Neurosurgery notes/Trauma/Management of trauma/Non surgical/Electrolyte

Electrolyte

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Non surgical

Electrolyte and endocrine disturbances

  • Na Disorders
    • Common after TBI
    • Hypo- and hypernatraemia have adverse effects on the injured brain.
    • A systematic approach to diagnosis and treatment is essential.
        • Finding
        SIADH
        CSWS
        CDI
        Plasma volume
        Raised
        Lowered
        Lowered
        Sodium balance
        Positive/equal
        Negative
        Equal
        Water balance
        Positive
        Negative
        Negative
        Serum sodium
        Low
        Low
        High
        Serum osmolality
        Lowered
        High/normal
        High
        Urine sodium
        High
        High
        Normal
        Urine osmolality
        High
        Normal/high
        Low
        Management
        - Electrolyte-free water restriction—initially to 1000–1500 ml/day—if cardiovascular status allows
        - Demeclocycline—inhibits renal response to ADH
        - ADH-receptor antagonists—inhibit binding of ADH to renal receptors
        - Volume and sodium resuscitation
        - Fludrocortisone may limit sodium loss
        - Replace fluids to maintain normovolaemia
        - DDAVP if high urine output (>250 ml/h) continues
      • ADH, antidiuretic hormone; CDI, central diabetes insipidus; CSWS, cerebral salt wasting syndrome; DDAVP, 1-deamino-8-D-arginine vasopressin; SIADH, syndrome of inappropriate ADH secretion.

Magnesium for neuro-protection in head injury

  • Double blind parallel group randomised trial, Class II evidence
  • N = 499, Seattle, 1998-2004
  • Primary outcome: functional status, seizures, neuropsychological tests
  • Conclusions:
    • IV magnesium sulphate given within 8hr of moderate to severe TBI does not improve outcome and may have detrimental effect
    • Critique:
      • Single centre study
      • Composite outcome measure including 39 measures