Assessment of Blood Glucose and Electrolytes during Cardiopulmonary Bypass in Diabetic and Non-Diabetic Patients of Pakistan

Abstract

Introduction:Perioperative hyperglycemia has been shown to be related to higher levels of morbidity and mortality in patients on cardiopulmonary bypass (CPB) undergoing coronary artery bypass grafting (CABG), both diabetic and non-diabetic. Blood electrolytes, like sodium, potassium, calcium, and chloride play a very important role in the normal functioning of the body and can lead to a variety of clinical disorders if they become deficient. A minimal number of studies have been conducted on the simultaneous perioperative changes in both blood glucose and electrolyte levels during CPB in Pakistan. Therefore, our aim is to record and compare the changes in blood glucose and electrolyte levels during CPB in diabetic and non-diabetic patients.Materials and Methods:This was a prospective, observational study conducted on 200 patients who underwent CABG with CPB, from October 2014 to March 2015. The patients were recruited from the Cardiac Surgery Ward, Civil Hospital Karachi after they complied with the inclusion criteria. Repeated-measures analysis of variance (ANOVA) was used to compare the trend of the changes perioperatively for the two groups.Results:There was no significant difference in changes in blood glucose between the two groups (P = 0.62). The only significant difference detected between the two groups was for PaCO2 (P = 0.001). Besides, further analysis revealed insignificant group differences for the trend changes in other blood electrolytes (P > 0.05).Conclusion:Our findings highlighted that there is no significant difference in blood electrolytes changes and the increase in blood glucose levels between diabetic and non-diabetic patients.

Levels and Predictors of Self-Care Among Patients with Hypertension in Pakistan

“…The lack of awareness among the participants in the current study is consistent with findings of previous Pakistani studies, which also reported inadequate awareness about the risk factors related to NCDs affecting patients' adherence to lifestyle modifications. 18,19 In contrast, studies in developed countries like China 20 and the USA 21 reported higher awareness and knowledge among patients who were living with hypertension, possibly attributable to differences in literacy rates of the population, as more than half of the participants in our study had no education which technically meant that they could not read and write their names. Despite widespread prevalence of hypertension, and its prediction to rise steeply, 22 previous and current studies have shown that low patient awareness about the hypertension, its risks, and complications is ubiquitous.…”

“…Medication adherence was seen in 72% of the participants amongst all socio-economic strata. Higher level of medication adherence has also been reported by previous studies 19,27,30 conducted with cardiac patients where medication compliance was taken relatively seriously by the participants as compared to any other self-management behavior. Participants give importance to the prescription because they are personalized and directly written by the doctors whom they are answerable to on subsequent visits.…”

“…Other researchers have also pointed out that the existence of a communication gap between the patients and the healthcare providers regarding health education leads to a trend of low awareness regarding self-care practices. 19,28 Therefore, there is a need in this context to develop stronger health education strategies which make basic knowledge of the disease accessible to all, regardless of demand and capacity.…”

Biochemical Changes in Cardiopulmonary Bypass in Cardiac Surgery: New Insights

“…The hyperhydrated patient may present facial or generalized edema, ascites, pleural effusion, respiratory failure, asthenia, disorientation, delirium and seizures or other neurological manifestations. Hyperhydration is a complication that is accentuated in patients with low amounts of proteins in the body, representing another risk factor for this individual when performing surgical procedures, considering that the oncotic pressure of the plasma is reduced and allows extravasation of liquids from the plasma to the interstitial space, especially if the liquid supply is not adequately dimensioned [31,32].…”

“…In this context, sodium (Na + ) is the main ion for sustaining water balance, since its loss can cause a reduction in extracellular osmotic pressure and, consequently, cause the transition from this compartment to the intercellular compartment. However, if there is an increase in extracellular sodium levels, there is an increase in osmotic pressure and, consequently, this results in the interstitial accumulation of water, with the development of edema [31,32].…”