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Fluid Volume Monitoring with Glucose Dilution

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Academic medicine can be very satisfying. I am pleased when I see one of my residents takes excellent care of a seriously injured patient. I am pleased when a junior member of the faculty publishes a really good paper. I am pleased when the program attracts an especially good group of residents. Sources of satisfaction can be multiple when one is a teacher, but Ishihara has presented me with one of the best.

He has taken an idea, which arose from a related research project in 1979, and devoted his career to exploring every ramification and answering almost every question related to it. The related research had to do with the mechanism of hyperglycemia in various states of general and regional anesthesia. The idea that triggered his imagination was to use glucose as a marker for the measurement of central extracellular fluid (ECF) volume. His exhaustive work forms the material for this book.

He has studied animals and humans, healthy people and sick. He has answered the pressing questions, whether simple or complex. He has compared his technique to the recognized gold standards of analysis in a wide variety of complex clinical situations. When I say a wide variety of complex clinical situations, I mean patients in his intensive care unit with severe hemorrhagic hypovolemia, congestive heart failure, respiratory failure on longterm ventilator support, adrenal insufficiency, and metabolic imbalance on insulin infusions. His studies have always been directed to the goal of improved decision making in the area of fluid therapy and inotropic support. His dedication has paid off. He has the answers. The initial distribution volume of glucose (IDVG) is a valuable marker of central ECF volume and a valuable guide to therapy. Why then has it not become more popular? I believe because it is too simple and does not generate profit for anybody but the patient. It does not involve computers or expensive new drugs. It does not posses an army of salesmen who promote its virtues in the coffee rooms of relaxing anesthesiologists and intensivists.
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