Potassium Sparing Diuretics as Adjunct to Mannitol Therapy in Neurocritical Care Patients with Cerebral Edema: Effects on Potassium Homeostasis and Cardiac Arrhythmias

Bilotta, Federico; Giovannini, F.; Aghilone, Flavia; Stazi, Elisabetta; Titi, Luca; Zeppa, Ivan Orlando; Rosa, G.

doi:10.1007/s12028-011-9652-2

Cited by 12 publications

(11 citation statements)

References 16 publications

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“…Although this does not prove that polyuresis was the cause of electrolyte deficiencies in severe hypokalaemia group, it seems likely that high urine production and renal excretion of electrolytes contributed to the occurrence of electrolyte disorders. Previous studies have shown that mannitol can produce the effect of increasing potassium urinary excretion and reducing serum potassium [19]. While, there was no significant difference in dosage of mannitol among three groups.…”

Section: Discussionmentioning

confidence: 52%

Prevalence of severe hypokalaemia in patients with traumatic brain injury

Lü

et al. 2015

Injury

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Section: Discussionmentioning

confidence: 52%

Prevalence of severe hypokalaemia in patients with traumatic brain injury

Lü

et al. 2015

Injury

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“…The substance can dehydrate brain tissues, reduce brain volume, and decrease the ICP. During this process, charged ions in the extracellular fluid move to the plasma with water molecules and consequently reduce the electrically conductive fluid of brain tissues (Bilotta et al, 2012). These occurrences are manifested by the impedance increase in the EIT images.…”

Section: Discussionmentioning

confidence: 99%

Comparison of electrical impedance tomography and intracranial pressure during dehydration treatment of cerebral edema

Yang

et al. 2019

NeuroImage: Clinical

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Cerebral edema after brain injury can lead to brain damage and death if diagnosis and treatment are delayed. This study investigates the feasibility of employing electrical impedance tomography (EIT) as a non-invasive imaging tool for monitoring the development of cerebral edema, in which impedance imaging of the brain related to brain water content is compared with intracranial pressure (ICP). We enrolled forty patients with cerebral hemorrhage who underwent lateral external ventricular drain with intraventricular ICP and EIT monitoring for 3 h after initiation of dehydration treatment. The average reconstructed impedance value (ARV) calculated from EIT images was compared with ICP. Dehydration effects induced changes in ARV and ICP showed a close negative correlation in all patients, and the mean correlation reached R 2 = 0.78 ± 0.16 ( p < .001). A regression equation ( R 2 = 0.62, p < .001) was formulated from the total of measurement data. The 95% limits of agreement were − 6.13 to 6.13 mmHg. Adaptive clustering and variance analysis of normalized changes in ARV and ICP showed 92.5% similarity and no statistically significant differences ( p > .05). Moreover, the sensitivity, specificity and area under the curve of changes in ICP >10 mmHg were 0.65, 0.73 and 0.70 respectively. The findings show that EIT can monitor changes in brain water content associated with cerebral edema, which could provide a real-time and non-invasive imaging tool for early identification of cerebral edema and the evaluation of mannitol dehydration.

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“…In the present study, patients with constipation were more prone to take other cathartics like lactulose or mannitol before bowel preparation with polyethylene glycol, even early when admitted to hospital. Mannitol administration could also induce hypokalemia [ 11 ]. We also identified that patients in whom ≥2 types of oral cathartics were used were more likely to develop hypokalemia.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and risk factors for hypokalemia in patients scheduled for laparoscopic colorectal resection and its association with post-operative recovery

Zhu

Tan

et al. 2018

BMC Gastroenterol

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BackgroundPerioperative serum potassium levels are closely associated with postoperative clinical outcomes after gastrointestinal surgery. The aim of our retrospective study was to identify the prevalence and risk factors for preoperative hypokalemia (before pneumoperitoneum) and to evaluate the influence of preoperative hypokalemia on the recovery of postoperative gastrointestinal function.MethodsIn this retrospective study, patients scheduled for laparoscopic colorectal resection from November 11 2014 to October 20 2016, were considered for inclusion. A blood potassium level between 3.5 and 5.5 mmol/L was defined as normal, with levels between 3.0 to 3.5 mmol/L, 2.5 to 3.0 mmol/L and < 2.5 mmol/L considered as slight, moderate, and severe level of hypokalemia. The factors including age, gender, ASA grade, BMI, hypertension, diabetes, anti-hypertension drugs, lactose oral soluble, oral cathartics, oral cathartics, cathartic enemas, and blood potassium level before gastrointestinal preparation which might be associated with blood potassium level before pneumoperitoneum were analysed. The time to postoperative first flatus (FFL) and first feces (FFE) was compared between patients with and without hypokalemia.ResultsThe final analysis was based on the data of 108 patients. Hypokalemia was identified in 70.37% patients, with the following distribution of blood potassium levels before pneumoperitoneum: slight, 49 (45.37%) patients; moderate, 23 (21.30%); and severe, 4 (3.70%) patients. Hypokalemia was significantly associated with hypertension and the use of ≥2 types of oral cathartics for preoperative gastrointestinal preparation. With treatment, potassium levels recovered to normal levels in all patients within 48 h postoperatively. Hypokalemia was associated with a longer postoperative time to first feces, compared to patients with a normal potassium level before pneumoperitoneum.ConclusionsOur findings underlie the importance of early monitoring and management of serum potassium levels in these patients.

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Potassium Sparing Diuretics as Adjunct to Mannitol Therapy in Neurocritical Care Patients with Cerebral Edema: Effects on Potassium Homeostasis and Cardiac Arrhythmias

Abstract: In patients receiving neurocritical care for cerebral edema, the adjunct of a potassium sparing diuretic (canrenone) to mannitol therapy reduces potassium urinary loss, prevents hypokalemia, and reduces the incidence of new cardiac arrhythmias.

Cited by 12 publications

References 16 publications

Prevalence of severe hypokalaemia in patients with traumatic brain injury

Prevalence of severe hypokalaemia in patients with traumatic brain injury

Comparison of electrical impedance tomography and intracranial pressure during dehydration treatment of cerebral edema

Prevalence and risk factors for hypokalemia in patients scheduled for laparoscopic colorectal resection and its association with post-operative recovery

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