title: Basic and clinical assessment of initial distribution volume of glucose in hemodynamically stable pediatric intensive care patients.
abstract: 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.
authors.affiliation: Department of Anesthesiology, Kuroishi-Kousei Hospital, 9-1 Tateishi, Kuroishi-shi, Aomori 036-0351 Japan.
authors.forename: Hironori
authors.initials: H
authors.lastname: Ishihara
authors.affiliation: Department of Anesthesiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki-shi, Aomori 036-8562 Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Hashiba
authors.affiliation: Department of Anesthesiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki-shi, Aomori 036-8562 Japan.
authors.forename: Hirobumi
authors.initials: H
authors.lastname: Okawa
authors.affiliation: Department of Anesthesiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki-shi, Aomori 036-8562 Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Saito
authors.affiliation: Department of Anesthesiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki-shi, Aomori 036-8562 Japan.
authors.forename: Toshinori
authors.initials: T
authors.lastname: Kasai
authors.affiliation: Department of Anesthesiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki-shi, Aomori 036-8562 Japan.
authors.forename: Toshihito
authors.initials: T
authors.lastname: Tsubo
keywords: Cardiac output; Children; Distribution volume; Glucose; Measurement techniques