Abstract
BackgroundHow the initial infusion rate of glucose solution should be set to avoid hyperglycemia in the perioperative setting is unclear.MethodsComputer simulations were performed based on data from seven studies where the kinetics of glucose was calculated using a one-compartment model. Glucose had been infused intravenously on 44 occasions to volunteers and on 256 occasions to surgical patients at various stages of the perioperative process. The rates that yield plasma glucose concentrations of 7, 9, and 12 mmol/l were calculated and standardized to a 5 % glucose solution infused in a subject weighing 70 kg.ResultsThe lowest infusion rates were found during surgery and the first hours after surgery. No more than 0.5 ml/min of glucose 5 % could be infused if plasma glucose above 7 mmol/l was not allowed, while 2 ml/min maintained a steady state concentration of 9 mmol/l. Intermediate infusion rates could be used in the preoperative period and 1–2 days after moderate-sized surgery (e.g., hysterectomy or hip replacement). Here, the half-lives averaged 30 min, which means that plasma glucose would rise by another 25 % if a control sample is taken 1 h after a continuous infusion is initiated. The highest infusion rates were found in non-surgical volunteers, where 8 ml/min could be infused before 9 mmol/l was reached.ConclusionsComputer simulations suggested that rates of infusion of glucose should be reduced by 50 % in the perioperative period and a further 50 % on the day of surgery in order to avoid hyperglycemia.
Highlights
How the initial infusion rate of glucose solution should be set to avoid hyperglycemia in the perioperative setting is unclear
Providing intravenous glucose carries the risk of inducing hyperglycemia, which promotes postoperative infection (Hahn and Hahn 2011; Sieber et al 1987; Kwon et al 2013; Frisch et al 2010; Hanazaki et al 2009; Lipshutz and Gropper 2009) and osmotic diuresis (Doze and White 1987)
Infusion rates that provide effective fluid and nutritional support therapy while avoiding hyperglycemia might be difficult to determine in the perioperative setting, as glucose turnover becomes impaired as part of the trauma response (Ljunggren et al 2014a)
Summary
How the initial infusion rate of glucose solution should be set to avoid hyperglycemia in the perioperative setting is unclear. Intravenous glucose is the hallmark of maintenance fluid therapy to prevent starvation and provide free water for intracellular hydration. Oral intake is the recommended type of carbohydrate administration in routine patients, but various reasons may call for the use of intravenous glucose both before and after surgery. Infusion rates that provide effective fluid and nutritional support therapy while avoiding hyperglycemia might be difficult to determine in the perioperative setting, as glucose turnover becomes impaired as part of the trauma response (Ljunggren et al 2014a). Plasma glucose should be measured to guide adjustments of the infusion rate, but the point at which the check best reflects the risk of hyperglycemia is unclear to most clinicians
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