Prevence iatrogenniacutechhypohypernatremiiacute

pomociacute sodneacuteho protokolu v neurointenzivniacute peacuteči

MUDr VĚRA ŠPATENKOVAacute PhD

NEUROCENTRUM JIP LIBEREC ČESKAacute REPUBLIKA

2016

18th Colours of Sepsis Ostrava

1 Akutniacute poškozeniacute mozku

DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI

2 Naacutesledek terapeutickyacutech postupů

3 Iatrogenniacute přiacutečiny

1 Akutniacute poškozeniacute mozku

DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI

2 Naacutesledek terapeutickyacutech postupů

3 Iatrogenniacute přiacutečiny

Management hypohypernatremiiacute

v neurointenzivniacute peacuteči

1 Akutniacute poškozeniacute mozku

DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI

2 Naacutesledek terapeutickyacutech postupů

3 Iatrogenniacute přiacutečiny

Management hypohypernatremiiacute

v neurointenzivniacute peacuteči

Management hypohypernatremiiacute

v neurointenzivniacute peacuteči

Ciacutel neurointenzivniacute peacuteče

DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI

Prevence iatrogenniacutech dysnatremiiacute

Sodnyacute protokol

Sodnyacute protokol

DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI

Prevence iatrogenniacutech dysnatremiiacute

Diagnostika amp terapie

DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI

HYPONATREMIE amp HYPERNATREMIE

Časteacute a vaacutežneacute komplikace v neurointenzivniacute peacuteči

Qureshi AI Suri MF Sung GY Straw RN Yahia AM Saad M et al Prognostic significance of hypernatremia and hyponatremia among patients with aneurysmal subarachnoid hemorrhage Neurosurgery 2002 50 749-55

Diringer MN Zazulia AR Hyponatremia in neurologic patients consequences and approaches to treatment Neurologist 2006 12 117-26

Beties MG Hyponatremia in acute brain disease the cerebral salt wasting syndrome Eur J Intern Med 2002 13 9-14

Aiyagari V Deibert E Diringer M Hypernatremia in the neurologic intensive care unit how high is too high J Crit Care 2006 21 163-72

Fraser JF Stieg PE Hyponatremia in the neurosurgical patient epidemiology pathophysiology diagnosis and management Neurosurgery 2006 59 222-9

DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI

Hyponatremie

Hypernatremie

Qureshi AI Suri MF Sung GY Straw RN Yahia AM Saad M et al Prognostic significance of hypernatremia and hyponatremia among patients withaneurysmal subarachnoid hemorrhage Neurosurgery 2002 50 749-55

Spatenkova V Bradac O Skrabalek P The impact of a Standardized Sodium Protocol on incidence and Outcome of Dysnatremias in Neurocirticalcare J Neurol Surg A Cent Eur Neurosurg 2015 Jul76(4)279-90 doi 101055s-0034-1393927 Epub 2014 Dec 24PMID 25539069

častějšiacute

zaacutevažnějšiacute

DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI

SEKUNDAacuteRNIacute POŠKOZENIacute MOZKU

NATRIUM

H2O

V neurointenzivniacute peacuteči je nutneacute se jim věnovat a aktivně vyhledaacutevat

Poruchy efektivniacute osmolality

HyponatremieHypernatremie

Sodnyacute protokol

DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI

Prevence iatrogenniacutech dysnatremiiacute

Diagnostika amp terapie

DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI

HYPONATREMIE amp HYPERNATREMIE

Časteacute a vaacutežneacute komplikace v neurointenzivniacute peacuteči

Qureshi AI Suri MF Sung GY Straw RN Yahia AM Saad M et al Prognostic significance of hypernatremia and hyponatremia among patients with aneurysmal subarachnoid hemorrhage Neurosurgery 2002 50 749-55

Diringer MN Zazulia AR Hyponatremia in neurologic patients consequences and approaches to treatment Neurologist 2006 12 117-26

Beties MG Hyponatremia in acute brain disease the cerebral salt wasting syndrome Eur J Intern Med 2002 13 9-14

Aiyagari V Deibert E Diringer M Hypernatremia in the neurologic intensive care unit how high is too high J Crit Care 2006 21 163-72

Fraser JF Stieg PE Hyponatremia in the neurosurgical patient epidemiology pathophysiology diagnosis and management Neurosurgery 2006 59 222-9

DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI

Hyponatremie

Hypernatremie

Qureshi AI Suri MF Sung GY Straw RN Yahia AM Saad M et al Prognostic significance of hypernatremia and hyponatremia among patients withaneurysmal subarachnoid hemorrhage Neurosurgery 2002 50 749-55

Spatenkova V Bradac O Skrabalek P The impact of a Standardized Sodium Protocol on incidence and Outcome of Dysnatremias in Neurocirticalcare J Neurol Surg A Cent Eur Neurosurg 2015 Jul76(4)279-90 doi 101055s-0034-1393927 Epub 2014 Dec 24PMID 25539069

častějšiacute

zaacutevažnějšiacute

DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI

SEKUNDAacuteRNIacute POŠKOZENIacute MOZKU

NATRIUM

H2O

V neurointenzivniacute peacuteči je nutneacute se jim věnovat a aktivně vyhledaacutevat

Poruchy efektivniacute osmolality

HyponatremieHypernatremie

DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI

HYPONATREMIE amp HYPERNATREMIE

Časteacute a vaacutežneacute komplikace v neurointenzivniacute peacuteči

Qureshi AI Suri MF Sung GY Straw RN Yahia AM Saad M et al Prognostic significance of hypernatremia and hyponatremia among patients with aneurysmal subarachnoid hemorrhage Neurosurgery 2002 50 749-55

Diringer MN Zazulia AR Hyponatremia in neurologic patients consequences and approaches to treatment Neurologist 2006 12 117-26

Beties MG Hyponatremia in acute brain disease the cerebral salt wasting syndrome Eur J Intern Med 2002 13 9-14

Aiyagari V Deibert E Diringer M Hypernatremia in the neurologic intensive care unit how high is too high J Crit Care 2006 21 163-72

Fraser JF Stieg PE Hyponatremia in the neurosurgical patient epidemiology pathophysiology diagnosis and management Neurosurgery 2006 59 222-9

DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI

Hyponatremie

Hypernatremie

Qureshi AI Suri MF Sung GY Straw RN Yahia AM Saad M et al Prognostic significance of hypernatremia and hyponatremia among patients withaneurysmal subarachnoid hemorrhage Neurosurgery 2002 50 749-55

Spatenkova V Bradac O Skrabalek P The impact of a Standardized Sodium Protocol on incidence and Outcome of Dysnatremias in Neurocirticalcare J Neurol Surg A Cent Eur Neurosurg 2015 Jul76(4)279-90 doi 101055s-0034-1393927 Epub 2014 Dec 24PMID 25539069

častějšiacute

zaacutevažnějšiacute

DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI

SEKUNDAacuteRNIacute POŠKOZENIacute MOZKU

NATRIUM

H2O

V neurointenzivniacute peacuteči je nutneacute se jim věnovat a aktivně vyhledaacutevat

Poruchy efektivniacute osmolality

HyponatremieHypernatremie

DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI

Hyponatremie

Hypernatremie

Qureshi AI Suri MF Sung GY Straw RN Yahia AM Saad M et al Prognostic significance of hypernatremia and hyponatremia among patients withaneurysmal subarachnoid hemorrhage Neurosurgery 2002 50 749-55

Spatenkova V Bradac O Skrabalek P The impact of a Standardized Sodium Protocol on incidence and Outcome of Dysnatremias in Neurocirticalcare J Neurol Surg A Cent Eur Neurosurg 2015 Jul76(4)279-90 doi 101055s-0034-1393927 Epub 2014 Dec 24PMID 25539069

častějšiacute

zaacutevažnějšiacute

DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI

SEKUNDAacuteRNIacute POŠKOZENIacute MOZKU

NATRIUM

H2O

V neurointenzivniacute peacuteči je nutneacute se jim věnovat a aktivně vyhledaacutevat

Poruchy efektivniacute osmolality

HyponatremieHypernatremie

DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI

SEKUNDAacuteRNIacute POŠKOZENIacute MOZKU

NATRIUM

H2O

V neurointenzivniacute peacuteči je nutneacute se jim věnovat a aktivně vyhledaacutevat

Poruchy efektivniacute osmolality

HyponatremieHypernatremie

Poruchy efektivniacute osmolality

HyponatremieHypernatremie

Hlavniacute extracelulaacuterniacute kationt

Největšiacute podiacutel na efektivniacute osmolalitě ECT

IVT IST ICTIntravazaacutelniacute Intersticiaacutelniacute Intracelulaacuterniacute

NATRIUM

ECT ICT

Kazda A Vnitřniacute prostřediacute In Zima T Laboratorniacute diagnostika Galeacuten 2002 265-96

NATRIUM

IVT IST ICTIntravazaacutelniacute Intersticiaacutelniacute Intracelulaacuterniacute

NATRIUM

ECT ICT

Kazda A Vnitřniacute prostřediacute In Zima T Laboratorniacute diagnostika Galeacuten 2002 265-96

NATRIUM

Změna v ECTvytvaacuteřiacute osmotickyacute gradient mezi ECT a ICT

vyrovnaacutevaacuten přesunem vody

edeacutem nebo dehydratace buněk

DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI

NITROLEBNIacute PROSTOR

Uzavřenyacute nitrolebniacute prostor limituje naacuterůst objemu

ICP

Nitrolebniacute objem

MOZEK

Monroova ndash Kellieho doktriacutenaV uzavřeneacutem prostoru intrakrania

V mozku + V krve + V likvoru = konst

Nitrolebniacute hypertenze

Nitrolebniacute hypotenze

Alexander Monro ndash skotskyacute anatom a chirurg George Kellie ndash skotskyacute anatom

IVT IST ICTIntravazaacutelniacute Intersticiaacutelniacute Intracelulaacuterniacute

NATRIUM

ECT ICT

Kazda A Vnitřniacute prostřediacute In Zima T Laboratorniacute diagnostika Galeacuten 2002 265-96

NATRIUM

Změna v ECTvytvaacuteřiacute osmotickyacute gradient mezi ECT a ICT

vyrovnaacutevaacuten přesunem vody

edeacutem nebo dehydratace buněk

DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI

NITROLEBNIacute PROSTOR

Uzavřenyacute nitrolebniacute prostor limituje naacuterůst objemu

ICP

Nitrolebniacute objem

MOZEK

Monroova ndash Kellieho doktriacutenaV uzavřeneacutem prostoru intrakrania

V mozku + V krve + V likvoru = konst

Nitrolebniacute hypertenze

Nitrolebniacute hypotenze

Alexander Monro ndash skotskyacute anatom a chirurg George Kellie ndash skotskyacute anatom

DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI

NITROLEBNIacute PROSTOR

Uzavřenyacute nitrolebniacute prostor limituje naacuterůst objemu

ICP

Nitrolebniacute objem

MOZEK

Monroova ndash Kellieho doktriacutenaV uzavřeneacutem prostoru intrakrania

V mozku + V krve + V likvoru = konst

Nitrolebniacute hypertenze

Nitrolebniacute hypotenze

Alexander Monro ndash skotskyacute anatom a chirurg George Kellie ndash skotskyacute anatom

ICP

Nitrolebniacute objem

MOZEK

Monroova ndash Kellieho doktriacutenaV uzavřeneacutem prostoru intrakrania

V mozku + V krve + V likvoru = konst

Nitrolebniacute hypertenze

Nitrolebniacute hypotenze

Alexander Monro ndash skotskyacute anatom a chirurg George Kellie ndash skotskyacute anatom

Management hypohypernatremiiacute

v neurointenzivniacute peacuteči

Sodnyacute protokol maacute svaacute specifika v neurointenzivniacute peacutečiSPATENKOVA V Protokol diagnostiky a leacutečby hyponatremie a hypernatremie v neurointenzivniacute peacuteči

Cesk Slov Neurol N 20157834-37

HYPONATREMIE

HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI

HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI

Hyponatremie

SNa lt 135 mmoll

Lehkaacute 130 ndash 134 mmollStředniacute 129 ndash 125 mmoll Těžkaacute lt 125 mmoll

HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI

NEUROLOGICKEacute PŘIacuteZNAKY

Hypoosmolaacutelniacute

Edeacutem mozku Nitrolebniacute hypertenze

EFEKTIVNĚ OSMOLAacuteLNIacute DYSNATREMIE

Hyponatremie

Dysnatraemia is frequently a poor prognostic indicator in patients with acute subarachnoidhemorrhage having targeted sodium managementSpatenkova V 1 Bradac O 2 de Lacy P 3 Skrabalek P 4 Suchomel P 51 Neurocenter Neurointensive Care Unit Regional Hospital Liberec Czech Republic2 Department of Neurosurgery Central Military Hospital Charles University Prague Czech Republic3

Department of Neurosurgery Royal Hallamshire Hospital Sheffield United Kingdom4 Department of Clinical Biochemistry Regional Hospital Liberec Czech Republic5 Neurocenter Department ofNeurosurgery Regional Hospital Liberec Czech RepublicBACKGROUND Dysnatraemias are common and carry a risk of poor prognosis in acutesubarachnoid hemorrhage (SAH) patients The aim of this study was to determine the frequency and outcome of dysnatraemias in 344 SAH patients treated by a targeted sodium management regimenMETHODS We performed a 10-year observational dysnatraemia study Hyponatraemiawas defined as serum sodium (SNa) below 135 mmoll hypernatraemia SNa above 150 mmoll RESULTS Dysnatraemia occurred in 358 patients (pts) this was more frequently hyponatraemia(198) with a mean SNa 13223plusmn209 mmoll (160 mild 32 moderate 06 severe) Hypernatraemia occurred less commonly in 119 plt0001 with a mean SNa 15421plusmn372 mmoll (61 mild 29 moderate 29 severe) In 48 of pts there were episodes of bothdysnatraemias The incidence of hypo-osmolar hyponatraemia was 64 Cerebral salt wasting(CSW) 35 syndrome of inappropriate secretion of antidiuretic hormone (SIADH) 03 and Central diabetes insipidus 17 The hypernatraemic pts had a higher inpatient mortality rate(p=0001) and a worse overall outcome (plt0001) than those hyponatraemic or normotraemicpatients Multivariate logistic regression showed that hypernatraemia was an independent risk factorfor increased inpatient mortality and poor outcome in patients with SAHCONCLUSIONS Our 10-year targeted sodium management regimen in acute SAH patients showed that dysnatraemias werefrequent predominantly hyponatraemia of which the more usual causes were CSW and not SIADH Hypernatraemia was shown to be an independent risk factor for inpatient mortality and pooroutcome

Měřenaacute serovaacute osmolality (SOsm)

OSMOLALITA

Osmometr

HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI

Hyponatremie

SNa lt 135 mmoll

Lehkaacute 130 ndash 134 mmollStředniacute 129 ndash 125 mmoll Těžkaacute lt 125 mmoll

HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI

NEUROLOGICKEacute PŘIacuteZNAKY

Hypoosmolaacutelniacute

Edeacutem mozku Nitrolebniacute hypertenze

EFEKTIVNĚ OSMOLAacuteLNIacute DYSNATREMIE

Hyponatremie

Dysnatraemia is frequently a poor prognostic indicator in patients with acute subarachnoidhemorrhage having targeted sodium managementSpatenkova V 1 Bradac O 2 de Lacy P 3 Skrabalek P 4 Suchomel P 51 Neurocenter Neurointensive Care Unit Regional Hospital Liberec Czech Republic2 Department of Neurosurgery Central Military Hospital Charles University Prague Czech Republic3

Department of Neurosurgery Royal Hallamshire Hospital Sheffield United Kingdom4 Department of Clinical Biochemistry Regional Hospital Liberec Czech Republic5 Neurocenter Department ofNeurosurgery Regional Hospital Liberec Czech RepublicBACKGROUND Dysnatraemias are common and carry a risk of poor prognosis in acutesubarachnoid hemorrhage (SAH) patients The aim of this study was to determine the frequency and outcome of dysnatraemias in 344 SAH patients treated by a targeted sodium management regimenMETHODS We performed a 10-year observational dysnatraemia study Hyponatraemiawas defined as serum sodium (SNa) below 135 mmoll hypernatraemia SNa above 150 mmoll RESULTS Dysnatraemia occurred in 358 patients (pts) this was more frequently hyponatraemia(198) with a mean SNa 13223plusmn209 mmoll (160 mild 32 moderate 06 severe) Hypernatraemia occurred less commonly in 119 plt0001 with a mean SNa 15421plusmn372 mmoll (61 mild 29 moderate 29 severe) In 48 of pts there were episodes of bothdysnatraemias The incidence of hypo-osmolar hyponatraemia was 64 Cerebral salt wasting(CSW) 35 syndrome of inappropriate secretion of antidiuretic hormone (SIADH) 03 and Central diabetes insipidus 17 The hypernatraemic pts had a higher inpatient mortality rate(p=0001) and a worse overall outcome (plt0001) than those hyponatraemic or normotraemicpatients Multivariate logistic regression showed that hypernatraemia was an independent risk factorfor increased inpatient mortality and poor outcome in patients with SAHCONCLUSIONS Our 10-year targeted sodium management regimen in acute SAH patients showed that dysnatraemias werefrequent predominantly hyponatraemia of which the more usual causes were CSW and not SIADH Hypernatraemia was shown to be an independent risk factor for inpatient mortality and pooroutcome

Měřenaacute serovaacute osmolality (SOsm)

OSMOLALITA

Osmometr

HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI

NEUROLOGICKEacute PŘIacuteZNAKY

Hypoosmolaacutelniacute

Edeacutem mozku Nitrolebniacute hypertenze

EFEKTIVNĚ OSMOLAacuteLNIacute DYSNATREMIE

Hyponatremie

Dysnatraemia is frequently a poor prognostic indicator in patients with acute subarachnoidhemorrhage having targeted sodium managementSpatenkova V 1 Bradac O 2 de Lacy P 3 Skrabalek P 4 Suchomel P 51 Neurocenter Neurointensive Care Unit Regional Hospital Liberec Czech Republic2 Department of Neurosurgery Central Military Hospital Charles University Prague Czech Republic3

Department of Neurosurgery Royal Hallamshire Hospital Sheffield United Kingdom4 Department of Clinical Biochemistry Regional Hospital Liberec Czech Republic5 Neurocenter Department ofNeurosurgery Regional Hospital Liberec Czech RepublicBACKGROUND Dysnatraemias are common and carry a risk of poor prognosis in acutesubarachnoid hemorrhage (SAH) patients The aim of this study was to determine the frequency and outcome of dysnatraemias in 344 SAH patients treated by a targeted sodium management regimenMETHODS We performed a 10-year observational dysnatraemia study Hyponatraemiawas defined as serum sodium (SNa) below 135 mmoll hypernatraemia SNa above 150 mmoll RESULTS Dysnatraemia occurred in 358 patients (pts) this was more frequently hyponatraemia(198) with a mean SNa 13223plusmn209 mmoll (160 mild 32 moderate 06 severe) Hypernatraemia occurred less commonly in 119 plt0001 with a mean SNa 15421plusmn372 mmoll (61 mild 29 moderate 29 severe) In 48 of pts there were episodes of bothdysnatraemias The incidence of hypo-osmolar hyponatraemia was 64 Cerebral salt wasting(CSW) 35 syndrome of inappropriate secretion of antidiuretic hormone (SIADH) 03 and Central diabetes insipidus 17 The hypernatraemic pts had a higher inpatient mortality rate(p=0001) and a worse overall outcome (plt0001) than those hyponatraemic or normotraemicpatients Multivariate logistic regression showed that hypernatraemia was an independent risk factorfor increased inpatient mortality and poor outcome in patients with SAHCONCLUSIONS Our 10-year targeted sodium management regimen in acute SAH patients showed that dysnatraemias werefrequent predominantly hyponatraemia of which the more usual causes were CSW and not SIADH Hypernatraemia was shown to be an independent risk factor for inpatient mortality and pooroutcome

Měřenaacute serovaacute osmolality (SOsm)

OSMOLALITA

Osmometr

Dysnatraemia is frequently a poor prognostic indicator in patients with acute subarachnoidhemorrhage having targeted sodium managementSpatenkova V 1 Bradac O 2 de Lacy P 3 Skrabalek P 4 Suchomel P 51 Neurocenter Neurointensive Care Unit Regional Hospital Liberec Czech Republic2 Department of Neurosurgery Central Military Hospital Charles University Prague Czech Republic3

Department of Neurosurgery Royal Hallamshire Hospital Sheffield United Kingdom4 Department of Clinical Biochemistry Regional Hospital Liberec Czech Republic5 Neurocenter Department ofNeurosurgery Regional Hospital Liberec Czech RepublicBACKGROUND Dysnatraemias are common and carry a risk of poor prognosis in acutesubarachnoid hemorrhage (SAH) patients The aim of this study was to determine the frequency and outcome of dysnatraemias in 344 SAH patients treated by a targeted sodium management regimenMETHODS We performed a 10-year observational dysnatraemia study Hyponatraemiawas defined as serum sodium (SNa) below 135 mmoll hypernatraemia SNa above 150 mmoll RESULTS Dysnatraemia occurred in 358 patients (pts) this was more frequently hyponatraemia(198) with a mean SNa 13223plusmn209 mmoll (160 mild 32 moderate 06 severe) Hypernatraemia occurred less commonly in 119 plt0001 with a mean SNa 15421plusmn372 mmoll (61 mild 29 moderate 29 severe) In 48 of pts there were episodes of bothdysnatraemias The incidence of hypo-osmolar hyponatraemia was 64 Cerebral salt wasting(CSW) 35 syndrome of inappropriate secretion of antidiuretic hormone (SIADH) 03 and Central diabetes insipidus 17 The hypernatraemic pts had a higher inpatient mortality rate(p=0001) and a worse overall outcome (plt0001) than those hyponatraemic or normotraemicpatients Multivariate logistic regression showed that hypernatraemia was an independent risk factorfor increased inpatient mortality and poor outcome in patients with SAHCONCLUSIONS Our 10-year targeted sodium management regimen in acute SAH patients showed that dysnatraemias werefrequent predominantly hyponatraemia of which the more usual causes were CSW and not SIADH Hypernatraemia was shown to be an independent risk factor for inpatient mortality and pooroutcome

Měřenaacute serovaacute osmolality (SOsm)

OSMOLALITA

Osmometr

Měřenaacute serovaacute osmolality (SOsm)

OSMOLALITA

Osmometr

1 krok v diagnostice hyponatreacutemiiacute

HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI

Hodnota měřeneacute seacuteroveacute osmolality

1 Akutniacute poškozeniacute mozkuCSWS SIADH

HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI

2 Naacutesledek terapeutickyacutech postupůThiazidy

3 Iatrogenniacute přiacutečinyHypotonickyacute roztokIatrogenniacute SIADH (normonatremie a desmopressin)

1 Akutniacute poškozeniacute mozkuCSWS SIADH

HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI

2 Naacutesledek terapeutickyacutech postupůThiazidy

3 Iatrogenniacute přiacutečinyHypotonickyacute roztokIatrogenniacute SIADH (normonatremie a desmopressin)

Diagnostickyacute management

HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI

fyziologickaacute odpověď organismu

ADH ndash ledviny

diagnoacuteza

PORUCHY EFEKTIVNIacute OSMOLALITY U AKUTNIacuteHO POŠKOZENIacute MOZKU

renaacutelniacute funkčniacute parametry

Lolin Y Jackowski A Hyponatraemia in neurosurgical patients diagnosis using derived parameters of sodium and water homeostasis Br J Neurosurg 1992 6 457-66

Shoker AS Application of the clearance concept to hyponatremic and hypernatremic disorders a phenomenological analysis Clin Chem 1994 40 1220-7

Kazda A Vnitřniacute prostřediacute In Zima T Laboratorniacute diagnostika Galeacuten 2002 265-96Kazda A Balik M Osmolaacutelniacute dysbalance v intenzivniacute peacuteči a možnosti jejich monitorovaacuteni Klin Biochem Metab 1995 4 223-7Kazda A Balik M Jabor A Efektivniacute osmolalita a jejiacute poruchy Anesteziologie a neodkladnaacute peacuteče 1999 4 142-6Jabor A Voda ionty a modelovaacuteniacute poruch vnitřniacuteho prostřediacute STAPRO Pardubice 1999Jabor A Hodnoceniacute poruch osmolality s využitiacutem efektivniacute osmolaacutelniacute clearance clearance sodiacuteku clearance bezelektrolytoveacute vody a modelu

extracelulaacuterniacuteho a intracelulaacuterniacuteho prostoru Klin Biochem Metab 1997 4 241-2Jabor A Kazda A Vyacuteukoveacute možnosti u poruch metabolismu vody a iontů Anesteziologie a neodkladnaacute peacuteče 1999 4 157-61Jabor A Clearance bezelektrolytoveacute vody u selhaacutevajiacuteciacutech ledvin při hypernatreacutemii a hyponatreacutemii Klin Biochem Metab 1997 4 248-50

1 Akutniacute poškozeniacute mozkuCSWS SIADH

HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI

2 Naacutesledek terapeutickyacutech postupůThiazidy

3 Iatrogenniacute přiacutečinyHypotonickyacute roztokIatrogenniacute SIADH (normonatremie a desmopressin)

Diagnostickyacute management

HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI

fyziologickaacute odpověď organismu

ADH ndash ledviny

diagnoacuteza

PORUCHY EFEKTIVNIacute OSMOLALITY U AKUTNIacuteHO POŠKOZENIacute MOZKU

renaacutelniacute funkčniacute parametry

Lolin Y Jackowski A Hyponatraemia in neurosurgical patients diagnosis using derived parameters of sodium and water homeostasis Br J Neurosurg 1992 6 457-66

Shoker AS Application of the clearance concept to hyponatremic and hypernatremic disorders a phenomenological analysis Clin Chem 1994 40 1220-7

Kazda A Vnitřniacute prostřediacute In Zima T Laboratorniacute diagnostika Galeacuten 2002 265-96Kazda A Balik M Osmolaacutelniacute dysbalance v intenzivniacute peacuteči a možnosti jejich monitorovaacuteni Klin Biochem Metab 1995 4 223-7Kazda A Balik M Jabor A Efektivniacute osmolalita a jejiacute poruchy Anesteziologie a neodkladnaacute peacuteče 1999 4 142-6Jabor A Voda ionty a modelovaacuteniacute poruch vnitřniacuteho prostřediacute STAPRO Pardubice 1999Jabor A Hodnoceniacute poruch osmolality s využitiacutem efektivniacute osmolaacutelniacute clearance clearance sodiacuteku clearance bezelektrolytoveacute vody a modelu

extracelulaacuterniacuteho a intracelulaacuterniacuteho prostoru Klin Biochem Metab 1997 4 241-2Jabor A Kazda A Vyacuteukoveacute možnosti u poruch metabolismu vody a iontů Anesteziologie a neodkladnaacute peacuteče 1999 4 157-61Jabor A Clearance bezelektrolytoveacute vody u selhaacutevajiacuteciacutech ledvin při hypernatreacutemii a hyponatreacutemii Klin Biochem Metab 1997 4 248-50

Diagnostickyacute management

HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI

fyziologickaacute odpověď organismu

ADH ndash ledviny

diagnoacuteza

PORUCHY EFEKTIVNIacute OSMOLALITY U AKUTNIacuteHO POŠKOZENIacute MOZKU

renaacutelniacute funkčniacute parametry

Lolin Y Jackowski A Hyponatraemia in neurosurgical patients diagnosis using derived parameters of sodium and water homeostasis Br J Neurosurg 1992 6 457-66

Shoker AS Application of the clearance concept to hyponatremic and hypernatremic disorders a phenomenological analysis Clin Chem 1994 40 1220-7

Kazda A Vnitřniacute prostřediacute In Zima T Laboratorniacute diagnostika Galeacuten 2002 265-96Kazda A Balik M Osmolaacutelniacute dysbalance v intenzivniacute peacuteči a možnosti jejich monitorovaacuteni Klin Biochem Metab 1995 4 223-7Kazda A Balik M Jabor A Efektivniacute osmolalita a jejiacute poruchy Anesteziologie a neodkladnaacute peacuteče 1999 4 142-6Jabor A Voda ionty a modelovaacuteniacute poruch vnitřniacuteho prostřediacute STAPRO Pardubice 1999Jabor A Hodnoceniacute poruch osmolality s využitiacutem efektivniacute osmolaacutelniacute clearance clearance sodiacuteku clearance bezelektrolytoveacute vody a modelu

extracelulaacuterniacuteho a intracelulaacuterniacuteho prostoru Klin Biochem Metab 1997 4 241-2Jabor A Kazda A Vyacuteukoveacute možnosti u poruch metabolismu vody a iontů Anesteziologie a neodkladnaacute peacuteče 1999 4 157-61Jabor A Clearance bezelektrolytoveacute vody u selhaacutevajiacuteciacutech ledvin při hypernatreacutemii a hyponatreacutemii Klin Biochem Metab 1997 4 248-50

diagnoacuteza

PORUCHY EFEKTIVNIacute OSMOLALITY U AKUTNIacuteHO POŠKOZENIacute MOZKU

renaacutelniacute funkčniacute parametry

Lolin Y Jackowski A Hyponatraemia in neurosurgical patients diagnosis using derived parameters of sodium and water homeostasis Br J Neurosurg 1992 6 457-66

Shoker AS Application of the clearance concept to hyponatremic and hypernatremic disorders a phenomenological analysis Clin Chem 1994 40 1220-7

Kazda A Vnitřniacute prostřediacute In Zima T Laboratorniacute diagnostika Galeacuten 2002 265-96Kazda A Balik M Osmolaacutelniacute dysbalance v intenzivniacute peacuteči a možnosti jejich monitorovaacuteni Klin Biochem Metab 1995 4 223-7Kazda A Balik M Jabor A Efektivniacute osmolalita a jejiacute poruchy Anesteziologie a neodkladnaacute peacuteče 1999 4 142-6Jabor A Voda ionty a modelovaacuteniacute poruch vnitřniacuteho prostřediacute STAPRO Pardubice 1999Jabor A Hodnoceniacute poruch osmolality s využitiacutem efektivniacute osmolaacutelniacute clearance clearance sodiacuteku clearance bezelektrolytoveacute vody a modelu

extracelulaacuterniacuteho a intracelulaacuterniacuteho prostoru Klin Biochem Metab 1997 4 241-2Jabor A Kazda A Vyacuteukoveacute možnosti u poruch metabolismu vody a iontů Anesteziologie a neodkladnaacute peacuteče 1999 4 157-61Jabor A Clearance bezelektrolytoveacute vody u selhaacutevajiacuteciacutech ledvin při hypernatreacutemii a hyponatreacutemii Klin Biochem Metab 1997 4 248-50

HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI

Assessment of axis ADH-kidneys

Hypoosmolality hypotonicity ndash serum osmolality lt 280 mmolkg

EWC gt 0116 mls (10 lday)helliphelliphelliphellipnormal response ADH-kidneys EWC 0006 ndash 0116 mlshelliphelliphelliphelliphellipimpaired response ADH-kidneysEWC lt 0006 mls (05 lday)helliphelliphellipabnormal response ADH-kidneys

Hyperosmolality hypertonicity ndash serum osmolality gt 295 mmolkg

EWC lt 0005 mls (04 lday)helliphellipnormal response ADH-kidneysEWC ge 0005 mlshelliphelliphelliphelliphelliphelliphelliphellipabnormal response ADH-kidneys

Shoker AS Application of the clearance concept to hyponatremic and hypernatremic disorders a phenomenological analysis Clin Chem 1994 40 1220-7

SIADH

Kazuistika

34-letaacute pacientka Akutniacute subarachnoidaacutelniacute krvaacuteceniacute z ruptury

aneurysmatu na arteria carotis interna (coiling) WFNS (World Federation of Neurological

Surgeons) skoacutere I Fisher skoacutere 2

CASE REPORT KAZUISTIKAPolyurie v neurointenzivniacute peacuteci ndash kazuistika

Polyuria in Neurocritical Care ndash a Case Report

Cesk Slov Neurol N 2014 77110(5) 647ndash647

V Špatenkovaacute1 P Škrabaacutelek2 Krajskaacute nemocnice Liberec as1 Neurocentrum Neurointenzivniacute jednotka

2 Odde leniacute klinickeacute biochemie

CASE REPORT KAZUISTIKAPolyurie v neurointenzivniacute peacuteci ndash kazuistika

Polyuria in Neurocritical Care ndash a Case Report

Cesk Slov Neurol N 2014 77110(5) 647ndash647

V Špatenkovaacute1 P Škrabaacutelek2 Krajskaacute nemocnice Liberec as1 Neurocentrum Neurointenzivniacute jednotka

2 Odde leniacute klinickeacute biochemie

Den NJIP

SNammoll

SOsmmmolkg

Diureacutezamlden

EWCmls

Desmopressin

1 138 294

3 135 286 4 500 0016 10 ugden

4 130 265

Renaacutelniacute funkčniacute parametry součaacutestiacute

biochemickeacuteho souboru z OKB

HYPERNATREMIE

HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI

HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI

Hypernatremie

SNa gt 145 mmoll

Lehkaacute 151 ndash 155 mmollStředniacute 156 ndash 160 mmoll Těžkaacute gt 160 mmoll

J Crit Care 2006 Jun21(2)163-72Hypernatremia in the neurologic intensive care unit how high is too highAiyagari V Deibert E Diringer MNSourceNeurologyNeurosurgery Intensive Care Unit Departments of Neurology and Neurosurgery Washington University School of Medicine St Louis MO USA aiyagariuiceduAbstractHypernatremia is associated with increased mortality in hospitalized patients and in medicalsurgicalintensive care units This relationship has not been studied in neurologicneurosurgical intensive care units(NNICUs) where hypernatremia is often a component of treatment of cerebral edema We performed a retrospective analysis of prospectively collected data in patients admitted to the NNICU over a 65-year period Hypernatremia (serum sodium gt150 mEqL) was seen in 339 patients (79) and was more common(243) in patients who were treated with mannitol Hypernatremic patients had a lower median admissionGlasgow Coma Scale score (8 vs 14 P lt 001) higher initial Acute Physiology and Chronic HealthEvaluation II probability of death (349 vs 191 P lt 001) higher incidence of mechanical ventilation(805 vs 4115 P lt 001) higher mortality (301 vs 102 P lt 001) and higher incidence of renalfailure (103 vs 09 P lt 001) Mortality increased with increasing hypernatremia however only severe hypernatremia (serum sodium gt160 mEqL) was independently associated with increased mortality Otherfactors independently associated with mortality were age mechanical ventilation initial Acute Physiologyand Chronic Health Evaluation II probability of death or low admission Glasgow Coma Scale score and a diagnosis of cerebrovascular disease In conclusion hypernatremia is common in the NNICU more so in patients treated with mannitol In this population severe (but not mild or moderate) hypernatremia isindependently associated with increased mortality

34-letaacute pacientka Akutniacute subarachnoidaacutelniacute krvaacuteceniacute z ruptury

aneurysmatu na arteria carotis interna (coiling) WFNS (World Federation of Neurological

Surgeons) skoacutere I Fisher skoacutere 2

CASE REPORT KAZUISTIKAPolyurie v neurointenzivniacute peacuteci ndash kazuistika

Polyuria in Neurocritical Care ndash a Case Report

Cesk Slov Neurol N 2014 77110(5) 647ndash647

V Špatenkovaacute1 P Škrabaacutelek2 Krajskaacute nemocnice Liberec as1 Neurocentrum Neurointenzivniacute jednotka

2 Odde leniacute klinickeacute biochemie

CASE REPORT KAZUISTIKAPolyurie v neurointenzivniacute peacuteci ndash kazuistika

Polyuria in Neurocritical Care ndash a Case Report

Cesk Slov Neurol N 2014 77110(5) 647ndash647

V Špatenkovaacute1 P Škrabaacutelek2 Krajskaacute nemocnice Liberec as1 Neurocentrum Neurointenzivniacute jednotka

2 Odde leniacute klinickeacute biochemie

Den NJIP

SNammoll

SOsmmmolkg

Diureacutezamlden

EWCmls

Desmopressin

1 138 294

3 135 286 4 500 0016 10 ugden

4 130 265

Renaacutelniacute funkčniacute parametry součaacutestiacute

biochemickeacuteho souboru z OKB

HYPERNATREMIE

HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI

HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI

Hypernatremie

SNa gt 145 mmoll

Lehkaacute 151 ndash 155 mmollStředniacute 156 ndash 160 mmoll Těžkaacute gt 160 mmoll

J Crit Care 2006 Jun21(2)163-72Hypernatremia in the neurologic intensive care unit how high is too highAiyagari V Deibert E Diringer MNSourceNeurologyNeurosurgery Intensive Care Unit Departments of Neurology and Neurosurgery Washington University School of Medicine St Louis MO USA aiyagariuiceduAbstractHypernatremia is associated with increased mortality in hospitalized patients and in medicalsurgicalintensive care units This relationship has not been studied in neurologicneurosurgical intensive care units(NNICUs) where hypernatremia is often a component of treatment of cerebral edema We performed a retrospective analysis of prospectively collected data in patients admitted to the NNICU over a 65-year period Hypernatremia (serum sodium gt150 mEqL) was seen in 339 patients (79) and was more common(243) in patients who were treated with mannitol Hypernatremic patients had a lower median admissionGlasgow Coma Scale score (8 vs 14 P lt 001) higher initial Acute Physiology and Chronic HealthEvaluation II probability of death (349 vs 191 P lt 001) higher incidence of mechanical ventilation(805 vs 4115 P lt 001) higher mortality (301 vs 102 P lt 001) and higher incidence of renalfailure (103 vs 09 P lt 001) Mortality increased with increasing hypernatremia however only severe hypernatremia (serum sodium gt160 mEqL) was independently associated with increased mortality Otherfactors independently associated with mortality were age mechanical ventilation initial Acute Physiologyand Chronic Health Evaluation II probability of death or low admission Glasgow Coma Scale score and a diagnosis of cerebrovascular disease In conclusion hypernatremia is common in the NNICU more so in patients treated with mannitol In this population severe (but not mild or moderate) hypernatremia isindependently associated with increased mortality

CASE REPORT KAZUISTIKAPolyurie v neurointenzivniacute peacuteci ndash kazuistika

Polyuria in Neurocritical Care ndash a Case Report

Cesk Slov Neurol N 2014 77110(5) 647ndash647

V Špatenkovaacute1 P Škrabaacutelek2 Krajskaacute nemocnice Liberec as1 Neurocentrum Neurointenzivniacute jednotka

2 Odde leniacute klinickeacute biochemie

Den NJIP

SNammoll

SOsmmmolkg

Diureacutezamlden

EWCmls

Desmopressin

1 138 294

3 135 286 4 500 0016 10 ugden

4 130 265

Renaacutelniacute funkčniacute parametry součaacutestiacute

biochemickeacuteho souboru z OKB

HYPERNATREMIE

HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI

HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI

Hypernatremie

SNa gt 145 mmoll

Lehkaacute 151 ndash 155 mmollStředniacute 156 ndash 160 mmoll Těžkaacute gt 160 mmoll

J Crit Care 2006 Jun21(2)163-72Hypernatremia in the neurologic intensive care unit how high is too highAiyagari V Deibert E Diringer MNSourceNeurologyNeurosurgery Intensive Care Unit Departments of Neurology and Neurosurgery Washington University School of Medicine St Louis MO USA aiyagariuiceduAbstractHypernatremia is associated with increased mortality in hospitalized patients and in medicalsurgicalintensive care units This relationship has not been studied in neurologicneurosurgical intensive care units(NNICUs) where hypernatremia is often a component of treatment of cerebral edema We performed a retrospective analysis of prospectively collected data in patients admitted to the NNICU over a 65-year period Hypernatremia (serum sodium gt150 mEqL) was seen in 339 patients (79) and was more common(243) in patients who were treated with mannitol Hypernatremic patients had a lower median admissionGlasgow Coma Scale score (8 vs 14 P lt 001) higher initial Acute Physiology and Chronic HealthEvaluation II probability of death (349 vs 191 P lt 001) higher incidence of mechanical ventilation(805 vs 4115 P lt 001) higher mortality (301 vs 102 P lt 001) and higher incidence of renalfailure (103 vs 09 P lt 001) Mortality increased with increasing hypernatremia however only severe hypernatremia (serum sodium gt160 mEqL) was independently associated with increased mortality Otherfactors independently associated with mortality were age mechanical ventilation initial Acute Physiologyand Chronic Health Evaluation II probability of death or low admission Glasgow Coma Scale score and a diagnosis of cerebrovascular disease In conclusion hypernatremia is common in the NNICU more so in patients treated with mannitol In this population severe (but not mild or moderate) hypernatremia isindependently associated with increased mortality

Renaacutelniacute funkčniacute parametry součaacutestiacute

biochemickeacuteho souboru z OKB

HYPERNATREMIE

HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI

HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI

Hypernatremie

SNa gt 145 mmoll

Lehkaacute 151 ndash 155 mmollStředniacute 156 ndash 160 mmoll Těžkaacute gt 160 mmoll

J Crit Care 2006 Jun21(2)163-72Hypernatremia in the neurologic intensive care unit how high is too highAiyagari V Deibert E Diringer MNSourceNeurologyNeurosurgery Intensive Care Unit Departments of Neurology and Neurosurgery Washington University School of Medicine St Louis MO USA aiyagariuiceduAbstractHypernatremia is associated with increased mortality in hospitalized patients and in medicalsurgicalintensive care units This relationship has not been studied in neurologicneurosurgical intensive care units(NNICUs) where hypernatremia is often a component of treatment of cerebral edema We performed a retrospective analysis of prospectively collected data in patients admitted to the NNICU over a 65-year period Hypernatremia (serum sodium gt150 mEqL) was seen in 339 patients (79) and was more common(243) in patients who were treated with mannitol Hypernatremic patients had a lower median admissionGlasgow Coma Scale score (8 vs 14 P lt 001) higher initial Acute Physiology and Chronic HealthEvaluation II probability of death (349 vs 191 P lt 001) higher incidence of mechanical ventilation(805 vs 4115 P lt 001) higher mortality (301 vs 102 P lt 001) and higher incidence of renalfailure (103 vs 09 P lt 001) Mortality increased with increasing hypernatremia however only severe hypernatremia (serum sodium gt160 mEqL) was independently associated with increased mortality Otherfactors independently associated with mortality were age mechanical ventilation initial Acute Physiologyand Chronic Health Evaluation II probability of death or low admission Glasgow Coma Scale score and a diagnosis of cerebrovascular disease In conclusion hypernatremia is common in the NNICU more so in patients treated with mannitol In this population severe (but not mild or moderate) hypernatremia isindependently associated with increased mortality

HYPERNATREMIE

HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI

HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI

Hypernatremie

SNa gt 145 mmoll

Lehkaacute 151 ndash 155 mmollStředniacute 156 ndash 160 mmoll Těžkaacute gt 160 mmoll

J Crit Care 2006 Jun21(2)163-72Hypernatremia in the neurologic intensive care unit how high is too highAiyagari V Deibert E Diringer MNSourceNeurologyNeurosurgery Intensive Care Unit Departments of Neurology and Neurosurgery Washington University School of Medicine St Louis MO USA aiyagariuiceduAbstractHypernatremia is associated with increased mortality in hospitalized patients and in medicalsurgicalintensive care units This relationship has not been studied in neurologicneurosurgical intensive care units(NNICUs) where hypernatremia is often a component of treatment of cerebral edema We performed a retrospective analysis of prospectively collected data in patients admitted to the NNICU over a 65-year period Hypernatremia (serum sodium gt150 mEqL) was seen in 339 patients (79) and was more common(243) in patients who were treated with mannitol Hypernatremic patients had a lower median admissionGlasgow Coma Scale score (8 vs 14 P lt 001) higher initial Acute Physiology and Chronic HealthEvaluation II probability of death (349 vs 191 P lt 001) higher incidence of mechanical ventilation(805 vs 4115 P lt 001) higher mortality (301 vs 102 P lt 001) and higher incidence of renalfailure (103 vs 09 P lt 001) Mortality increased with increasing hypernatremia however only severe hypernatremia (serum sodium gt160 mEqL) was independently associated with increased mortality Otherfactors independently associated with mortality were age mechanical ventilation initial Acute Physiologyand Chronic Health Evaluation II probability of death or low admission Glasgow Coma Scale score and a diagnosis of cerebrovascular disease In conclusion hypernatremia is common in the NNICU more so in patients treated with mannitol In this population severe (but not mild or moderate) hypernatremia isindependently associated with increased mortality

HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI

Hypernatremie

SNa gt 145 mmoll

Lehkaacute 151 ndash 155 mmollStředniacute 156 ndash 160 mmoll Těžkaacute gt 160 mmoll

J Crit Care 2006 Jun21(2)163-72Hypernatremia in the neurologic intensive care unit how high is too highAiyagari V Deibert E Diringer MNSourceNeurologyNeurosurgery Intensive Care Unit Departments of Neurology and Neurosurgery Washington University School of Medicine St Louis MO USA aiyagariuiceduAbstractHypernatremia is associated with increased mortality in hospitalized patients and in medicalsurgicalintensive care units This relationship has not been studied in neurologicneurosurgical intensive care units(NNICUs) where hypernatremia is often a component of treatment of cerebral edema We performed a retrospective analysis of prospectively collected data in patients admitted to the NNICU over a 65-year period Hypernatremia (serum sodium gt150 mEqL) was seen in 339 patients (79) and was more common(243) in patients who were treated with mannitol Hypernatremic patients had a lower median admissionGlasgow Coma Scale score (8 vs 14 P lt 001) higher initial Acute Physiology and Chronic HealthEvaluation II probability of death (349 vs 191 P lt 001) higher incidence of mechanical ventilation(805 vs 4115 P lt 001) higher mortality (301 vs 102 P lt 001) and higher incidence of renalfailure (103 vs 09 P lt 001) Mortality increased with increasing hypernatremia however only severe hypernatremia (serum sodium gt160 mEqL) was independently associated with increased mortality Otherfactors independently associated with mortality were age mechanical ventilation initial Acute Physiologyand Chronic Health Evaluation II probability of death or low admission Glasgow Coma Scale score and a diagnosis of cerebrovascular disease In conclusion hypernatremia is common in the NNICU more so in patients treated with mannitol In this population severe (but not mild or moderate) hypernatremia isindependently associated with increased mortality

J Crit Care 2006 Jun21(2)163-72Hypernatremia in the neurologic intensive care unit how high is too highAiyagari V Deibert E Diringer MNSourceNeurologyNeurosurgery Intensive Care Unit Departments of Neurology and Neurosurgery Washington University School of Medicine St Louis MO USA aiyagariuiceduAbstractHypernatremia is associated with increased mortality in hospitalized patients and in medicalsurgicalintensive care units This relationship has not been studied in neurologicneurosurgical intensive care units(NNICUs) where hypernatremia is often a component of treatment of cerebral edema We performed a retrospective analysis of prospectively collected data in patients admitted to the NNICU over a 65-year period Hypernatremia (serum sodium gt150 mEqL) was seen in 339 patients (79) and was more common(243) in patients who were treated with mannitol Hypernatremic patients had a lower median admissionGlasgow Coma Scale score (8 vs 14 P lt 001) higher initial Acute Physiology and Chronic HealthEvaluation II probability of death (349 vs 191 P lt 001) higher incidence of mechanical ventilation(805 vs 4115 P lt 001) higher mortality (301 vs 102 P lt 001) and higher incidence of renalfailure (103 vs 09 P lt 001) Mortality increased with increasing hypernatremia however only severe hypernatremia (serum sodium gt160 mEqL) was independently associated with increased mortality Otherfactors independently associated with mortality were age mechanical ventilation initial Acute Physiologyand Chronic Health Evaluation II probability of death or low admission Glasgow Coma Scale score and a diagnosis of cerebrovascular disease In conclusion hypernatremia is common in the NNICU more so in patients treated with mannitol In this population severe (but not mild or moderate) hypernatremia isindependently associated with increased mortality

HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI

Hypernatreacutemie

EFEKTIVNĚ OSMOLAacuteLNIacute DYSNATREMIE

Dehydratace mozku Nitrolebniacute hypotenze

1 Akutniacute poškozeniacute mozkuCentraacutelniacute diabetes insipidus (CDI)

HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI

2 Naacutesledek terapeutickyacutech postupůOsmoterapie ndash Manitol NaCl Furosemid

3 Iatrogenniacute přiacutečinyZvyacutešenyacute přiacutejem soli profuzniacute poceniacute

Centraacutelniacute diabetes insipidus

Neniacute nejčastěji se vyskytujiacuteciacute hypernatreacutemie

Multifaktoriaacutelniacute osmoterapie manitol renaacutelniacute selhaacuten

HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI

Wong MF Chin NM Lew TW Diabetes insipidus in neurosurgical patients Ann Acad Med Singapure 1998 27 340-3

Tisdall M Crocker M Watkiss J Smith J Smith M Disturbances of sodium in critically ill adult neurologic patients a clinical review J Neurosurg Anesthesiol 2006 18 57-63

Aiyagari V Deibert E Diringer M Hypernatremia in the neurologic intensive care unit how high is too high J Crit Care 2006 21 163-72

Zaacutevěr

DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI

Sodnyacute management maacute sveacute miacutesto v neurointenzivniacute peacuteči Dysnatremiiacutem je nutneacute se v neurointenzivniacute peacuteči věnovat a aktivně vyhledaacutevat

Ciacutelem neurointenzivniacute peacuteče je prevence hypohypernatremiiacute z iatrogenniacutech přiacutečin

Sodnyacute protokol maacute svaacute specifika v neurointenzivniacute peacuteči

DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI

NEUROINTENZIVNIacute PEacuteČEDěkuji za pozornost

• Sniacutemek čiacuteslo 1
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 4
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 9
• Sniacutemek čiacuteslo 10
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 12
• NATRIUM
• NATRIUM
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• MOZEK
• Sniacutemek čiacuteslo 17
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 21
• OSMOLALITA
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• PORUCHY EFEKTIVNIacute OSMOLALITY U AKUTNIacuteHO POŠKOZENIacute MOZKU
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 29
• Sniacutemek čiacuteslo 30
• Sniacutemek čiacuteslo 31
• Sniacutemek čiacuteslo 32
• HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 35
• HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 39
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 42
• NEUROINTENZIVNIacute PEacuteČE

Centraacutelniacute diabetes insipidus

Neniacute nejčastěji se vyskytujiacuteciacute hypernatreacutemie

Multifaktoriaacutelniacute osmoterapie manitol renaacutelniacute selhaacuten

HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI

Wong MF Chin NM Lew TW Diabetes insipidus in neurosurgical patients Ann Acad Med Singapure 1998 27 340-3

Tisdall M Crocker M Watkiss J Smith J Smith M Disturbances of sodium in critically ill adult neurologic patients a clinical review J Neurosurg Anesthesiol 2006 18 57-63

Aiyagari V Deibert E Diringer M Hypernatremia in the neurologic intensive care unit how high is too high J Crit Care 2006 21 163-72

Zaacutevěr

DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI

Sodnyacute management maacute sveacute miacutesto v neurointenzivniacute peacuteči Dysnatremiiacutem je nutneacute se v neurointenzivniacute peacuteči věnovat a aktivně vyhledaacutevat

Ciacutelem neurointenzivniacute peacuteče je prevence hypohypernatremiiacute z iatrogenniacutech přiacutečin

Sodnyacute protokol maacute svaacute specifika v neurointenzivniacute peacuteči

DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI

NEUROINTENZIVNIacute PEacuteČEDěkuji za pozornost

• Sniacutemek čiacuteslo 1
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 4
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 9
• Sniacutemek čiacuteslo 10
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 12
• NATRIUM
• NATRIUM
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• MOZEK
• Sniacutemek čiacuteslo 17
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 21
• OSMOLALITA
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• PORUCHY EFEKTIVNIacute OSMOLALITY U AKUTNIacuteHO POŠKOZENIacute MOZKU
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 29
• Sniacutemek čiacuteslo 30
• Sniacutemek čiacuteslo 31
• Sniacutemek čiacuteslo 32
• HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 35
• HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 39
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 42
• NEUROINTENZIVNIacute PEacuteČE

Zaacutevěr

DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI

Sodnyacute management maacute sveacute miacutesto v neurointenzivniacute peacuteči Dysnatremiiacutem je nutneacute se v neurointenzivniacute peacuteči věnovat a aktivně vyhledaacutevat

Ciacutelem neurointenzivniacute peacuteče je prevence hypohypernatremiiacute z iatrogenniacutech přiacutečin

Sodnyacute protokol maacute svaacute specifika v neurointenzivniacute peacuteči

DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI

NEUROINTENZIVNIacute PEacuteČEDěkuji za pozornost

• Sniacutemek čiacuteslo 1
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 4
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 9
• Sniacutemek čiacuteslo 10
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 12
• NATRIUM
• NATRIUM
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• MOZEK
• Sniacutemek čiacuteslo 17
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 21
• OSMOLALITA
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• PORUCHY EFEKTIVNIacute OSMOLALITY U AKUTNIacuteHO POŠKOZENIacute MOZKU
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 29
• Sniacutemek čiacuteslo 30
• Sniacutemek čiacuteslo 31
• Sniacutemek čiacuteslo 32
• HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 35
• HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 39
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 42
• NEUROINTENZIVNIacute PEacuteČE

Sodnyacute management maacute sveacute miacutesto v neurointenzivniacute peacuteči Dysnatremiiacutem je nutneacute se v neurointenzivniacute peacuteči věnovat a aktivně vyhledaacutevat

Ciacutelem neurointenzivniacute peacuteče je prevence hypohypernatremiiacute z iatrogenniacutech přiacutečin

Sodnyacute protokol maacute svaacute specifika v neurointenzivniacute peacuteči

DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI

NEUROINTENZIVNIacute PEacuteČEDěkuji za pozornost

• Sniacutemek čiacuteslo 1
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 4
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 9
• Sniacutemek čiacuteslo 10
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 12
• NATRIUM
• NATRIUM
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• MOZEK
• Sniacutemek čiacuteslo 17
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 21
• OSMOLALITA
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• PORUCHY EFEKTIVNIacute OSMOLALITY U AKUTNIacuteHO POŠKOZENIacute MOZKU
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 29
• Sniacutemek čiacuteslo 30
• Sniacutemek čiacuteslo 31
• Sniacutemek čiacuteslo 32
• HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 35
• HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 39
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 42
• NEUROINTENZIVNIacute PEacuteČE

NEUROINTENZIVNIacute PEacuteČEDěkuji za pozornost

• Sniacutemek čiacuteslo 1
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 4
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 9
• Sniacutemek čiacuteslo 10
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 12
• NATRIUM
• NATRIUM
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• MOZEK
• Sniacutemek čiacuteslo 17
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 21
• OSMOLALITA
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• PORUCHY EFEKTIVNIacute OSMOLALITY U AKUTNIacuteHO POŠKOZENIacute MOZKU
• HYPONATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 29
• Sniacutemek čiacuteslo 30
• Sniacutemek čiacuteslo 31
• Sniacutemek čiacuteslo 32
• HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 35
• HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• HYPERNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 39
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• DYSNATREMIE V NEUROINTENZIVNIacute PEacuteČI
• Sniacutemek čiacuteslo 42
• NEUROINTENZIVNIacute PEacuteČE