Administering Hypertonic Saline to Patients with Severe Traumatic Brain Injury

Mortimer, Diane; Jancik, Jon T.

doi:10.1097/01376517-200606000-00002

Cited by 23 publications

(11 citation statements)

References 30 publications

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“…(30) The relatively short lifespan of intravascular crystalloids has led to investigating the use of hypertonic saline in trauma, hemorrhagic shock and traumatic brain injury. (31,32) There is circumstantial evidence that albumin administration in these cases is associated with increased mortality. (25,33,34) Shock related mortality is independent of maintaining or normalizing the blood pressure alone, but is directly related to low cardiac index and low mixed venous oxygen saturations (21).…”

Section: Treatmentmentioning

confidence: 99%

Pediatric Shock

2008

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Section: Treatmentmentioning

confidence: 99%

Pediatric Shock

2008

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“…Medications to suppress ADH activity (demeclocycline hydrochloride) or inhibit renal response to ADH (lithium carbonate) are also options. 3,6 Administration of hypertonic intravenous solutions such as 3% sodium chloride requires careful titration because a too-rapid correction of hyponatremia can result in central pontine myelinolysis, 13 an irreversible demyelination of the neurons in the pons of the brain stem. The exact mechanism that causes demyelination is unknown; the recommended rate of serum sodium correction is 10 to 20 mEq/d.…”

Section: Syndrome Of Inappropriate Secretion Of Antidiuretic Hormonementioning

confidence: 99%

“…The exact mechanism that causes demyelination is unknown; the recommended rate of serum sodium correction is 10 to 20 mEq/d. 13 Nursing Management. Nursing management for patients with SIADH and hyponatremia is comparable to the management of patients with CNDI.…”

Section: Syndrome Of Inappropriate Secretion Of Antidiuretic Hormonementioning

confidence: 99%

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Central Neurogenic Diabetes Insipidus, Syndrome of Inappropriate Secretion of Antidiuretic Hormone, and Cerebral Salt-Wasting Syndrome in Traumatic Brain Injury

John

Day

2012

Critical Care Nurse

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Central neurogenic diabetes insipidus, syndrome of inappropriate secretion of antidiuretic hormone, and cerebral salt-wasting syndrome are secondary events that affect patients with traumatic brain injury. All 3 syndromes affect both sodium and water balance; however, they have differences in pathophysiology, diagnosis, and treatment. Differentiating between hypernatremia (central neurogenic diabetes insipidus) and the 2 hyponatremia syndromes (syndrome of inappropriate secretion of antidiuretic hormone, and cerebral salt-wasting syndrome) is critical for preventing worsening neurological outcomes in patients with head injuries.

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“…[13][14][15][16] Since neuroprotective drugs can be delivered in the field and are considered safe for different types of brain injury, their administration to TBI patients soon after trauma will improve patients' chances of survival and recovery. 17 In this work, we arbitrarily selected five out of hundreds of drugs in common clinical use for treatment of head injury victims, namely hypertonic saline, 18 mannitol, 19 morphine, 20 melatonin, 21 and minocycline. 22 A short description of each is given in the Results section.…”

Section: Introductionmentioning

confidence: 99%

Differential effects of early postinjury treatment with neuroprotective drugs in a mouse model using diffuse reflectance spectroscopy

Shochat

Abookasis

2015

Neurophoton

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Abstract. The time required for the arrival of an ambulance crew and administration of first aid is critical to clinical outcome, particularly in the case of head injury victims requiring neuroprotective drugs following a car accident, falls, and assaults. Short response times of the medical team, together with proper treatment, can limit injury severity and even save a life before transportation to the nearest medical center. We present a comparative evaluation of five different neuroprotective drugs frequently used in intensive care and operating units in the early phase following traumatic brain injury (TBI): hypertonic saline (HTS), mannitol, morphine, melatonin, and minocycline. The effectiveness of these drugs in terms of changes in brain tissue morphology (cell organelle size, density, distribution, etc.) and biochemical tissue properties (chromophores' content) was experimentally evaluated through analysis of the spectral reduced scattering and optical absorption coefficient parameters in the near-infrared (NIR) optical range (650 to 1000 nm). Experiments were conducted on anesthetized male mice subjected to a noninvasive closed head weight-drop model of focal TBI (n ¼ 50 and n ¼ 10 control) and monitored using an NIR diffuse reflectance spectroscopy system utilizing independent source-detector separation and location. After 10 min of baseline measurement, focal TBI was induced and measurements were conducted for 20 min. Subsequently, a neuroprotective drug was administrated and measurements were recorded for another 30 min. This work's major findings are threefold: first, minocycline was found to improve hemodynamic outcome at the earliest time postinjury. Second, HTS decreased brain water content and inhibited the increase in intracranial pressure. Third, the efficacy of neuroprotective drugs can be monitored noninvasively with diffuse reflectance spectroscopy. The demonstrated ability to noninvasively detect cerebral physiological properties following early administration of neuroprotective drugs underlines the need for more extensive investigation of the combined use of clinical drugs in larger-scale preclinical experiments to find the most beneficial drug treatment for brain injury patients.

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Administering Hypertonic Saline to Patients with Severe Traumatic Brain Injury

Cited by 23 publications

References 30 publications

Pediatric Shock

Pediatric Shock

Central Neurogenic Diabetes Insipidus, Syndrome of Inappropriate Secretion of Antidiuretic Hormone, and Cerebral Salt-Wasting Syndrome in Traumatic Brain Injury

Differential effects of early postinjury treatment with neuroprotective drugs in a mouse model using diffuse reflectance spectroscopy

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