Fluid-Electrolyte Imbalances and Extracorporeal Therapy in the Neurosurgical Setting

  • Kelly Liang
  • Lori Shutter


Fluid-electrolyte imbalances are important causes of morbidity and mortality in neurocritical care. Hyponatremia is common, and awareness of volume status can differentiate cerebral salt wasting from syndrome of inappropriate antidiuretic hormone secretion and guide management. Hypernatremia in this population may occur from central diabetes insipidus due to damage of the hypothalamic-pituitary region. Cerebral perfusion is crucial in neurocritical care and can be improved by maintaining serum sodium at 145–155 mmol/L with hypertonic saline. Management of blood pressure (BP) and autonomic issues differs based on the underlying neurological condition, and guidelines for management exist for the most common conditions. Acute kidney injury occurs at variable rates in this setting, and many medications used in care of these patients have nephrotoxic effects. When needed, continuous renal replacement therapy (RRT) is preferred in the neurocritical care setting due to the importance of volume and hemodynamic control in preventing cerebral ischemia.


Traumatic Brain Injury Renal Replacement Therapy Acute Kidney Injury Cerebral Perfusion Pressure Hypertonic Saline 
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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Renal-Electrolyte Division, Department of MedicineUniversity of PittsburghPittsburghUSA
  2. 2.Department of Critical Care MedicineUniversity of Pittsburgh Medical CenterPittsburghUSA

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