| Accession Number | <strong>00130478-200401000-00019</strong>. |
|---|---|
| Author | Ahlsson, Fredrik MD; Gedeborg, Rolf MD, PhD; Hesselager, Goran MD, PhD; Tuvemo, Torsten MD, PhD; Enblad, Per MD, PhD |
| Institution | From the Department of Pediatrics (FA, TT), Department of Surgical Sciences-Anesthesiology and Intensive Care (RG), and Department of Neurosciences-Neurosurgery (GH, PE), Uppsala University Hospital, Uppsala, Sweden. |
| Title | |
| Source | Pediatric Critical Care Medicine. 5(1):89-92, January 2004. |
| Abstract | Objective: Description of a pediatric patient with hyperosmolar hyperglycemic nonketotic syndrome where the treatment was monitored with intracerebral microdialysis. Design: Case report. Setting: Intensive care unit at a university hospital. Patient: An 11-yr-old boy with new-onset diabetes who presented with a blood glucose concentration of 100 mmol/L (1800 mg/dL) and a serum osmolality of 448 mOsm/kg. Interventions: Interventions included intracerebral and subcutaneous microdialysis as well as intracranial pressure monitoring during correction of the hyperosmolar condition. The strategy was to decrease osmolality by 1 mOsm[middle dot]kg-1[middle dot]hr-1 and blood glucose by 1.5 mmol[middle dot]L-1[middle dot]hr-1 (27 mg/dL). Measurements and Main Results: The concentrations of glucose in the subcutaneous dialysates corresponded to the blood glucose concentrations. The brain/subcutaneous glucose ratio varied between 0.20 and 1.28 (mean, 0.43; median, 0.4). When the blood glucose decreased quickly after steady state, the brain/subcutaneous ratio increased sharply, demonstrating that the normalization of glucose in the brain was slower than that in blood. Conclusions: Microdialysis can be used to monitor the brain/subcutaneous glucose ratio in patients with extreme hyperglycemia. A rapid decrease in blood glucose increases the brain/subcutaneous glucose ratio, which may be a potential risk factor for osmotic brain edema. Microdialysis may prove to be a valuable tool in treatment management. The child made a full recovery. (C)2004The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies |