Intravenous hydration with a 2.5% glucose solution in Type II diabetes

Abstract

Physicians are often unclear about how fast intravenous glucose solutions should be administered to adequately hydrate patients with Type II diabetes while avoiding hyperglycaemia and excessive plasma volume expansion. The aim of the present study was to analyse the disposition of a 2.5% glucose solution and create a nomogram which could serve as a guide to fluid therapy in these patients. Twelve males (mean body mass index, 29 kg/m2) with Type II diabetes due to insulin resistance, as quantified by an euglycaemic hyperinsulinaemic glucose clamp, received an infusion of iso-osmotic 2.5% glucose solution with electrolytes (70 mmol/l sodium, 45 mmol/l chloride and 25 mmol/l acetate) at individual rates over 30 and 60 min respectively. Blood glucose and haemoglobin levels were measured repeatedly over 3.5 h to estimate the kinetics of glucose and fluid volume. Mean insulin sensitivity was 4.2×10−4 dl·kg−1·min−1·(μ-units/ml)−1. The individualized infusion rates reached the predetermined blood glucose level of 12 mmol/l with a mean difference of 0.2 mmol/l. The disposition of glucose was an important factor governing fluid distribution. The volume of distribution of exogenous glucose averaged 19.8 litres, but for the fluid volume it was only 3.7 litres. The clearance was 0.37 litre/min for glucose and 0.10 litre/min for the fluid volume, and the results of the 30-min and 60-min infusions agreed reasonably well. It is concluded that kinetic analysis can be used to guide the infusion time and infusion rate of 2.5% glucose to reach any predetermined glucose level and volume expansion.