremental plasma glucose concentrations using a one compartment model. Correlations were obtained between the IDVG and cardiac output (r = 0.89, n = 27, P < 0.001), and between the incremental plasma glucose concentrations three minutes after the injection and the IDVG (r = 0.94, n = 27, P < 0.001). No difference was found between the IDVG with or without continuous insulin infusions. The results indicate that the IDVG reflects cardiac output rather than glucose metabolism in patients without congestive heart failure.
Résumé
Il est possible de mesurer la concentration plasmatique du glucose avec précision et rapidité. Cependent, après un test d’hyperglycémie provoquée, le métabolisme peut modifier le cynétique du glucose. Pour cette raison le glucose n’est pas employé comme indicateur pour l’analyse volumétrique par la méthode de dilution. Pour vérifier l’hypothèse selon laquelle le volume de distribution initial du glucose (VDIG) reflète le débit cardiaque plutôt que le métabolisme glucidique chez le grand malade, la relation entre VDIG et débit cardiaque est comparée à 27 moments chez 13 grands malades non chirurgicaux sans insuffisance cardiaque. Le VDIG est calculé à partir de concentrations plasmatiques croissantes dans un modèle à compartiment unique. On détermine la corrélation entre VDIG et débit cardiaque (r = 0,89, n = 27, P <0,001), et entre les concentrations croissantes de glucose plasmatique trois minutes après l’injection et le VDIG (r = 0,94, n = 27, P < 0,001). Il n’y a pas de différence entre le VDIG mesuré avec ou sans perfusions d’insuline. Les résultats démontrent que le VDIG reflète plus le débit cardiaque que le métabolisme glucidique chez le malade qui ne présente pas d’insuffisance cardiaque.
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References
Riggs DS. The mathematical approach to physiological problems: a critical primer. Cambridge, MA: MIT press, 1963.
Ghoneim M, Pearson K. Pharmacokinetics of drugs administered intravenously.In: Scurr C, Feldman S, Soni N (Eds). Scientific Foundations of Anaesthesia, 4th ed., Chicago: Year Book Medical Publishers, 1990: 559–71.
Bennet LZ, Sheiner LB. Pharmacokinetics: The dynamics of drug absorption, distribution, and elimination.In: Goodman Gilman A, Goodman LS, Rall TW, Murad F (Eds). The Pharmacological Basis of Therapeutics., New York: Macmillian Publishing Co., 1985: 3–34.
Yamaoka K, Tanigawara Y, Nakagawa T. Uno T A pharmacokinetic analysis program (MULTI) for microcomputer. J Pharm Dyn 1981; 4: 879–85.
Cunningham VJ, Heath DF. An interpretation of the intravenous glucose tolerance test in the light of recent findings on the kinetics of glucose and insulin in man. Clin Sci Mol Med 1978; 54: 161–73.
Cobelli C, Bier DM, Ferrannini E. Modeling glucose metabolism in man: Theory and Practice. Horm Metab Res (Suppl) 1990; 24: 1–10.
Avram MJ, Krejcie TC, Henthorn TK. The relationship of age to the pharmacokinetics of early drug distribution: The concurrent disposition of thiopental and indocyanine green. Anesthesiology 1990; 72: 403–11.
Wick AN, Drury DR, Mackay EM. Glucose space of the body. Am J Physiol 1950; 163: 224–8.
Ishihara H, Tanioka F, Katagai H, et al. Effects of and surgery on glucose space in man. Jap J Anesth 1986; 35: 1057–60.
Ishihara H, Tanioka F, Isozaki K, Matsuki A, Oyama T. Postoperative management of diabetic patients in ICU.In: Matsuki A, Ishihara H, Oyama T (Eds). Endocrine Response to Anesthesia and Intensive Care. Amsterdam: Elsevier Science Publishers, 1990: 221–6.
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Ishihara, H., Shimodate, Y., Koh, H. et al. The initial distribution volume of glucose and cardiac output in the critically ill. Can J Anaesth 40, 28–31 (1993). https://doi.org/10.1007/BF03009314
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DOI: https://doi.org/10.1007/BF03009314