Considerations in Fluids and Electrolytes After Traumatic Brain Injury

Abstract

Appropriate fluid management of patients with traumatic brain injury (TBI) presents a challenge for many clinicians. Many of these patients may receive osmotic diuretics for the treatment of increased intracranial pressure or develop sodium disturbances, which act to alter fluid balance. However, establishment of fluid balance is extremely important for improving patient outcomes after neurologic injury. The use of hyperosmolar fluids, such as hypertonic saline, has gained significant interest because they are devoid of dehydrating properties and may have other beneficial properties for patients with TBI. Electrolyte derangements are also common after neurologic injury, with many having neurologic manifestations. In addition, the role of electrolyte abnormalities in the secondary neurologic injury cascade is being delineated and may offer a potential future therapeutic intervention.

Evaluation of Serum Electrolytes in Traumatic Brain Injury Patients: Prospective Randomized Observational Study

“…Electrolyte derangements are common in patients with head injury [7]. Most common and notable electrolyte derangements are serum sodium and potassium levels following a head injury [23] Changes in fluid level secondary to resuscitative measures and pharmacological therapy (use of Furosemide and Mannitol) [24] are mainly responsible for these.…”

RETRACTED CHAPTER: Brain Trauma and Nutritional Support

“…Fluid restriction in patients with TBI, as it was publicized in the past with the idea of avoiding cerebral edema, has been widely left (Rhoney and Parker 2006). Fluid management in patients with TBI is a crucial topic: a recent study showed that a fluid balance lower than À 596 ml within the first 4 days on the ICU was associated with an adverse effect on the outcome (Clifton et al 2002).…”

“…Electrolyte imbalances may also clinically present with neurological abnormalities, most of which are reversible upon treatment of the underlying disorder. Early recognition and an immediate treatment of the underlying pathophysiological disorders are essential, as electrolyte derangements may worsen secondary injury (Rhoney and Parker 2006).…”

“…Common causes for hypernatremia include diabetes insipidus (injury and/or edema of the hypothalamus or pituitary gland leads to a decreased secretion of ADH, Fig. 6) and iatrogenic causes such as infusion of hypertonic, hyperoncotic saline or osmodiuretics (mannitol) (Rhoney and Parker 2006). Diabetes insipidus occurs in about 20 % of patients with TBI, which is -in most cases -transient.…”

Cytotoxic edema: mechanisms of pathological cell swelling

“…With appropriate changes in capillary permeability,138 the new gradient created by cytotoxic edema results in driving transcapillary formation of ionic Excellent reviews that summarize current knowledge on this topic have been published. 10,21,37,46,[71][72][73]112,125,166 In our recent review,138 we examined molecular mechanisms involved in transcapillary flux of Na + , water, plasma ultrafiltrate, and blood that lead to brain swelling. In this paper, we review molecular mechanisms involved in cytotoxic edema.…”