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.