Intravenous hydration with a 2.5% glucose solution in Type II diabetes

Abstract

Physicians are often unclear about how fast intravenous glucose solutions should be administered to adequately hydrate patients with Type II diabetes while avoiding hyperglycaemia and excessive plasma volume expansion. The aim of the present study was to analyse the disposition of a 2.5% glucose solution and create a nomogram which could serve as a guide to fluid therapy in these patients. Twelve males (mean body mass index, 29 kg/m(2)) with Type II diabetes due to insulin resistance, as quantified by an euglycaemic hyperinsulinaemic glucose clamp, received an infusion of iso-osmotic 2.5% glucose solution with electrolytes (70 mmol/l sodium, 45 mmol/l chloride and 25 mmol/l acetate) at individual rates over 30 and 60 min respectively. Blood glucose and haemoglobin levels were measured repeatedly over 3.5 h to estimate the kinetics of glucose and fluid volume. Mean insulin sensitivity was 4.2x10(-4) dlxkg(-1)xmin(-1)x(micro-units/ml)(-1). The individualized infusion rates reached the predetermined blood glucose level of 12 mmol/l with a mean difference of 0.2 mmol/l. The disposition of glucose was an important factor governing fluid distribution. The volume of distribution of exogenous glucose averaged 19.8 litres, but for the fluid volume it was only 3.7 litres. The clearance was 0.37 litre/min for glucose and 0.10 litre/min for the fluid volume, and the results of the 30-min and 60-min infusions agreed reasonably well. It is concluded that kinetic analysis can be used to guide the infusion time and infusion rate of 2.5% glucose to reach any predetermined glucose level and volume expansion.

Plasma Volume Expansion Resulting from Intravenous Glucose Tolerance Test

“…Hence, the size of the body fluid space expanded by the infused volume could not have been larger than the plasma volume. This finding is not intuitive but is in agreement with previous kinetic studies based on IV infusion of isotonic glucose solutions in healthy volunteers [6, 9] and in surgical [7] and diabetic [10] patients.…”

Progressive decrease in glucose clearance during surgery

“…This promotes a slower restoration of the plasma glucose curve after infusion than indicated by the actual metabolism. This large V d might possibly be an effect of epidural analgesia, but we have recently observed a similarly large V d , almost corresponding to the expected size of the ECF space, in diabetes type II patients (15). These results suggest the existence of physiological and metabolic conditions in which V d for exogenous glucose becomes markedly larger than in healthy volunteers.…”

Modelling of Peripheral Fluid Accumulation after a Crystalloid Bolus in Female Volunteers – A Mathematical Study

“…Previous studies, however, conducted mainly on sheep, indicate that the kinetic parameters are fairly robust within clinical feasible limits [23,24]. Furthermore, it has been shown that the kinetic parameters may be used for controlling infusion rate, in order to achieve a pre-determined target dilution [25].…”