Article

Disorders of Water Homeostasis in Neurosurgical Patients

Royal College of Surgeons in Ireland, Dublin, Leinster, Ireland
The Journal of Clinical Endocrinology and Metabolism (Impact Factor: 6.31). 02/2012; 97(5):1423-33. DOI: 10.1210/jc.2011-3201
Source: PubMed

ABSTRACT Disorders of water balance are common in neurosurgical patients and usually manifest as hypo- or hypernatremia. They are most commonly seen after subarachnoid hemorrhage, traumatic brain injury, with intracranial tumors, and after pituitary surgery.
We reviewed the experience of endocrine evaluation and management of disorders of salt and water balance in a large cohort of inpatients attending the national neurosciences referral centre in Dublin, Ireland, and compared this experience with findings from other studies.
The study group included unselected neurosurgical patients admitted to our centre and requiring endocrine evaluation.
We conducted investigations to determine the underlying mechanistic basis for disorders of salt and water balance in neurosurgical patients and treatment to restore normal metabolism.
Morbidity and mortality associated with deranged salt and water balance were measured.
The underlying pathophysiology of disordered water balance in neurosurgical patients is complex and varied and dictates the optimal therapeutic approach.
A systematic and well-informed approach is needed to properly diagnose and manage disorders of salt and water balance in neurosurgical patients.

0 Bookmarks
 · 
90 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: La estrategia diagnóstica ante un síndrome poliurodípsico con poliuria hipotónica debe orientarse, en primer lugar, a descartar las causas de diabetes insípida (DI) nefrogénica adquiridas del adulto (hipercalcemia, hipopotasemia, tratamiento con litio, enfermedad renal). Algunas de las causas (neuroquirúrgicas o traumáticas) de DI de origen central (también denominada neurogénica o hipotalamohipofisaria) resultan evidentes. En caso contrario, es preciso disponer en primera instancia de una resonancia magnética que pueda evidenciar una posible lesión tumoral, infiltrativa o inflamatoria. El estudio debe completarse mediante el análisis del resto de funciones de la hipófisis y la investigación de signos generales de una enfermedad sistémica. Sólo es en caso de DI aislada, sin anomalías morfológicas en la resonancia magnética, cuando debe efectuarse una prueba de restricción hídrica, a fin de descartar una polidipsia primaria. Las causas predominantes de DI de origen central del adulto son los tumores, tanto lesiones primarias como metástasis. A continuación están las granulomatosis, tan frecuentes como las hipofisitis y las neuroinfundibulitis. Por último, en un 25% de los casos, la etiología resulta desconocida y la DI se denomina «idiopática», aunque es muy probable que estas DI sean la secuela de una hipofisitis o una neuroinfundibulitis que hayan pasado desapercibidas en el momento de la fase aguda al haberse resuelto de forma espontánea. El tratamiento de la DI recurre a un análogo de la vasopresina, la desamino-D-arginina-vasopresina o desmopresina.
    09/2014; 18(3):1–6. DOI:10.1016/S1636-5410(14)68145-9
  • [Show abstract] [Hide abstract]
    ABSTRACT: Management of critically ill neurosurgical patients is often complicated by the presence or development of endocrinological ailments which complicate the clinical scenario and adversely affect the prognosis of these patients. The anatomical proximity to the vital centers regulating the endocrinological physiology and alteration in the neurotransmitter release causes disturbances in the hormonal homeostasis. This paves the way for development of diverse disorders where single or multiple hormones may be involved which can have deleterious effect on the different organ system. Understanding and awareness of these disorders is important for the treating intensivist to recognize these changes early in their course, so that appropriate and timely therapeutic measures can be initiated along with the treatment of the primary malady.
    11/2014; 18(6):778-83. DOI:10.4103/2230-8210.140240
  • [Show abstract] [Hide abstract]
    ABSTRACT: Hypernatremia is defined by a serum sodium concentration of more than 145mmol/L and reflects a disturbance of the regulation between water and sodium. The high incidence of hypernatremia in patients with severe brain injury is due various causes including poor thirst, diabetes insipidus, iatrogenic sodium administration, and primary hyperaldosteronism. Hypernatremia in the intensive care unit is independently associated with increased mortality and complications rates. Because of the rapid brain adaptation to extracellular hypertonicity, sustained hypernatremia exposes the patient to an exacerbation of brain edema during attempt to normalize natremia. Like serum glucose, serum sodium concentration must be tightly monitored in the intensive care unit.
    Annales francaises d'anesthesie et de reanimation 06/2014; · 0.77 Impact Factor