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Basic and clinical assessment of initial distribution volume of glucose in hemodynamically stable pediatric intensive
Hironori Ishihara1, Eiji Hashiba2, Hirobumi Okawa2
1Department of Anesthesiology, Kuroishi-Kousei Hospital, 9-1 Tateishi, Kuroishi-shi, Aomori 036-0351 Japan.
Insights
Initial distribution volume of glucose (IDVG) can indicate fluid status in pediatric intensive care patients. Two-point IDVG measurements are more accurate than one-point for assessing extracellular fluid volume in children.
Area of Science:
- Pediatric intensive care
- Pharmacokinetics
- Extracellular fluid volume assessment
Background:
- Initial distribution volume of glucose (IDVG) is a proposed indicator of central extracellular fluid volume in adults.
- Limited data exists on IDVG in pediatric populations.
- This study investigated IDVG in critically ill children.
Purpose of the Study:
- To examine pharmacokinetic data of IDVG in children.
- To compare IDVG with other clinical variables.
- To evaluate IDVG as a marker for fluid volume status in pediatric patients.
Main Methods:
- Analyzed 128 daily data sets from 60 pediatric intensive care patients (body weight ≥8.0 kg).
- Administered glucose (0.1 g/kg) and determined IDVG using a one-compartment model.
- Calculated approximated IDVG (1-point and 2-point) and evaluated correlations with cardiac output and circulating blood volume.
Main Results:
- Mean indexed IDVG (IDVGI) was 144 ± 22 mL/kg in 55 children.
- Two-point IDVG showed better bias and precision compared to 1-point IDVG.
- Postoperative IDVGI increased in the first two days after cardiovascular surgery.
- IDVGI correlated significantly with indexed cardiac output and circulating blood volume.
Conclusions:
- IDVG shows potential as a fluid volume status marker in children.
- Body movement during measurement is a significant limitation for IDVG determination.
- Two-point IDVG is a more reliable method for approximating IDVG in pediatric patients.
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.
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