RELATIONSHIP BETWEEN HYPERGLYCEMIA AND OUTCOME IN

CHILDREN WITH SEVERE TRAUMATIC BRAIN INJURY

Written by: Rebecca L. Smith, John C. Lin, David Adelson, Patrick M. Kochanek, Erica L. Fink, Stephen R. Wisniewski, Huelya Bayir, Elizabeth C. Tyler-Kabra, Robert S. B. Clark, S. Danielle Brown,

Michael J. Bell

Presented by: Lucan Sanchez

Introduction

Over 300,000 concussions are diagnosed, in athletes, annually

50,000 deaths a year due to TBI’s

2% of the US’ population lives with neurological disabilities resulting from TBI’s

Nuerometabolic Cascade of Concussion

The series of steps that follow a TBI in the brain

1. Calcium and Potassium ion imbalance in the brain

2. Ion pumps work overtime in order to restore balance, require large amounts of glucose

3. Impaired blood flow to brain limits amount of glucose available, massive energy crisis

4. Brain begins anaerobic respiration, produces lactic acid which further damages the brain

Hyperglycemia

An excess of glucose in the brain

Why is it bad?

No definitive answer yet, all scientists have are theories

One theory is that the excess glucose in the brain produces oxygen free radicals that then attack the brain cells

Key Terms

Traumatic Brain Injury(TBI)- any impact to the head that can cause physical damage and long-term complications

Dextrose- a simple plant based monosaccharide used as a fluid and nutrient replenisher

Hypoglycemia- a shortage of glucose in the brain

Key Terms Cont.

Glasgow Coma Score- A scale from 3-15 that measures the severity of the TBI

Lactate- the lactic acid production by the brain during anaerobic respiration

NG, MHG, SHG

Review of Literature

Yung M, Wilkins B, Norton L, et al; Glucose control, organ failure, and mortality in pediatric intensive care Pediatr Crit Care Med 2008; 9:147-152

Hirshberg E, Larsen G, Van Duker H: Alterations in glucose homeostasis in the pediatric intensive care unit: Hyperglycemia and glucose variability are associated with increased mortality and morbidity Pediatr Crit Care Med 2008; 9:361-366

Review of Literature

Michaud LJ, Rivara FP, Longstreth WT Jr, et al: Elevated initial blood glucose levels and poor outcome following severe brain injuries in children. J Trauma 1991; 31:1356-1362

Hypothesis

To determine the relationship between hyperglycemia and outcome in infants and children after severe TBI

Methods and Materials

All Children admitted with a TBI and Glasgow Coma score <8 were eligible for the study

A subset of these kids were also enrolled in a trial in which they tested hypothermia as a nueroprotectant

Methods and Materials

Glucose administration avoided for 48 hours post-TBI

Glucose timing and insulin administration was at discretion of team

48 hours post injury 5% dextrose IV drip

Results

Early Late105

110

115

120

125

130

135

140

FavorableUnfavorable

Results

Early NG

Late NG 64% Late MHG 18% Late SHG 18%

Early MHG

Late NG 46% Late MHG 27% Late SHG 27%

Early SHG

Late NG 26% Late MHG 40% Late SHG 34%

Discussion/Conclusion

Insulin administration was a potential source of error

Hypothermia and the re-warming process could have skewed results

More regulated glucose administration after 48 hours may yield different results

Discussion/Conclusion

Hyperglycemia beyond 48 hours(Delayed hyperglycemia) post-injury results in poor outcome

This study found no association between early hyperglycemia and outcome

More research must be done in order to discover the optimal approach to treating kids with a TBI

Acknowledgments

Ms. Gleason My family Fellow Science Research Students

Questions??