title: Treatment of extreme hyperglycemia monitored with intracerebral microdialysis.
abstract: 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.
authors.affiliation: Department of Pediatrics, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Ahlsson
authors.forename: Rolf
authors.initials: R
authors.lastname: Gedeborg
authors.forename: Göran
authors.initials: G
authors.lastname: Hesselager
authors.forename: Torsten
authors.initials: T
authors.lastname: Tuvemo
authors.forename: Per
authors.initials: P
authors.lastname: Enblad
mesh_terms: 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*
chemical_list: D001786:Blood Glucose