Critical Care Medicine

Adult Critical Care

Relation between brain interstitial and systemic glucose concentrations after subarachnoid hemorrhage

Zetterling M, Hillered L, Enblad P, et al (Uppsala Univ, Sweden) J Neurosurg 115:66-74, 2011^§

Abstract

Object

The aim in the present investigation was to study the relation between brain interstitial and systemic blood glucose concentrations during the acute phase after subarachnoid hemorrhage (SAH). The authors also evaluated the effects of insulin administration on local brain energy metabolism.

Methods

Nineteen patients with spontaneous SAH were prospectively monitored with intracerebral microdialysis (MD). The relation between plasma glucose and MD-measured interstitial brain glucose concentrations as well as the temporal pattern of MD glucose, lactate, pyruvate, glutamate, and glycerol was studied for 7 days after SAH. Using a target plasma glucose concentration of 5–10 mmol/L, the effect of insulin injection was also evaluated.

Results

The mean (± SD) correlation coefficient between plasma glucose and MD glucose was 0.27 ± 0.27 (p = 0.0005), with a high degree of individual variation. Microdialysis glucose, the MD/plasma glucose ratio, and MD glutamate concentrations decreased in parallel with a gradual increase in MD pyruvate and MD lactate concentrations. There were no significant changes in the MD L/P ratio or MD glycerol levels. Insulin administration induced a decrease in MD glucose and MD pyruvate.

Conclusions

After SAH, there was a positive correlation between plasma and MD glucose concentrations with a high degree of individual variation. A gradual decline in MD glucose and the MD/plasma glucose ratio and an increase in MD pyruvate and MD lactate concentrations during the 1st week after SAH suggest a transition to a hyperglycolytic state with increased cerebral glucose consumption. The administration of insulin was related to a lowering of MD glucose and MD pyruvate, often to low levels even though plasma glucose values remained above 6 mmol/L. After SAH, the administration of insulin could impede the glucose supply of the brain (Figs 2 and 3).

Figure 2 Left: Graph demonstrating mean concentrations and 95% CIs for plasma glucose (728 measurements from 19 patients) and brain MD glucose (728 measurements from 19 patients). There was a significant decrease (asterisk) in MD glucose concentrations on Days 3–7 compared with Day 1. Right: Graph showing the mean concentrations and 95% CIs for the MPR (728 measurements from 19 patients). There was a significant decrease (asterisk) in the MPRs on Days 4–7 compared with Day 1. (Reprinted from Zetterling M, Hillered L, Enblad P, et al. Relation between brain interstitial and systemic glucose concentrations after subarachnoid hemorrhage. J Neurosurg. 2011;115:66-74, with permission from American Association for Neurological Surgeons, with Rockwater, Inc.)

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