Glucose control in acute brain injury

Godoy, Daniel A.; Behrouz, Réza; Napoli, Mario Di

doi:10.1097/mcc.0000000000000292

Cited by 25 publications

(33 citation statements)

References 44 publications

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“…Thus, a tight blood glucose reduction to levels that are considered within the normal ranges in otherwise healthy people could induce brain glycopenia in acute stroke patients and could even trigger a metabolic crisis in the ischemic brain. 67 Thus, for clinical practice, a moderate reduction of glucose levels with close monitoring to avoid hypoglycaemic events might be reasonable as it is currently recommended for hospitalised patients. 19 Another important challenge is the frequent lack of care of hyperglycaemia in acute stroke patients that has been reported in several studies 44,68,69 which could be favoured by the lack of strong recommendations on glucose management due to the limitations of the clinical trials as discussed before.…”

Section: Discussionmentioning

confidence: 99%

European Stroke Organisation (ESO) guidelines on glycaemia management in acute stroke

Fuentes

Ntaios

Putaala

et al. 2017

European Stroke Journal

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Background: Hyperglycaemia is a frequent complication in acute stroke that has been shown to be independently associated with larger infarct size, haematoma growth, poor clinical outcome and mortality. This Guideline Document presents the European Stroke Organisation (ESO) Guidelines for the management of blood glucose levels in patients with acute ischemic or haemorrhagic stroke. Methods: The working group identified related questions and developed its recommendations based on evidence from randomised controlled trials following the standard operating procedure of the ESO. This Guideline Document was reviewed and approved by the European Stroke Organisation Guidelines Committee and the European Stroke Organisation Executive Committee. Results: We found low-quality evidence from clinical trials in ischemic or haemorrhagic stroke exploring the use of intravenous insulin aimed to achieve a tight glycaemic control with different glucose level targets and several other sources of heterogeneity. None of these trials neither the meta-analysis of them have demonstrated any significant benefit of tight glycaemic control with intravenous insulin in acute ischemic or haemorrhagic stroke patients on functional outcome or in survival and they have shown an increased risk for hypoglycaemia. Conclusions: We suggest against the routine use of tight glycaemic control with intravenous insulin as a means to improve outcomes. The currently available data about the management of glycaemia in patients with acute stroke are limited and the strengths of the recommendations are therefore weak. Nevertheless, this does not prevent that hyperglycaemia in acute stroke patients could be treated as any other hospitalised patient.

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Section: Discussionmentioning

confidence: 99%

European Stroke Organisation (ESO) guidelines on glycaemia management in acute stroke

Fuentes

Ntaios

Putaala

et al. 2017

European Stroke Journal

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“…Additionally, high blood glucose levels was also found to be an independent risk factor of prognosis of thrombolysed patients with acute ischemic stroke in our study, which was consistent with previous reports (Bruno & Hamilton, 2001; Bruno et al., 1999; Demchuk et al., 1999; Kase et al., 2001). Higher blood glucose levels may lead to secondary tissue acidosis and oxygen‐derived free radicals increase, resulting in brain cell metabolism disorders, increased brain tissue damage, and the blood–brain barrier disruption (Godoy, Behrouz, & Di Napoli, 2016; Tureyen et al., 2011). Furthermore, the study shows that higher SBP levels before thrombolysis may be detrimental to poor outcome.…”

Section: Discussionmentioning

confidence: 99%

Dehydration is a strong predictor of long‐term prognosis of thrombolysed patients with acute ischemic stroke

Yin

Zhou

et al. 2017

Brain and Behavior

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Background and PurposeDehydration was found to be involved in the poor prognosis of patients with acute ischemic stroke. It is unclear whether dehydration status before onset is related with prognosis of thrombolysed patients with acute ischemic stroke. If it is the case, quickly hydrating may improve the prognosis. The present study was designed to explore the issue.MethodsEligible 294 patients with acute ischemic stroke after thrombolysis were enrolled in the present study according to inclusion/exclusion criteria. According to the modified Rankin scale (mRS) 90 days post stroke, the patients were divided into two groups: mRS 0–2 (n = 191) and mRS 3–6 (n = 103). In the present study, BUN/Cr ≥ 15 combined with USG > 1.010 or either of them were chosen as dehydration marker. Clinical data were analyzed between two groups. Univariate and multivariate statistical analyses were carried out.ResultsAge, fibrinogen, blood glucose, BUN/Cr, NIHSS score at admission, the systolic blood pressure (SBP) before thrombolysis, dehydration status (BUN/Cr ≥ 15 plus USG > 1.010), hyperlipidemia, USG and D‐dimer on admission day, and TOAST classification showed significant difference between two groups (p < .05). Further stratification analysis showed that BUN/Cr ≥ 15, NIHSS ≥ 6, blood glucose ≥8, and SBP > 150 were markedly associated with poor outcome (mRS 3–6, p < .05). After adjusting for age, fibrinogen, USG, D‐dimer, dehydration status, NIHSS, blood glucose, SBP, hyperlipidemia, and BUN/Cr at admission, multivariate logistic regression showed that dehydration status, higher NIHSS, higher blood glucose, and higher SBP at admission were independent risk factors for predicting the long‐term poor prognosis of thrombolysed patients.ConclusionsThe present findings suggest that BUN/Cr ≥ 15 combined with USG > 1.010 as a marker of dehydration status was an independent risk factor for long‐term poor prognosis of thrombolysed patients with acute ischemic stroke.

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“…Por otro lado, el mantenimiento de los niveles de glucosa sanguínea durante la competición resulta fundamental en aquellos deportes en los que se requieren grandes niveles de coordinación, precisión y concentración; ya que nuestro cerebro consume como combustible principal glucosa (alrededor del 20% de la glucosa total consumida por nuestro organismo) 28 . Desafortunadamente, la ingestión de bebidas con elevadas concentraciones de glucosa puede tener efectos negativos en la capacidad de hidratación, fruto de la disminución de los volúmenes plasmáticos como consecuencia de la necesidad de garantizar un nivel de fluido intracelular óptimo 29 .…”

Section: Discussionunclassified

Balance hídrico en jugadoras amateur de baloncesto: seguimiento en 10 partidos

Batalla-Gavalda

Ródenas²,

Corbi-Soler

et al. 2016

Rev Esp Nutr Hum Diet

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Introducción: El objetivo del presente estudio fue analizar la evolución de las necesidades hídricas de un equipo de baloncesto femenino amateur, en situación de partido y durante toda una fase eliminatoria, a partir de la pérdida de peso experimentada. Además, se analizó la existencia de posibles diferencias en el nivel de deshidratación en función de la posición de juego. Material y Métodos:Estudio piloto de un solo grupo con mediciones antes de la competición y después de la competición. Jugadoras amateurs de baloncesto (n=10) y sus recipientes de rehidratación fueron pesadas antes y después de los 10 partidos analizados. Las variaciones de peso fueron evaluadas teniendo en cuenta el líquido ingerido de los bidones de reposición y el líquido evacuado a través de la orina.Resultados: Los resultados de este estudio sugieren la existencia de diferencias significativas entre el peso corporal antes y después de cada partido (z=8,551; p<,0005). La magnitud de estas diferencias parece ser muy distinta en función del partido y la jugadora analizada, con valores medios que oscilan entre los 0,63kg (0,9% Peso Corporal) y los 0,95kg (1,37% Peso Corporal) de pérdida de peso corporal. Además, no se observaron diferencias significativas en el nivel de deshidratación en función de la posición de juego (F=1,59; p=0,1929).Conclusiones: Se confirma la existencia de una alta variabilidad intra e interpersonal en cuanto a la pérdida de masa corporal durante los 10 partidos analizados, lo que sugiere la necesidad de una monitorización y rehidratación individualizada.

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Glucose control in acute brain injury

Cited by 25 publications

References 44 publications

European Stroke Organisation (ESO) guidelines on glycaemia management in acute stroke

European Stroke Organisation (ESO) guidelines on glycaemia management in acute stroke

Dehydration is a strong predictor of long‐term prognosis of thrombolysed patients with acute ischemic stroke

Balance hídrico en jugadoras amateur de baloncesto: seguimiento en 10 partidos

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