Relationship between hyperglycemia and outcome in children with severe traumatic brain injury

1. 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, HuelyaBayir, Elizabeth C. Tyler-Kabra, Robert S. B. Clark, S. Danielle Brown, Michael J. Bell Presented by: Lucan Sanchez

2. 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

3. 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

4. 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

5. 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

6. 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

7. Review of Literature • Yung M, Wilkins B, Norton L, et al; Glucose control, organ failure, and mortality in pediatric intensive care PediatrCrit 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 PediatrCrit Care Med 2008; 9:361-366

8. 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

9. Hypothesis • To determine the relationship between hyperglycemia and outcome in infants and children after severe TBI

10. 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

11. 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

12. Results

13. Results

14. 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

15. 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

16. Acknowledgments • Ms. Gleason • My family • Fellow Science Research Students

17. Questions??