Abstract
Acute osmolar gradients have been demonstrated to produce hemorrhage in the CNS of animals. Similar changes have been observed postmortem in brains of hyperglycemic premature infants. Studies were done in puppies at 1 day(n=5) and at 3-4 weeks of age(n=7) in which hyperglycemia was produced by IV administration of 25%(4ml/kg) or 10%(10ml/kg) glucose solutions. Similar results were noted between groups. Cerebrospinal fluid(CSF) osmolality(osm), pH and pressure were compared to simultaneous arterial blood samples. Brain water, Na and K were compared to normoglycemic controls. Plasma osm increased by 18.2±4.8mosm/1 at 10 minutes(p<0.01). CSF pH decreased from control values of 7.37±0.06 to 7.28±0.07 at 30 minutes. CSF pressure increased in all animals within 30 minutes, and decreased thereafter. CSF became bloody in each puppy usually within 1 hour of glucose administration. Gross and histologic changes noted in the brains included intramedullary and intracerebellar vascular congestion and hemorrhage. Brain water was decreased by 3%, Na was increased by 25% and K was increased by 42% in the newborn puppies; changes in older puppies were less pronounced. It is concluded that current regimens used to treat hypoglycemia in neonates produce abrupt osmolar gradients which can result in intracranial bleeding. The lesser water and electrolyte changes noted in brains of older puppies suggest that the CNS of infants at birth may be more vulnerable to abrupt changes in extracellular fluid osm than older infants.
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Arant, B., Gooch, W. 1110 EFFECTS OF ACUTE HYPERGLYCEMIA ON THE CNS OF NEONATAL PUPPIES. Pediatr Res 12 (Suppl 4), 549 (1978). https://doi.org/10.1203/00006450-197804001-01116
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DOI: https://doi.org/10.1203/00006450-197804001-01116