Artificial elevation of brain tissue glycerol by administration of a glycerol-containing agent. Case report.
In recent years the development of secondary brain damage and derangement of neurochemical parameters after severe head injury has been monitored using microdialysis. Provided the blood-brain barrier is intact, glycerol is regarded as a potential marker for membrane phospholipid degradation. The authors report a case in which marked elevation of interstitial glycerol was induced after exogenous administration of a glycerol-containing agent. A 25-year-old man was injured in a motorcycle accident and was admitted to the authors' institution with a unilateral dilated and fixed pupil and a Glasgow Coma Scale score of 3. Computerized tomography scans revealed a large subdural hematoma on the left side, subsequent midline shift, and generalized edema. Emergency craniotomy was performed for evacuation of the hematoma. The patient was prepared for multisensory monitoring and a microdialysis catheter was inserted into his left frontal lobe. After a routine enema containing 85% glycerol had been administered, the authors measured a marked increase in glycerol in the dialysate. This occurred while the patient was in as stable a condition as could be expected given the circumstances. The increase in interstitial glycerol in the injured tissue was most likely due to an impaired blood-brain barrier. Thus, the interstitial glycerol concentration had been corrupted by exogenous glycerol, and the marker properties of glycerol in this case became questionable. Consequently, administration of glycerol, which is frequently found in various infusions and emulsions, can promote secondary brain damage by adversely shifting osmotic gradients.
König
K
K
Neurochirurgische Klinik, Medizinische Hochschule Hannover, Germany. koenig.kathrin@mh-hannover.de
Rickels
E
E
Heissler
H E
HE
Zumkeller
M
M
Samii
M
M
D000328:Adult; D001921:Brain / Q000378:metabolism*; D006259:Craniocerebral Trauma / Q000150:complications; D004733:Enema; D005110:Extracellular Space / Q000378:metabolism; D017809:Fatal Outcome; D005990:Glycerol / Q000008:administration & dosage* / Q000378:metabolism* / Q000493:pharmacokinetics / Q000627:therapeutic use; D006408:Hematoma, Subdural / Q000209:etiology / Q000378:metabolism; D006801:Humans; D008297:Male; D017551:Microdialysis
D005990:Glycerol