Diabetic chronic hyperglycemia and cerebral pH recovery following global ischemia in dogs.
OBJECTIVE
We determined the effect of chronic hyperglycemia associated with diabetes on recovery of cerebral pH after global incomplete cerebral ischemia.


METHODS
31P magnetic resonance spectra and cerebral blood flow (radiolabeled microspheres) were measured in three groups of dogs: (1) chronic hyperglycemic diabetes (pancreatectomy followed by blood glucose > 10 mmol/L for 3 months; n = 8); (2) acute hyperglycemia during ischemia and reperfusion in nondiabetic dogs (n = 8); and (3) normoglycemic controls (n = 8). Incomplete ischemia was produced for 20 minutes by ventricular fluid infusion followed by 3 hours of reperfusion.


RESULTS
Cerebral blood flow was reduced to approximately 5 mL/min per 100 g in all groups during ischemia with individual values ranging from 1 to 11 mL/min per 100 g. Blood flow returned to preischemic values by 30 minutes of reperfusion in the normoglycemia group but remained elevated during reperfusion in the acute hyperglycemia and diabetes groups. Cerebral pH at the end of ischemia was lower in acute hyperglycemia (5.94 +/- 0.05; +/- SE) and diabetes (5.97 +/- 0.08) groups than in the normoglycemia group (6.27 +/- 0.02). However, recovery of pH through 90 minutes of reperfusion in the normoglycemia (7.08 +/- 0.05) and diabetes (7.00 +/- 0.04) groups was significantly greater than in the acute hyperglycemia group (6.74 +/- 0.11). Persistent acidosis in the acute hyperglycemia group was associated with a delayed reduction of cerebral oxygen consumption and high-energy phosphates and with greater cortical water content and impairment of somatosensory evoked potentials compared with the diabetes group.


CONCLUSIONS
This study shows that cerebral pH recovery after global incomplete ischemia is improved in chronic hyperglycemia compared with acute hyperglycemia, despite similar decreases in blood flow and pH during ischemia and similar levels of blood flow and glucose levels during ischemia and reperfusion. In addition, cerebral pH recovery in chronic hyperglycemic dogs was not different from that in normoglycemic controls. These results suggest that an adaptation occurs with chronic hyperglycemia that improves recovery of cerebral pH during reperfusion and that is associated with better maintenance of energy metabolism and evoked potentials and with less edema over 3 hours of reperfusion compared with acute hyperglycemia.
Department of Anesthesiology/Critical Care Medicine, Johns Hopkins University, Baltimore, Md.
F E
FE
Sieber
R C
RC
Koehler
P R
PR
Brown
S M
SM
Eleff
R J
RJ
Traystman
D000138:Acidosis / Q000209:etiology / Q000378:metabolism; D000818:Animals; D001921:Brain / Q000378:metabolism*; D002545:Brain Ischemia / Q000209:etiology* / Q000378:metabolism* / Q000503:physiopathology; D002560:Cerebrovascular Circulation; D002908:Chronic Disease; D004285:Dogs; D006863:Hydrogen-Ion Concentration; D006943:Hyperglycemia / Q000150:complications* / Q000378:metabolism* / Q000503:physiopathology; D015427:Reperfusion Injury / Q000378:metabolism / Q000503:physiopathology