BJA Advance Access originally published online on October 14, 2004
British Journal of Anaesthesia 2005 94(1):30-38; doi:10.1093/bja/aeh285
© The Board of Management and Trustees of the British Journal of Anaesthesia 2004
Volume kinetics of glucose 2.5% solution and insulin resistance after abdominal hysterectomy
1 Department of Anaesthesia, Söder Hospital, Sweden. 2 Karolinska Institute, Stockholm, Sweden
* Corresponding author. E-mail: robert.hahn{at}sos.sll.se
Background. We hypothesized that volume kinetics can be used to predict the rate of infusion of glucose 2.5% solution required to yield any predetermined plasma glucose level and degree of plasma dilution during the postoperative period.
Methods. In 15 women, mean age 50 yr (range 37–63), 2 days after an abdominal hysterectomy, a volume kinetic analysis was performed on an i.v. infusion of 12.5 ml kg–1 (
900 ml) of glucose 2.5% given over 45 min. The insulin resistance was measured by a glucose clamp, and it was compared with daily bioimpedance analyses, which indicated the hydration of the intra/extracellular body fluid spaces.
Results. The clearance of glucose was 0.42 litre min–1 (0.60 litre min–1 is normal) while the other five parameters in the kinetic model were similar to those obtained in healthy volunteers. Computer simulations indicated that in a 70-kg female, at steady state, the rate of infusion (ml min–1) should be three times the allowed increase in plasma glucose (mmol litre–1). To maintain a predetermined plasma dilution the corresponding rate factor was 160. The glucose uptake during clamping was 3.9 mg kg–1 min–1 (7.0 is normal), which, during the second day after hysterectomy, correlated with the dehydration of the intracellular space (r=0.77; P<0.002) and with the protein catabolism as indicated by the urinary excretion of 3-methylhistidine (r=–0.76, P<0.002).
Conclusion. The anaesthetist can prescribe postoperative administration of glucose 2.5% to reach any desired plasma glucose level and dilution by using the two presented nomograms. Insulin resistance correlated with intracellular dehydration and protein catabolism.