Neurocritical Care

, Volume 19, Issue 2, pp 222–231

Induced and Sustained Hypernatremia for the Prevention and Treatment of Cerebral Edema Following Brain Injury

  • Justine H. Ryu
  • Brian P. Walcott
  • Kristopher T. Kahle
  • Sameer A. Sheth
  • Randall T. Peterson
  • Brian V. Nahed
  • Jean-Valery C. E. Coumans
  • J. Marc Simard
Review

Abstract

Cerebral edema develops in response to and as a result of a variety of neurologic insults such as ischemic stroke, traumatic brain injury, and tumor. It deforms brain tissue, resulting in localized mass effect and increase in intracranial pressure (ICP) that are associated with a high rate of morbidity and mortality. When administered in bolus form, hyperosmolar agents such as mannitol and hypertonic saline have been shown to reduce total brain water content and decrease ICP, and are currently the mainstays of pharmacological treatment. However, surprisingly, little is known about the increasingly common clinical practice of inducing a state of sustained hypernatremia. Herein, we review the available studies employing sustained hyperosmolar therapy to induce hypernatremia for the prevention and/or treatment of cerebral edema. Insufficient evidence exists to recommend pharmacologic induction of hypernatremia as a treatment for cerebral edema. The strategy of vigilant avoidance of hyponatremia is currently a safer, potentially more efficacious paradigm.

Keywords

Hypernatremia Brain injuries Brain edema Intracranial pressure Stroke Renal insufficiency 

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Justine H. Ryu
    • 1
    • 2
    • 3
  • Brian P. Walcott
    • 1
    • 3
  • Kristopher T. Kahle
    • 1
  • Sameer A. Sheth
    • 1
  • Randall T. Peterson
    • 3
    • 4
  • Brian V. Nahed
    • 1
  • Jean-Valery C. E. Coumans
    • 1
  • J. Marc Simard
    • 5
  1. 1.Department of NeurosurgeryMassachusetts General Hospital and Harvard Medical SchoolBostonUSA
  2. 2.Boston University School of Medicine, Boston UniversityBostonUSA
  3. 3.Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical SchoolCharlestown, BostonUSA
  4. 4.Broad InstituteCambridgeUSA
  5. 5.Department of NeurosurgeryUniversity of MarylandBaltimoreUSA

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