Increasing the viscosity of chyme with a viscous soluble fiber has been shown clinically to lower cholesterol for cardiovascular health, improve glycemic control in type 2 diabetes, normalize stool form in both constipation (softens hard stool) and diarrhea (firms loose/liquid stool), and improve the objective clinical measures of metabolic syndrome (glycemic control, lipoprotein profile, body mass index/weight loss, and blood pressure).

Conivaptan was safe and effective in this small series of neurointensive care patients, including many patients who were hyponatremic despite traditional treatments to maintain normal sodium levels. Further studies are needed to clarify the role of conivaptan as an adjunctive and/or alternative therapy for hyponatremia in this patient population.

Sodium and fluid management in the brain injured patient directly impacts cerebral edema and cerebral perfusion pressure. Sodium is a major determinant of neuronal size and therefore hyponatremia is aggressively avoided, as hypoosmolar states result in cerebral edema. Negative fluid balance is often avoided because resultant drop in cerebral perfusion pressure can contribute to cerebral ischemia, further inducing secondary neuronal injury. Patients with brain injury are at risk for disorders of sodium and fluid balance (eg, syndrome of inappropriate antidiuresis, cerebral salt wasting, and diabetes insipidus). Knowledge of normal homeostatic and brain regulatory volume mechanisms is necessary to avoid inducing further neuronal or systemic injury while trying to correct sodium and fluid disorders in brain injured patients. Osmotherapy is a common part of managing cerebral edema in neurocritical care units, but more studies are needed to establish practice guidelines.