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: 6.21). 02/2012; 97(5):1423-33. DOI: 10.1210/jc.2011-3201
Source: PubMed


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.

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    • "L'incidence de ce trouble est de 3–10 % chez les patients de ré animation polyvalente et est associé a ` un risque accru de dé cè s et de complications [1] [2]. Cette incidence est de 10–50 % chez le patient cé ré brolé sé en raison de mé canismes propres a ` la lé sion cé ré brale, notamment une perte de la sensation de soif et un diabè te insipide central, mais aussi de l'utilisation de l'osmothé rapie pour traiter une hypertension intracrânienne (HTIC) [3] [4]. L'objectif de ce travail est de rappeler les grands principes de ré gulation de l'eau et du sel dans l'organisme, d'analyser les causes et consé quences de l'hypernatré mie, pour ré pondre a ` la question de l'utilité ou du danger de l'hypernatré mie chez le patient cé ré brolé sé . "
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