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Question: How should I manage a patient that has a low pre-Hyperbaric treatment blood sugar?

Ideally, an HBO program should have a detailed policy for the diabetic patient and the immediate steps that one should take to elevate the patient’s blood sugar. However, for the patient who has a recurring problem with blood sugars that are less than the recommended pretreatment level, there are several options. One option is to contact the managing physician and explain the need for relaxed glycemic control while receiving hyperbaric therapy.

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Cardiovascular Effects of Hyperbaric Oxygen Treatment, as described by Robert A. Warriner III, MD

Hyperbaric oxygen exposure can produce significant hemodynamic changes. An increase in systemic afterload due to hyperoxic vasoconstriction in well perfused tissues can lead to a decrease in left ventricular function and a decrease in ejection fraction in some patients. When this decrease in left ventricular function occurs in the setting of pulmonary arterial vasodilatation due to improved alveolar oxygenation with increased left atrial and left ventricular filling, acute left ventricular dysfunction and pulmonary edema can result. Cases have been reported in patients with a history of pulmonary edema or low left ventricular ejection fractions or in patients with sudden fluid shifts from volume overload. Acute pulmonary edema appears to be more common in monoplace than multiplace treatment settings, perhaps because of the requirement for patients to be in a more supine position in the monoplace chamber rather than the sitting position with legs dependent available in the multiplace chamber.

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