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      Reversal of Glucose-Insulin-Potassium-Induced Hyperglycemia by Aggressive Insulin Treatment in Postoperative Heart Failure

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          Abstract

          Metabolic support with glucose-insulin-potassium (GIK) significantly reduces the morbidity and mortality of patients in cardiogenic shock after hypothermic ischemic arrest for aortocoronary bypass surgery. However, a small subset of these patients develops postoperative insulin resistance regardless of their preoperative diabetic status. Whether GIK directly contributes to higher mortality in these patients is unknown. We reviewed the records of 322 patients whose treatment for postoperative cardiogenic shock included GIK. Ten patients (3%) had postoperative hyperglycemia (serum glucose ≧250 mg/dl or 13.9 mmol/l) due to insulin resistance. These were compared to randomly selected GIK-treated, insulin-responsive patients (n = 10) and non-GIK-treated patients (n = 10) for comparison. The insulin-resistant patients required increasing amounts of regular insulin up to 130 U/h until blood glucose levels fell below 250 mg/dl. However, short-term outcomes (IABP support time, length of stay in ICU, 7-day mortality) for insulin- resistant patients were indistinguishable from those for insulin-responsive patients. These data indicate that postoperative iatrogenic hyperglycemia in patients after cardiopulmonary bypass may not be detrimental per se and is reversible when treated with supplemental insulin.

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          Most cited references 12

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          Effects of an intravenous infusion of a potassium-glucose-insulin solution on the electrocardiographic signs of myocardial infarction

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            Plasma fatty acid levels in infants and adults after myocardial ischemia.

            High levels of fatty acids are detrimental during reperfusion of ischemic hearts in part because of an inhibition of myocardial glucose use. We therefore measured plasma fatty acids during and after myocardial ischemia in both adult and pediatric patients. In adult patients undergoing thrombolytic therapy after an acute myocardial infarction, plasma fatty acids levels were elevated on admission to hospital (0.96 +/- 0.06 vs 0.40 +/- 0.01 mmol/L in healthy control subjects) and remained elevated throughout the initial 48 hours of hospitalization. In adult patients undergoing cardiac surgery, plasma fatty acids were markedly increased during surgery and at the time of the release of the aortic cross clamp (2.21 +/- 0.54 and 1.61 +/- 0.32 mmol/L, respectively). In children and infants (mean age 4.33 +/- 0.44 years) who had surgery to correct congenital heart defects, fatty acid levels during surgery increased to 3.27 +/- 0.26 mmol/L and remained elevated during immediate reperfusion (1.91 +/- 0.15 mmol/L) and for 24 hours after surgery (1.67 +/- 0.22 mmol/L). Because experimental studies have shown that high levels of fatty acids are detrimental to recovery of adult animal hearts, we determined the effect of high fatty acid levels on reperfusion recovery of isolated working hearts from 1-day-old rabbits perfused with 0.4 mmol/L palmitate (normal fat) or 1.2 mmol/L palmitate (high fat) and subjected to 50 minutes of global ischemia followed by aerobic reperfusion.(ABSTRACT TRUNCATED AT 250 WORDS)
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              Effects of glucose and fatty acids on myocardial ischaemia and arrhythmias

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                Author and article information

                Journal
                CRD
                Cardiology
                10.1159/issn.0008-6312
                Cardiology
                S. Karger AG
                0008-6312
                1421-9751
                2004
                July 2004
                09 July 2004
                : 102
                : 2
                : 82-88
                Affiliations
                aDepartment of Internal Medicine, Division of Cardiology, The University of Texas-Houston Medical School, Houston, Tex., and bTexas Heart Institute at St. Luke’s Episcopal Hospital, Houston, Tex., USA
                Article
                77909 Cardiology 2004;102:82–88
                10.1159/000077909
                15103177
                © 2004 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 1, Tables: 3, References: 38, Pages: 7
                Categories
                General Cardiology

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