manitol

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

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?