Articles: glucose-therapeutic-use.
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The Journal of pediatrics · Oct 1988
Randomized Controlled Trial Comparative Study Clinical TrialRapid intravenous rehydration by means of a single polyelectrolyte solution with or without dextrose.
We compared the efficacy and safety of a single polyelectrolyte solution, Dhaka solution (DS), containing 133 mmol/L sodium, 13 mmol/L potassium, 98 mmol/L chloride, and 48 mmol/L acetate with and without 139 mmol/L (25 gm/L) dextrose in the rapid (4 hours) rehydration of 67 patients with diarrhea and moderate or severe dehydration requiring parenteral fluid therapy. Of the 67 patient, 31 were randomly assigned to receive the dextrose-containing solution (DS + D) and 36 DS without dextrose. On admission to the hospital, the two groups of patients were similar with respect to enteric pathogens detected, proportion with hyponatremia, magnitude of dehydration as assessed by clinical criteria, serum protein or creatinine concentration, and plasma glucose levels. ⋯ No other complications were noted. Serum protein values 24 hours after admission were little changed from 4-hour values, suggesting that rehydration was complete at the end of 4 hours. We conclude that, in our patients, rehydration can be carried out safely and rapidly with the use of a single solution and that adding 139 mmol/L (25 gm/L) of dextrose to the solution can prevent hypoglycemia without producing an osmotic diuresis.
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Two groups of 45 term, vaginally delivered infants were studied to determine effect of maternal intrapartum glucose therapy on neonatal blood glucose level at birth and at one and 2 hours of age. Twenty-three infants whose mother received glucose infusion prior to delivery (study group) had a significantly higher mean cord blood glucose level, lower 2 hour blood glucose levels and about three times higher incidence of hypoglycemia (glucose level less than or equal to 2.2 mmol/l) as compared to 22 infants whose mothers did not receive any glucose or fluid therapy. Neurobehavioral evaluation of the infants at 1 and 2 hour demonstrated, a significant association between hypoglycemia and a low muscle tone score and a delayed habituation to various stimuli. Blood glucose levels must be routinely monitored in infants whose mother receive glucose infusion prior to delivery to detect and treat early neonatal hypoglycemia.
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Haemodynamic and metabolic effects of glucose-potassium-insulin (GKI) were studied in 14 patients with peritonitis. Study entry criteria were: hypodynamic septic shock (mean arterial pressure less than 50 mmHg and cardiac index less than 3.5 l/min) despite a highly positive fluid balance (greater than +2,000 ml during the last 12 h) and use of catecholamines (greater than 15 mcg/kg/min Dobutamine). GKI (glucose 70% 1 g/kg + potassium 10 mval + insulin 1.5 U/kg) was infused within 15 min via a central venous catheter. ⋯ The haemodynamic improvement lasted from 30 min or less (n = 3; 21%) to several hours. Nine patients (64%) survived more than 2 days, and two patients (14%) were eventually discharged from the hospital. We conclude, that in hypodynamic septic shock refractory to volume loading and catecholamine treatment GKI may be beneficial, although the mechanism of action remains unclear.