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Plasma volume expansion from the intravenous glucose tolerance test before and after hip replacement surgery
Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Anaesthesiology and Surgery.
Karolinska Institute, Sweden.
Södertalje Hospital, Sweden.
2013 (English)In: Theoretical Biology Medical Modelling, ISSN 1742-4682, E-ISSN 1742-4682, Vol. 10, no 48Article in journal (Refereed) Published
Abstract [en]

Background

Hyperosmotic glucose is injected intravenously when an intravenous glucose tolerance test (IVGTT) is initiated. The extent and time period of plasma volume expansion that occurs in response to the glucose load has not been studied in the perioperative setting.

Methods

Twenty-two non-diabetic patients aged between 57 and 76 years (mean 68) underwent an IVGTT, during which 0.3 g/kg of glucose 30% (1 ml/kg) was injected as a bolus over one minute, one day before and two days after hip replacement surgery. Twelve blood samples were collected over 75 minutes from each patient. The turnover of both the exogenous glucose and the injected fluid volume was calculated by means of mass balance and volume kinetic analysis.

Results

The IVGTT raised plasma glucose by 9 mmol/L and the plasma volume by 8%. The extracellular fluid volume increased by 320 (SD 60) ml of which 2/3 could be accounted for in the plasma. The half-life of the exogenous glucose averaged 30 minutes before surgery and 36 minutes postoperatively (P < 0.02). The glucose elimination governed 86% of the decay of the plasma volume expansion, which occurred with a half-life of 12 minutes before to 21 minutes after the surgery (median, P < 0.001).

Conclusion

Hyperosmotic glucose translocated intracellular water to the plasma volume rather than to the entire extracellular fluid volume. The preferential re-distribution acts to dilute the plasma concentrations used to quantify insulin sensitivity and ß-cell function from an IVGTT. The greater-than-expected plasma dilution lasted longer after than before surgery.

Place, publisher, year, edition, pages
2013. Vol. 10, no 48
Keyword [en]
Kinetic model, Intravenous glucose tolerance test, Plasma volume expansion
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-99412DOI: 10.1186/1742-4682-10-48ISI: 000324673200001OAI: oai:DiVA.org:liu-99412DiVA: diva2:656886
Note

Funding Agencies|Stockholm County Council|2009-0433|Stiftelsen Olle Engkvist Byggmastare||

Available from: 2013-10-17 Created: 2013-10-17 Last updated: 2017-12-06

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