Influence of Blood Glucose Level on Acid-Base Balance
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background: This study was performed to evaluate whether blood glucose concentrations have a significant influence on acid-base balance. Methods: We studied 157 adult patients who underwent intra-abdominal operations under general anesthesia. Postoperative blood samples were withdrawn from radial artery and blood glucose concentrations, gas values, and chemistry values were measured. All patients were divided into three groups according to the postoperative blood glucose level. The group 1 contained the patients who had postoperative blood glucose level lower than 126 mg/dl, the group 2, the patients with glucose level higher than 126 mg/dl, lower than 180 mg/dl, and the group 3, the patients with glucose level higher than 180 mg/dl. Results: Metabolic acidosis rate was significantly higher in group 3 than in group 1, group 2 and arterial blood pH was significantly lower in group 3 than that in group 1, group 2. Regression analysis showed that [H+] was correlated with blood glucose level. Strong ion difference (SID) was significantly lower in group 3 than group 1 and PaCO2 level was significantly lower in group 2 and group 3 than that in group 1. In regression analysis, there was a negative correlation between blood glucose concentration and SID. [H+] had a negative correlation with SID and PaCO2 was correlated with SID. Conclusions: These findings suggest that blood glucose level affects acid-base balance and a disturbance in SID is accompanied with respiratory compensation.
Abstract
Background: This study was performed to evaluate whether blood glucose concentrations have a significant influence on acid-base balance. Methods: We studied 157 adult patients who underwent intra-abdominal operations under general anesthesia. Postoperative blood samples were withdrawn from radial artery and blood glucose concentrations, gas values, and chemistry values were measured. All patients were divided into three groups according to the postoperative blood glucose level. The group 1 contained the patients who had postoperative blood glucose level lower than 126 mg/dl, the group 2, the patients with glucose level higher than 126 mg/dl, lower than 180 mg/dl, and the group 3, the patients with glucose level higher than 180 mg/dl. Results: Metabolic acidosis rate was significantly higher in group 3 than in group 1, group 2 and arterial blood pH was significantly lower in group 3 than that in group 1, group 2. Regression analysis showed that [H+] was correlated with blood glucose level. Strong ion difference (SID) was significantly lower in group 3 than group 1 and PaCO2 level was significantly lower in group 2 and group 3 than that in group 1. In regression analysis, there was a negative correlation between blood glucose concentration and SID. [H+] had a negative correlation with SID and PaCO2 was correlated with SID. Conclusions: These findings suggest that blood glucose level affects acid-base balance and a disturbance in SID is accompanied with respiratory compensation.
참고문헌 (25)
- Norhammar AM, "Admission plasma glucose. Independent risk factor for long-term prognosis after myocardial infarction even in nondiabetic patients", Diabetes Care, 22, pp.1827~1831 (1999)
- McCowen KC, "Stress-induced hyperglycemia", Crit Care Clin, 17, pp.107~124 (2001)
- Fietsam R Jr, "Complications of coronary artery surgery in diabetic patients", Am Surg, 57, pp.551~557 (1991)
- O’Neill PA, "Stress hormone and blood glucose response following acute stroke in the elderly", Stroke, 22, pp.842~847 (1991)
- Van den Berghe G, "Intensive insulin therapy in the critically ill patients", N Engl J Med, 345, pp.1359~1367 (2001)
- Van den Berghe G, "Intensive insulin therapy in the medical ICU", N Engl J Med, 354, pp.449~461 (2006)
- Dandona P, "The potential therapeutic role of insulin in acute myocardial infarction in patients admitted to intensive care and in those with unspecified hyperglycemia", Diabetes Care, 26, pp.516~519 (2003)
- Mohanty P, "Glucose challenge stimulates reactive oxygen species (ROS) generation by leukocytes", J Clin Endocrinol Metab, 85, pp.2970~2973 (2000)
- Ceriello A, "Coagulation activation in diabetes mellitus: the role of hyperglycemia and therapeutic prospects", Diabetologia, 36, pp.1119~1125 (1993)
- Giugliano D, "Vascular effects of acute hyperglycemia in humans are reversed by L-arginine. Evidence for reduced availability of nitric oxide during hyperglycemia", Circulation, 95, pp.1783~1790 (1997)
- Pozzilli P, "Infections and diabetes: mechanisms and prospects for prevention", Diabet Med, 11, pp.935~941 (1994)
- Rassias AJ, "Insulin infusion improves neutophil function in diabetic cardiac surgery patients", Anesth Analg, 88, pp.1011~1016 (1999)
- Kurtz I, "A simple quantitative approach to analyzing the generation of the dysnatremias", Clin Exp Nephrol, 7, pp.138~143 (2003)
- Stewart PA, "Modern quantitative acid-base chemistry", Can J Physiol Pharmacol, 61, pp.1444~1461 (1983)
- Rossing TH, "Acid-base effects of altering plasma protein concentration in human blood in vitro", J Appl Physiol, 61, pp.2260~2265 (1986)
- Fencl V, "Stewart’s quantitative acid-base chemistry: application in biology and medicine", Respir Physiol, 91, pp.1~16 (1993)
- Gilfix BM, "A physical chemical approach to the analysis of acid-base balance in the clinical setting", J Crit Care, 8, pp.187~197 (1993)
- Stacpoole PW, "Natural history and course of acquired lactic acidosis in adults", Am J Med, 97, pp.47~54 (1994), DCA-Lactic Acidosis Study Group
- Katz MA, "Hyperglycemia-induced hyponatremia-calculation of expected serum sodium depression", N Engl J Med, 289, pp.843~844 (1973)
- Pitts RF, "Volume and composition of the body fluids. In: Physiology of the Kidney and Body Fluids", pp.11~34 (1974), Year Book Medical
- Nguyen MK, "Quantitative interrelationship between Gibbs-Donnan equilibrium, osmolality of body fluid compartments, and plasma water sodium concentration", J Appl Physiol, 100, pp.1293~1300 (2006)
- Wilkes P, "Hypoproteinemia, strong-ion difference, and acidbase status in critically ill patients", J Appl Physiol, 84, pp.1740~1748 (1998)
- Polak A, "Effects of chronic hypercapnia on electrolyte and acid-base equilibrium. I. Adaptation", J Clin Invest, 40, pp.1223~1237 (1961)
- Jones NL, "A quantitative physicochemical approach to acid-base physiology", Clin Biochem, 23, pp.189~195 (1990)
- Van Ypersele de Strihou C, "The respiratory response to chronic metabolic alkalosis and acidosis in disease", Clin Sci Mol Med, 45, pp.439~448 (1973)