Advanced

The osmotic link between hypoglycaemia and hypovolaemia

Sjostrand, F.; Berndtson, D LU ; Olsson, J.; Strandberg, P. and Hahn, R. G. (2008) In Scandinavian Journal of Clinical & Laboratory Investigation 68(2). p.117-122
Abstract
Objective . Hypoglycaemia is regularly accompanied by hypovolaemia. To suggest a mechanism for this phenomenon, we reviewed data from eight studies conducted by our group and examined the circumstances under which rebound hypoglycaemia develops after intravenous infusion of glucose solutions. Material and methods. Forty healthy volunteers and 40 patients received a total of 122 infusions of glucose solutions at different rates, volumes and concentrations. Plasma glucose and the haemodilution were measured repeatedly during and for at least 2 h after the infusions ended. Glucose kinetics was calculated using a one-compartment turnover model and the plasma volume expansion was estimated from changes in Hb. Results . A strong linear... (More)
Objective . Hypoglycaemia is regularly accompanied by hypovolaemia. To suggest a mechanism for this phenomenon, we reviewed data from eight studies conducted by our group and examined the circumstances under which rebound hypoglycaemia develops after intravenous infusion of glucose solutions. Material and methods. Forty healthy volunteers and 40 patients received a total of 122 infusions of glucose solutions at different rates, volumes and concentrations. Plasma glucose and the haemodilution were measured repeatedly during and for at least 2 h after the infusions ended. Glucose kinetics was calculated using a one-compartment turnover model and the plasma volume expansion was estimated from changes in Hb. Results . A strong linear correlation was found between the glucose level and the plasma volume expansion in all series of experiments (p<0.001). After infusion, there was a risk of hypoglycaemia and hypovolaemia developing in healthy volunteers with a high glucose clearance and when infusing glucose solutions of higher concentrations than 2.5 %. Few and mild hypoglycaemic events occurred in patients with insulin resistance, such as in diabetics and in those undergoing surgery. The immediate linear relationship between hypoglycaemia and hypovolaemia suggests an osmotic link between the two parameters. More specifically, infused fluid accompanies glucose during uptake into the cells, while volume expansion by the same fluid has already elicited an effective diuretic response. Conclusion . Hypovolaemia is a consequence of hypoglycaemia after intravenous infusion of glucose solution and is caused by the osmotic translocation of fluid from the extracellular to the intracellular fluid space that occurs despite effective renal elimination. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
hypovolaemia, hemodilution, diabetes fluids, glucose metabolism, hypoglycaemia, water
in
Scandinavian Journal of Clinical & Laboratory Investigation
volume
68
issue
2
pages
117 - 122
publisher
Informa Healthcare
external identifiers
  • wos:000254574300005
  • scopus:41649115410
ISSN
1502-7686
DOI
10.1080/00365510701541036
language
English
LU publication?
yes
id
7707e760-3a8e-4b14-8e8f-82612bbb9282 (old id 1207357)
date added to LUP
2008-08-27 15:15:41
date last changed
2017-01-01 05:53:54
@article{7707e760-3a8e-4b14-8e8f-82612bbb9282,
  abstract     = {Objective . Hypoglycaemia is regularly accompanied by hypovolaemia. To suggest a mechanism for this phenomenon, we reviewed data from eight studies conducted by our group and examined the circumstances under which rebound hypoglycaemia develops after intravenous infusion of glucose solutions. Material and methods. Forty healthy volunteers and 40 patients received a total of 122 infusions of glucose solutions at different rates, volumes and concentrations. Plasma glucose and the haemodilution were measured repeatedly during and for at least 2 h after the infusions ended. Glucose kinetics was calculated using a one-compartment turnover model and the plasma volume expansion was estimated from changes in Hb. Results . A strong linear correlation was found between the glucose level and the plasma volume expansion in all series of experiments (p&lt;0.001). After infusion, there was a risk of hypoglycaemia and hypovolaemia developing in healthy volunteers with a high glucose clearance and when infusing glucose solutions of higher concentrations than 2.5 %. Few and mild hypoglycaemic events occurred in patients with insulin resistance, such as in diabetics and in those undergoing surgery. The immediate linear relationship between hypoglycaemia and hypovolaemia suggests an osmotic link between the two parameters. More specifically, infused fluid accompanies glucose during uptake into the cells, while volume expansion by the same fluid has already elicited an effective diuretic response. Conclusion . Hypovolaemia is a consequence of hypoglycaemia after intravenous infusion of glucose solution and is caused by the osmotic translocation of fluid from the extracellular to the intracellular fluid space that occurs despite effective renal elimination.},
  author       = {Sjostrand, F. and Berndtson, D and Olsson, J. and Strandberg, P. and Hahn, R. G.},
  issn         = {1502-7686},
  keyword      = {hypovolaemia,hemodilution,diabetes fluids,glucose metabolism,hypoglycaemia,water},
  language     = {eng},
  number       = {2},
  pages        = {117--122},
  publisher    = {Informa Healthcare},
  series       = {Scandinavian Journal of Clinical & Laboratory Investigation},
  title        = {The osmotic link between hypoglycaemia and hypovolaemia},
  url          = {http://dx.doi.org/10.1080/00365510701541036},
  volume       = {68},
  year         = {2008},
}