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Cerebral energy metabolism during transient hyperglycemia in patients with severe brain trauma

Diaz-Parejo, P; Ståhl, Nils LU ; Xu, WB; Reinstrup, Peter LU ; Ungerstedt, U and Nordström, Carl-Henrik LU (2003) In Intensive Care Medicine 29(4). p.544-550
Abstract
Objective: To study whether transient hyperglycemia adversely affects cerebral energy metabolism in patients with severe traumatic brain lesions. Design and setting: Prospective, nonrandomized study in the neurosurgical intensive care unit of a university hospital. Patients: 108 patients treated for severe traumatic brain lesions. Interventions: All patients were treated according to neurosurgical intensive care routine including monitoring of, intracranial pressure. One microdialysis catheter was inserted via a burr hole frontally to that used for the intraventricular catheter ("better" position). In patients with focal lesions one or more catheters were inserted into cerebral cortex surrounding an evacuated focal contusion or underlying... (More)
Objective: To study whether transient hyperglycemia adversely affects cerebral energy metabolism in patients with severe traumatic brain lesions. Design and setting: Prospective, nonrandomized study in the neurosurgical intensive care unit of a university hospital. Patients: 108 patients treated for severe traumatic brain lesions. Interventions: All patients were treated according to neurosurgical intensive care routine including monitoring of, intracranial pressure. One microdialysis catheter was inserted via a burr hole frontally to that used for the intraventricular catheter ("better" position). In patients with focal lesions one or more catheters were inserted into cerebral cortex surrounding an evacuated focal contusion or underlying an evacuated hematoma ("worse" position). Perfusion rate was 0.3 mul/min and samples were taken every. 30 or 60 min. The levels of glucose, pyruvate, lactate, glutamate, and glycerol were analyzed and displayed bedside. Measurements and results: There were 18 episodes of moderate (12-15 mmol/1) and 6 episodes of pronounced (>15 mmol/1) hyperglycemia. Moderate hyperglycemia did not change intracerebral levels of lactate, pyruvate, glutamate, glycerol, or lactate/pyruvate ratio. Lactate concentrations increased during pronounced hyperglycemia. Pronounced cerebral lactic acidosis and a moderate increase in interstitial glycerol concentration indicating cell membrane degradation was observed in a single patient with pronounced, long-lasting hyperglycemia. Conclusions: Cerebral energy metabolism was affected by transient hyperglycemia only at blood glucose concentration above 15 mmol/l as shown by a moderate increase in interstitial lactate level. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
glutamate, lactate, glucose, cerebral microdialysis, hyperglycemia, head injury
in
Intensive Care Medicine
volume
29
issue
4
pages
544 - 550
publisher
Springer
external identifiers
  • pmid:12655390
  • wos:000182759600007
  • scopus:0037398145
ISSN
0342-4642
DOI
10.1007/s00134-003-1669-3
language
English
LU publication?
yes
id
6cf7ace9-da4d-4e89-8de2-357ad68b1495 (old id 312069)
date added to LUP
2007-08-29 11:54:20
date last changed
2018-05-29 09:22:03
@article{6cf7ace9-da4d-4e89-8de2-357ad68b1495,
  abstract     = {Objective: To study whether transient hyperglycemia adversely affects cerebral energy metabolism in patients with severe traumatic brain lesions. Design and setting: Prospective, nonrandomized study in the neurosurgical intensive care unit of a university hospital. Patients: 108 patients treated for severe traumatic brain lesions. Interventions: All patients were treated according to neurosurgical intensive care routine including monitoring of, intracranial pressure. One microdialysis catheter was inserted via a burr hole frontally to that used for the intraventricular catheter ("better" position). In patients with focal lesions one or more catheters were inserted into cerebral cortex surrounding an evacuated focal contusion or underlying an evacuated hematoma ("worse" position). Perfusion rate was 0.3 mul/min and samples were taken every. 30 or 60 min. The levels of glucose, pyruvate, lactate, glutamate, and glycerol were analyzed and displayed bedside. Measurements and results: There were 18 episodes of moderate (12-15 mmol/1) and 6 episodes of pronounced (>15 mmol/1) hyperglycemia. Moderate hyperglycemia did not change intracerebral levels of lactate, pyruvate, glutamate, glycerol, or lactate/pyruvate ratio. Lactate concentrations increased during pronounced hyperglycemia. Pronounced cerebral lactic acidosis and a moderate increase in interstitial glycerol concentration indicating cell membrane degradation was observed in a single patient with pronounced, long-lasting hyperglycemia. Conclusions: Cerebral energy metabolism was affected by transient hyperglycemia only at blood glucose concentration above 15 mmol/l as shown by a moderate increase in interstitial lactate level.},
  author       = {Diaz-Parejo, P and Ståhl, Nils and Xu, WB and Reinstrup, Peter and Ungerstedt, U and Nordström, Carl-Henrik},
  issn         = {0342-4642},
  keyword      = {glutamate,lactate,glucose,cerebral microdialysis,hyperglycemia,head injury},
  language     = {eng},
  number       = {4},
  pages        = {544--550},
  publisher    = {Springer},
  series       = {Intensive Care Medicine},
  title        = {Cerebral energy metabolism during transient hyperglycemia in patients with severe brain trauma},
  url          = {http://dx.doi.org/10.1007/s00134-003-1669-3},
  volume       = {29},
  year         = {2003},
}