[The role of serum osmolality monitoring in patients with severe intracranial lesion].
We dynamically determined serum osmolality in 1379 patients with severe intracranial lesion for 2843 times between January 1992 and July 1995. Using auto-control and after abandoned osmolality related interference factors we obtained the following results. Quantitative correlation analysis on the level of serum osmolality, intracranial pressure and the dose of mannitol showed that there was a negative correlation between the level of serum osmolality and intracranial pressure, while a positive correlation existed between the intracranial pressure and the dose of mannitol. The reasonable dose of mannitol was that which elevated the level of serum osmolality some 15-20 mOsm/kgH2O than its normal upper limit. The level of serum osmolality increesed to raised up 20-30 mOsm/kgH2O after administration of a single dose of mannitol. Complication increased with the increased level of osmolality of 300 mOsm/kgH2O, a warning level. An elevation of osmolality over 320 mOsm/kgH2O was considered the critical level for developing acute renal failure. The level of over 330 mOsm/kg H2O was another warning level for inducing nonketotic hyperosmotic diabetic coma. The efficious duration of mannitol, two different ways of diminishing or withdrawing the dose of mannitol, and the more safer velocity for correcting the state of hyperosmolality were also discussed. We conclude that to monitor the dynamic change of serum osmolality from time to time is of great help in lowering the incidence and mortality of hyperosmotic complications. Serum osmolality monitoring plays an important role in making fluid balance and compromizing the contradiction between dehydration and infusion as well as prevention and therapy of hyperosmotic complications, and outcome estimation as well.
Ding
Y
Y
Department of Neurosurgery Research, Xuan Wu Hospital, Beijing.
Duan
A
A
Lu
X
X
D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000503:physiopathology; D001932:Brain Neoplasms / Q000503:physiopathology*; D002543:Cerebral Hemorrhage / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D004234:Diuretics, Osmotic / Q000627:therapeutic use*; D005260:Female; D005910:Glioma / Q000503:physiopathology*; D006801:Humans; D006944:Hyperglycemic Hyperosmolar Nonketotic Coma / Q000517:prevention & control; D007427:Intracranial Pressure; D008297:Male; D008353:Mannitol / Q000627:therapeutic use*; D008875:Middle Aged; D009997:Osmotic Pressure
D004234:Diuretics, Osmotic; D008353:Mannitol