title: Effect of hypoglycemia on cerebral metabolism and carbon dioxide responsivity.
abstract: This study examined the effects of hypoglycemia (HG) on cerebral metabolism and cerebrovascular reactivity to carbon dioxide. Cerebral blood flow (CBF) was determined using radiolabeled microspheres in pentobarbital-anesthetized dogs. Cerebral oxygen, glucose, lactate, pyruvate, acetoacetate, and beta-hydroxybutyrate uptakes were calculated using the respective concentrations measured in arterial and sagittal sinus blood samples. EEG was recorded throughout each experiment. HG was induced with insulin to obtain a blood glucose less than 30 mg/100 ml. Hypercapnia was studied in 10 animals (3 control, 7 HG) by increasing arterial carbon dioxide tension (PaCO2) from control (35 +/- 4; mean +/- SE) to 54 +/- 2 Torr during normoglycemia (NG) and HG. Hypocapnia was studied in 11 animals (3 control, 8 HG) by decreasing PaCO2 from control (39 +/- 1) to 14 +/- 1 Torr in NG and HG. Measurements were taken after reaching steady-state PaCO2 in both groups at each control and altered PaCO2 state. In the hypercapnic group, glucose decreased from 71 +/- 3 to 28 +/- 3 mg/100 ml. CBF increased with hypercapnia to 175% of control in both NG and HG. Cerebral metabolic rate of oxygen and electroencephalogram (EEG) did not change in the hypercapnic group. In the hypocapnic group glucose decreased from 71 +/- 3 to 19 +/- 2 mg/100 ml. CBF decreased with hypocapnia to 62 +/- 5% of control in NG but remained at control in HG. This was not accompanied by changes in cerebral oxygen consumption; however, a flat EEG occurred in all HG hypocapnic animals. No change occurred in uptake of the other cerebral metabolites measured in any group. This study shows that the CBF hypercapnic response remains intact during HG; however, hypocapnia causes severe EEG disturbances and impairs the cerebral vasoconstriction response.
authors.affiliation: Department of Anesthesiology, Johns Hopkins Medical Institutions, Baltimore, Maryland 21205.
authors.forename: F E
authors.initials: FE
authors.lastname: Sieber
authors.forename: S A
authors.initials: SA
authors.lastname: Derrer
authors.forename: C D
authors.initials: CD
authors.lastname: Saudek
authors.forename: R J
authors.initials: RJ
authors.lastname: Traystman
mesh_terms: D000818:Animals; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000187:drug effects; D001921:Brain / Q000187:drug effects / Q000378:metabolism / Q000503:physiopathology*; D002245:Carbon Dioxide / Q000494:pharmacology*; D002560:Cerebrovascular Circulation / Q000187:drug effects; D004285:Dogs; D004569:Electroencephalography; D004837:Epinephrine / Q000097:blood; D007003:Hypoglycemia / Q000378:metabolism / Q000503:physiopathology*; D007328:Insulin / Q000494:pharmacology; D007657:Ketone Bodies / Q000097:blood; D007773:Lactates / Q000097:blood; D008297:Male; D009638:Norepinephrine / Q000097:blood; D010101:Oxygen Consumption / Q000187:drug effects; D011773:Pyruvates / Q000097:blood; D012016:Reference Values; D014655:Vascular Resistance / Q000187:drug effects
chemical_list: D001786:Blood Glucose; D007328:Insulin; D007657:Ketone Bodies; D007773:Lactates; D011773:Pyruvates; D002245:Carbon Dioxide; D009638:Norepinephrine; D004837:Epinephrine