Osmolality is the primary determinant of water movement across the intact blood–brain barrier (BBB), and we can predict that reducing serum osmolality would increase cerebral oedema and intracranial pressure. Brain injury affects the integrity of the BBB to varying degrees. With a complete breakdown of the BBB, there will be no osmotic/oncotic gradient, and water accumulates (brain oedema) consequentially to the pathological process. In regions with very moderate BBB injury, the oncotic gradient may be effective. Finally, osmotherapy is effective in brain areas with normal BBB; hypertonic solutions (mannitol, hypertonic saline) dehydrate normal brain tissue, with a decrease in cerebral volume and intracranial pressure. In patients with brain pathology, volume depletion and/or hypotension greatly increase morbidity and mortality. In addition to management of intravascular volume, fluid therapy must often be modified for water and electrolyte (mainly sodium) disturbances. These are common in patients with neurological disease and need to be adequately treated.

Volume and electrolyte management / C. Tommasino, V. Picozzi. - In: BEST PRACTICE & RESEARCH. CLINICAL ANAESTHESIOLOGY. - ISSN 1753-3740. - 21:4(2007), pp. 497-516. [10.1016/j.bpa.2007.07.002]

Volume and electrolyte management

C. Tommasino
Primo
;
2007

Abstract

Osmolality is the primary determinant of water movement across the intact blood–brain barrier (BBB), and we can predict that reducing serum osmolality would increase cerebral oedema and intracranial pressure. Brain injury affects the integrity of the BBB to varying degrees. With a complete breakdown of the BBB, there will be no osmotic/oncotic gradient, and water accumulates (brain oedema) consequentially to the pathological process. In regions with very moderate BBB injury, the oncotic gradient may be effective. Finally, osmotherapy is effective in brain areas with normal BBB; hypertonic solutions (mannitol, hypertonic saline) dehydrate normal brain tissue, with a decrease in cerebral volume and intracranial pressure. In patients with brain pathology, volume depletion and/or hypotension greatly increase morbidity and mortality. In addition to management of intravascular volume, fluid therapy must often be modified for water and electrolyte (mainly sodium) disturbances. These are common in patients with neurological disease and need to be adequately treated.
Settore MED/41 - Anestesiologia
2007
Article (author)
File in questo prodotto:
Non ci sono file associati a questo prodotto.
Pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/45423
Citazioni
  • ???jsp.display-item.citation.pmc??? 6
  • Scopus 30
  • ???jsp.display-item.citation.isi??? ND
social impact