manitol

  1. 0
    the manitol works in two phases.
    in the first one he is a volume expander and there is a dilutional hyponatremia .if the pt is already hyponatremic thus will lower the na+ further and as you know the most freqent cause of cerebral edema is na<120 meq/l.
    in the second phase he will dehydrate the brain and the vascular compartment.today the tendency to restrict fluids is replaced by euvolemia.no more dehydration.
    overdehydration will cause a lot of troubles(acidosis,atn,)
    thank you for the attention and i will be glad to participate in the forum.

    by-by

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  3. 0
    Quote from failou
    the manitol works in two phases.
    in the first one he is a volume expander and there is a dilutional hyponatremia .if the pt is already hyponatremic thus will lower the na+ further and as you know the most freqent cause of cerebral edema is na<120 meq/l.
    in the second phase he will dehydrate the brain and the vascular compartment.today the tendency to restrict fluids is replaced by euvolemia.no more dehydration.
    overdehydration will cause a lot of troubles(acidosis,atn,)
    thank you for the attention and i will be glad to participate in the forum.

    by-by
    You are right...
    over hydration defeats the purpose of utilizing mannitol.Places a very sick patient at risk for FPE- not pretty not pretty...acidosis...lactic acid....bicarbs outta whack...rehydrates the brain etc etc .
    In our ICU we utilize the ICP to guide us more which way to lean...
    EUVOLEMIA - vs - dehydrated. The higher the ICP the tighter control we need of the fluids....the lower the icp......the more we trend towards euvolemia.
    Curious...can you answer me a question everyone :
    1. How strict are your neuro ICU's regarding what your drips are mixed with?Are your neurosurgeons "ok" with any d5 piggy backs/cardiac drips etc etc?Or are they going strictly with NS only?I have seen one HCF where it was a major deal to not utilize any d5 at all bc it kinda acts like fuel for the brain and promotes mild cerebral edema.Then I have seen the opposite at another HCF where they really dont mind the d5 as a dilutent...so does your NSICU have any "set" ideas/protocols re: d5?


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