Treatment of extreme hyperglycemia monitored with intracerebral microdialysis.
OBJECTIVE
Description of a pediatric patient with hyperosmolar hyperglycemic nonketotic syndrome where the treatment was monitored with intracerebral microdialysis.


METHODS
Case report.


METHODS
Intensive care unit at a university hospital.


METHODS
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.


METHODS
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.kg(-1).hr(-1) and blood glucose by 1.5 mmol.L(-1).hr(-1) (27 mg/dL).


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.
Ahlsson
Fredrik
F
Department of Pediatrics, Uppsala University Hospital, Uppsala, Sweden.
Gedeborg
Rolf
R
Hesselager
Göran
G
Tuvemo
Torsten
T
Enblad
Per
P
D001786:Blood Glucose / Q000032:analysis*; D001921:Brain / Q000378:metabolism*; D001929:Brain Edema / Q000097:blood / Q000175:diagnosis*; D002648:Child; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D007427:Intracranial Pressure; D008297:Male; D017551:Microdialysis / Q000379:methods*
D001786:Blood Glucose