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Titolo:
Hypophosphatemia and hypomagnesemia induced by cooling in patients with severe head injury
Autore:
Polderman, KH; Peerdeman, SM; Girbes, ARJ;
Indirizzi:
Vrije Univ Amsterdam, Univ Hosp, Surg Intens Care Unit, NL-1007 MB Amsterdam, Netherlands Vrije Univ Amsterdam Amsterdam Netherlands NL-1007 MB erdam, Netherlands Vrije Univ Amsterdam, Univ Hosp, Dept Neurosurg, NL-1007 MB Amsterdam, Netherlands Vrije Univ Amsterdam Amsterdam Netherlands NL-1007 MB erdam, Netherlands
Titolo Testata:
JOURNAL OF NEUROSURGERY
fascicolo: 5, volume: 94, anno: 2001,
pagine: 697 - 705
SICI:
0022-3085(200105)94:5<697:HAHIBC>2.0.ZU;2-H
Fonte:
ISI
Lingua:
ENG
Soggetto:
CEREBRAL-ARTERY INFARCTION; MODERATE HYPOTHERMIA; MILD HYPOTHERMIA; BRAIN INJURY; INTRACRANIAL HYPERTENSION; INTENSIVE-CARE; CARDIAC-ARREST; MAGNESIUM; DOGS; ILL;
Keywords:
head injury; hypothermia; electrolyte depletion; hypomagnesemia; hypokalemia; hypophosphatemia; cardiac arrhythmia; outcome;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
39
Recensione:
Indirizzi per estratti:
Indirizzo: Polderman, KH Vrije Univ Amsterdam, Univ Hosp, Surg Intens Care Unit, POB 7057, NL-1007 MB Amsterdam, Netherlands Vrije Univ Amsterdam POB 7057 Amsterdam Netherlands NL-1007 MB
Citazione:
K.H. Polderman et al., "Hypophosphatemia and hypomagnesemia induced by cooling in patients with severe head injury", J NEUROSURG, 94(5), 2001, pp. 697-705

Abstract

Object. Induced hypothermia in patients with severe head injury may prevent additional brain injury and improve outcome. However, this treatment is associated with severe side effects, including life-threatening cardiac tachyarrhythmias. The authors hypothesized that these arrhythmias might be caused by electrolyte disorders and therefore studied the effects of induced hypothermia on urine production and electrolyte levels in patients with severe head injury. Methods. Urine production, urine electrolyte excretion, and plasma levels of Mg, phosphate, K, Ca. and Na were measured in 41 patients with severe head injury. Twenty-one patients (Group 1, study group) were treated using induced hypothermia and pentobarbital administration, and 20 patients (Group 2, controls) were treated with pentobarbital administration alone. In Group1, Mg levels decreased from 0.98 +/- 0.15 to 0.58 +/- 0.13 mmol/L (mean +/- standard deviation; p < 0.01), phosphate levels from 1.09 +/- 0.19 to 0.51 +/- 0.18 mmol/L (p < 0.01), Ca levels from 2.13 +/- 0.25 to 1.94 +/- 0.14mmol/L (p < 0.01), and K levels from 4.2 +/- 0.59 to 3.6 +/- 0.7 mmol/L (p< 0.01) during the first 6 hours of cooling. Electrolyte levels in the control Group 2 remained unchanged. Electrolyte depletion in Group 1 occurred despite the fact that moderate and, in some cases, substantial doses of electrolyte supplementation were given to many patients, and supplementation doses were often increased during the cooling period. Average urine production increased during the cooling period, from 219 +/- 70 to 485 +/- 209 ml/hour. When the target ed con temperature of 32 degreesC was reached, urine production returned to levels that approximated precooling levels (241 +/- 102 ml/hour). Electrolyte levels rose in response to high-dose supplementation. In the control group, urine production and electrolyte excretion remained unchanged throughout the study period. Conclusions. Induced hypothermia is associated with severe electrolyte depletion, which is at least partly due to increased urinary excretion throughhypothermia-induced polyuria. This may be the mechanism through which induced hypothermia can lead to arrhythmias. When using this promising new treatment in patients with severe head injury, stroke, or postanoxic coma following cardiopulmonary resuscitation, prophylactic electrolyte supplementation should be considered and electrolyte levels should be monitored frequently.

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Documento generato il 01/12/20 alle ore 01:11:11