Document Detail

Hyperglycemia and cerebral glucose in aneurysmal subarachnoid hemorrhage.
MedLine Citation:
PMID:  18320167     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To determine whether hyperglycemia exerts deleterious effects via cerebral energy metabolism and to illuminate the effects of cerebral high/low glucose in patients with aneurysmal subarachnoid hemorrhage. DESIGN AND SETTING: Prospective, nonrandomized single-center study over a 2-year period in an intensive care unit at a primary-level university hospital. PATIENTS: 28 subarachnoid hemorrhage patients (age 53 +/- 10 years, WFNS grade 2.8 +/- 1.5) classified as asymptomatic (n = 5) or symptomatic with acute focal or delayed ischemic neurological deficits (n = 23). MEASUREMENTS AND RESULTS: Hyperglycemia (> 7.8 mmol/l; >140 mg/dl) was more frequent in symptomatic patients and was reflected in higher glycerol concentrations than in asymptomatic patients. In all patients a microdialysis catheter was inserted into the tissue at risk; dialysates were collected hourly for 10 days. Cerebral low-glucose episodes (0.6 mmol/l) and high-glucose episodes (>2.6 mmol/l) occurred independently of blood glucose levels. During high-glucose episodes cerebral microdialysate levels were normal, while cerebral low glucose, occurring more frequently in symptomatic patients, was associated with severe cellular distress (increase in lactate/pyruvate ratio, glutamate, glycerol) and with unfavorable outcome if combined with hyperglycemia. CONCLUSIONS: Although hyperglycemia was more frequent in symptomatic patients and associated with high glycerol levels, hyperglycemia was not related to cerebral high glucose. It appears that the association of adverse outcome with acute-phase hyperglycemia is not mediated by cerebral glucose metabolism. Cerebral low glucose was associated with severe metabolic distress and may present a target for therapy to improve clinical outcome.
Florian Schlenk; Alexandra Nagel; Daniela Graetz; Asita S Sarrafzadeh
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Publication Detail:
Type:  Journal Article     Date:  2008-03-05
Journal Detail:
Title:  Intensive care medicine     Volume:  34     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-06-25     Completed Date:  2008-12-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1200-7     Citation Subset:  IM    
Department of Neurosurgery, Charité Campus Virchow Medical Center, Augustenburger Platz 1, 13353, Berlin, Germany.
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MeSH Terms
Energy Metabolism
Glucose / metabolism*
Hyperglycemia / complications*,  metabolism*
Intensive Care Units
Intracranial Aneurysm / complications*
Middle Aged
Prospective Studies
Subarachnoid Hemorrhage / classification,  etiology*,  metabolism*
Reg. No./Substance:
Comment In:
Intensive Care Med. 2008 Jul;34(7):1169-72   [PMID:  18320166 ]

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