Polyethylene glycol induced thirst: A dual stimulatory mechanism?

Hyperoncotic colloid dialysis with polyethylene glycol (PG) resulted in significant water intakes for rats within 1 hr post-treatment, when water was made immediately available. Associated with reliable drinking were azo temia (52%) and hypernatremia (6%), but not hypovolemia. When PG treated rats were delayed without food-water for 6 hr post-PG treatment, the greatest volumes of water were consumed and the rats were both azotemic (111%) and hypovolemic (11–25%). The dipsogenic properties of urea were tested, and demonstrated. The combined data suggest that PG treatment may stimulate thirst via cellular (azotemia and/or hypernatremia) and extracellular (hypovolemia) mechanisms.     

Hypernatremia severity and the risk of death after traumatic brain injury

Purpose

To investigate the relationship between severity of hypernatremia and the risk of death for patients with traumatic brain injury (TBI) who have been admitted to the neurosurgical intensive care unit (NICU).

Methods

A total of 1044 patients with TBI were admitted to our NICU from January 2005 to January 2010. Of these patients, 881 were included in this study. Based on blood serum sodium level in the NICU the 881 patients were divided into four groups: 614 had normal serum sodium (Na < 150 mmol/L), 34 had mild hypernatremia (Na 150–<155 mmol/L), 66 had moderate hypernatremia (Na 155–160 mmol/L) and 167 had severe hypernatremia (Na ≥ 160 mmol/L).

Results

The mortality rates for the mild, moderate, and severe hypernatremia groups were 20.6%, 42.4%, and 86.8%, respectively; the mortality rate for the normal group was 2.0%. In multivariable analysis, mild, moderate, and severe hypernatremia were independent risk factors for mortality; compared with the normal group the odds ratios of mild, moderate, and severe hypernatremia were 9.50, 4.34, and 29.35, respectively.

Conclusions

Severe hypernatremia is an independent risk factor with extremely high odds ratio for death in patients with TBI who are admitted to the NICU.     

干预治疗对颅脑损伤后高钠血症患者预后的影响

目的探讨干预治疗对颅脑损伤后高钠血症患者预后的影响。方法收集2007年1月—2009年4月我院外科重症监护室(SICU)收治的颅脑损伤后高钠血症患者52例,根据干预治疗后血钠水平分为两组,血钠恢复正常组22例,未恢复正常组30例,两组在疾病严重程度、年龄等基本一致的情况下,采用单因素分析和多因素Logis-tic回归分析,筛选和判定干预治疗对颅脑损伤后高钠血症患者预后的影响。结果高钠血症期间Glasgow昏迷量表(GCS)评分、急性生理慢性健康状况Ⅱ(APACHEⅡ)评分、血钠水平等均是影响颅脑损伤后高钠血症患者预后的因素。经Logistic回归分析,干预治疗后血钠恢复正常组,APACHEⅡ评分是影响预后的独立危险因素;血钠未恢复正常组,血钠水平是影响预后的独立危险因素。结论颅脑损伤后高钠血症的干预治疗应以原发病为主,同时注重影响血浆渗透压的各种因素,通过动态监测GCS评分、APACHEⅡ评分可对干预治疗的效果进行评估。     

开颅术后或脑损伤并发高钠血症68例患者的预后分析

[目的]探讨高钠血症对各种颅脑损伤预后的影响。[方法]对203例不同原因所致的脑损伤患者的临床资料进行分析,记录病情发展过程中血钠的变化值以及出现高钠血症的时间,将所得数值与患者的预后进行相关性分析,并进行统计学处理。[结果]203例颅脑损伤患者中有68例并发高钠血症,伴高钠血症患者的预后明显较不伴高钠血症者差,P﹤0.05;在颅脑损伤后72h以上并发高钠血症的患者预后较24h以内或24～72h并发者差,P值分别﹤0.05或﹤0.001;而高血钠发生在24h以内者与发生在24～72h者的预后差异无统计学意义(P﹥0.05)。[结论]颅脑损伤后出血高钠血症预示着患者的预后不佳,且出现时间越晚,预后越差,临床上对这类患者需提高警惕。