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.
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?