Appropriate fluid management of patients with traumatic brain injury (TBI)
presents a challenge for many clinicians. Many of these patients may receive
osmotic diuretics for the treatment of increased intracranial pressure or
develop sodium disturbances, which act to alter fluid balance. However,
establishment of fluid balance is extremely important for improving patient
outcomes after neurologic injury. The use of hyperosmolar fluids, such as
hypertonic saline, has gained significant interest because they are devoid of
dehydrating properties and may have other beneficial properties for patients
with TBI. Electrolyte derangements are also common after neurologic injury,
with many having neurologic manifestations. In addition, the role of
electrolyte abnormalities in the secondary neurologic injury cascade is being
delineated and may offer a potential future therapeutic intervention.
Get full access to this article
View all access options for this article.
References
1.
Sosin DM, Sacks JJ, Smith SM. Head injury-associated deaths in the
United States from 1979 to 1986. JAMA.1989
;262:2251–
2255.
2.
Thurman D, Guerrero J. Trends in hospitalization associated with
traumatic brain injury. JAMA.1999
;282:954–
957.
3.
Thurman DJ, Alverson C, Dunn KA, Guerrero J, Sniezek JE. Traumatic
brain injury in the United States: a public health perspective. J
Head Trauma Rehabil.1999;14:602–
615.
4.
Becker DP, Miller JD, Ward JD, Greenberg RP, Young HF, Sakalas R.
The outcome from severe head injury with early diagnosis and intensive
management. J Neurosurg.1977
;47:491–
502.
5.
Sosin DM, Sniezek JE, Waxweiler RJ. Trends in death associated with
traumatic brain injury, 1979 through 1992: success and failure.
JAMA.1995;273:1778–
1780.
6.
Rose J, Valtonen S, Jennett B. Avoidable factors contributing to
death after head injury. BMJ.1977
;2:615–
618.
7.
The Brain Trauma Foundation, the American Association of
Neurological Surgeons, the Joint Section on Neurotrauma and Critical Care.
Trauma systems. J Neurotrauma.2000
;17:457–
462.
8.
The Brain Trauma Foundation, the American Association of
Neurological Surgeons, the Joint Section on Neurotrauma and Critical Care.
Pupillary diameter and light reflex. J Neurotrauma.2000
;17:583–
590.
9.
The Brain Trauma Foundation, the American Association of
Neurological Surgeons, the Joint Section on Neurotrauma and Critical Care.
Age. J Neurotrauma.2000
;17:573–
581.
10.
The Brain Trauma Foundation, the American Association of
Neurological Surgeons, the Joint Section on Neurotrauma and Critical Care.
Glasgow Coma Scale score. J Neurotrauma.2000
;17:563–
571.
11.
The Brain Trauma Foundation, the American Association of
Neurological Surgeons, the Joint Section on Neurotrauma and Critical Care.
Hypotension. J Neurotrauma.2000
;17:591–
595.
12.
Bramlett HM, Dietrich WD. Pathophysiology of cerebral ischemia and
brain trauma: similarities and differences. J Cereb Blood Flow
Metab.2004;24:133–
150.
13.
Luer MS, Rhoney DH, Hughes M, Hatton J. New pharmacologic
strategies for acute neuronal injury. Pharmacotherapy.1996
;16:830–
848.
14.
Gabriel EJ, Ghajar J, Jagoda A, et al. Guidelines for prehospital
management of traumatic brain injury. J Neurotrauma.2002
;19:111–
174.
15.
The Brain Trauma Foundation, the American Association of
Neurological Surgeons, the Joint Section on Neurotrauma and Critical Care.
Guidelines for cerebral perfusion pressure. J
Neurotrauma.2000;17:507–
511.
16.
Adelson PD, Bratton SL, Carney NA, et al. Guidelines for the acute
medical management of severe traumatic brain injury in infants, children, and
adolescents: chapter 4: resuscitation of blood pressure and oxygenation and
prehospital brain-specific therapies for the severe pediatric traumatic brain
injury patient. Pediatr Crit Care Med.2003
;4(3 suppl):S12–
S18.
17.
Stocchetti N, Furlan A, Volta F. Hypoxemia and arterial hypotension
at the accident scene in head injury. J Trauma.1996
;40:764–
766.
18.
Chesnut RM, Marshall LF, Klauber MR, et al. The role of secondary
brain injury in determining outcome from severe head injury. J
Trauma.1993;34:216–
222.
19.
Pietropaoli JA, Rogers FB, Shackford SR, Wald SL, Schmoker JD,
Zhuang J. The deleterious effects of intraoperative hypotension on outcome in
patients with severe head injuries. J Trauma.1992
;33:403–
407.
20.
Vassar MJ, Fischer RP, O'Brien PE, et al. A multicenter trial for
resuscitation of injured patients with 7.5% sodium chloride: the effect of
added dextran 70: the Multicenter Group for the Study of Hypertonic Saline in
Trauma Patients. Arch Surg.1993
;128:1003–
1013.
21.
The Brain Trauma Foundation, the American Association of
Neurological Surgeons, the Joint Section on Neurotrauma and Critical Care.
Recommendations for intracranial pressure monitoring technology. J
Neurotrauma.2000;17:497–
506.
22.
The Brain Trauma Foundation, the American Association of
Neurological Surgeons, the Joint Section on Neurotrauma and Critical Care.
Intracranial pressure treatment threshold. J
Neurotrauma.2000;17:493–
495.
23.
Juul N, Morris GF, Marshall SB, Marshall LF. Intracranial
hypertension and cerebral perfusion pressure: influence on neurological
deterioration and outcome in severe head injury: the Executive Committee of
the International Selfotel Trial. J Neurosurg.2000
;92:1–
6.
24.
Robertson CS. Management of cerebral perfusion pressure after
traumatic brain injury. Anesthesiology.2001
;95:1513–
1517.
25.
Robertson CS, Valadka AB, Hannay HJ, et al. Prevention of secondary
ischemic insults after severe head injury. Crit Care
Med.1999;27:2086–
2095.
26.
Balestreri M, Czosnyka M, Huchinson P, et al. Impact of
intracranial pressure and cerebral perfusion pressure on severe disability and
mortality after head injury. Neurocrit Care.2006
;4:8–
13.
27.
The Brain Trauma Foundation, the American Association of
Neurological Surgeons, the Joint Section on Neurotrauma and Critical Care.
Critical pathway for the treatment of established intracranial hypertension.
J Neurotrauma.2000
;17:537–
538.
28.
Shenkin HA, Bezier HS, Bouzarth WF. Restricted fluid intake:
rational management of the neurosurgical patient. J
Neurosurg.1976;45:432–
436.
29.
Eker C, Asgeirsson B, Grande PO, Schalen W, Nordstrom CH. Improved
outcome after severe head injury with a new therapy based on principles for
brain volume regulation and preserved microcirculation. Crit Care
Med.1998;26:1881–
1886.
30.
Morse ML, Milstein JM, Haas JE, Taylor E. Effect of hydration on
experimentally induced cerebral edema. Crit Care Med.1985
;13:563–
565.
31.
Gaab M, Knoblich OE, Schupp J, Herrmann F, Fuhrmeister U,
Pflughaupt KW. Effect of furosemide (Lasix) on acute severe experimental
cerebral edema. J Neurol.1979
;220:185–
197.
32.
Vincent JL, Berre J. Primer on medical management of severe brain
injury. Crit Care Med.2005
;33:1392–
1399.
33.
Clifton GL, Miller ER, Choi SC, Levin HS. Fluid thresholds and
outcome from severe brain injury. Crit Care Med.2002
;30:739–
745.
34.
Andrews BT. Fluid and electrolyte disorders in neurosurgical
intensive care. Neurosurg Clin N Am.1994
;5:707–
723.
35.
Lobo DN. Fluid, electrolytes and nutrition: physiological and
clinical aspects. Proc Nutr Soc.2004
;63:453–
466.
36.
Jeremitsky E, Omert L, Dunham CM, Protetch J, Rodriguez A.
Harbingers of poor outcome the day after severe brain injury: hypothermia,
hypoxia, and hypoperfusion. J Trauma.2003
;54:312–
319.
37.
Rovlias A, Kotsou S. The influence of hyperglycemia on neurological
outcome in patients with severe head injury.
Neurosurgery.2000
;46:335–
343.
38.
Lam AM, Winn HR, Cullen BF, Sundling N. Hyperglycemia and
neurological outcome in patients with head injury. J
Neurosurg.1991;75:545–
551.
39.
Walia S, Sutcliffe AJ. The relationship between blood glucose, mean
arterial pressure and outcome after severe head injury: an observational
study. Injury.2002
;33:339–
344.
40.
Kramer GC. Hypertonic resuscitation: physiologic mechanisms and
recommendations for trauma care. J Trauma.2003
;54(5 suppl):S89–
S99.
41.
Zornow MH, Prough DS. Fluid management in patients with traumatic
brain injury. New Horiz.1995
;3:488–
498.
42.
Drummond JC, Patel PM, Cole DJ, Kelly PJ. The effect of the
reduction of colloid oncotic pressure, with and without reduction of
osmolality, on post-traumatic cerebral edema.
Anesthesiology.1998
;88:993–
1002.
43.
Prough DS, Johnson JC, Stullken EH, Stump DA, Poole GV Jr, Howard
G. Effects on cerebral hemodynamics of resuscitation from endotoxic shock with
hypertonic saline versus lactated Ringer's solution. Crit Care
Med.1985;13:1040–
1044.
44.
Tommasino C, Moore S, Todd MM. Cerebral effects of isovolemic
hemodilution with crystalloid or colloid solutions. Crit Care
Med.1988;16:862–
868.
45.
Ogden AT, Mayer SA, Connolly ES Jr. Hyperosmolar agents in
neurosurgical practice: the evolving role of hypertonic saline.
Neurosurgery.2005
;57:207–
215.
46.
Knapp JM. Hyperosmolar therapy in the treatment of severe head
injury in children: mannitol and hypertonic saline. AACN Clin
Issues.2005;16:199–
211.
47.
The Brain Trauma Foundation, the American Association of
Neurological Surgeons, the Joint Section on Neurotrauma and Critical Care. Use
of mannitol. J Neurotrauma.2000
;17:521–
525.
48.
Schwartz ML, Tator CH, Rowed DW, Reid SR, Meguro K, Andrews DF. The
University of Toronto Head Injury Treatment Study: a prospective, randomized
comparison of pentobarbital and mannitol. Can J Neurol
Sci.1984;11:434–
440.
49.
Adelson PD, Bratton SL, Carney NA, et al. Guidelines for the acute
medical management of severe traumatic brain injury in infants, children, and
adolescents: chapter 17: critical pathway for the treatment of established
intracranial hypertension in pediatric traumatic brain injury.
Pediatr Crit Care Med.2003
;4(3 suppl):S65–
S67.
50.
Tommasino C. Fluids and the neurosurgical patient.
Anesthesiol Clin North America.2002
;20:329–
346, vi.
51.
Qureshi AI, Suarez JI. Use of hypertonic saline solutions in
treatment of cerebral edema and intracranial hypertension. Crit
Care Med.2000;28:3301–
3313.
Bhardwaj A, Ulatowski JA. Hypertonic saline solutions in brain
injury. Curr Opin Crit Care.2004
;10:126–
131.
54.
Doyle JA, Davis DP, Hoyt DB. The use of hypertonic saline in the
treatment of traumatic brain injury. J Trauma.2001
;50:367–
383.
55.
Ware ML, Nemani VM, Meeker M, Lee C, Morabito DJ, Manley GT.
Effects of 23.4% sodium chloride solution in reducing intracranial pressure in
patients with traumatic brain injury: a preliminary study.
Neurosurgery.2005
;57:727–
736.
56.
Vassar MJ, Perry CA, Gannaway WL, Holcroft JW. 7.5% Sodium
chloride/dextran for resuscitation of trauma patients undergoing helicopter
transport. Arch Surg.1991
;126:1065–
1072.
57.
Vassar MJ, Perry CA, Holcroft JW. Prehospital resuscitation of
hypotensive trauma patients with 7.5% NaCl versus 7.5% NaCl with added
dextran: a controlled trial. J Trauma.1993
;34:622–
633.
58.
Wade CE, Kramer GC, Grady JJ, Fabian TC, Younes RN. Efficacy of
hypertonic 7.5% saline and 6% dextran-70 in treating trauma: a meta-analysis
of controlled clinical studies. Surgery.1997
;122:609–
616.
59.
Cooper DJ, Myles PS, McDermott FT, et al. Prehospital hypertonic
saline resuscitation of patients with hypotension and severe traumatic brain
injury: a randomized controlled trial. JAMA.2004
;291:1350–
1357.
60.
Larive LL, Rhoney DH, Parker D Jr, Coplin WM, Carhuapoma JR.
Introducing hypertonic saline for cerebral edema: an academic center
experience. Neurocrit Care.2004
;1:435–
440.
61.
Gross D, Landau EH, Klin B, Krausz MM. Quantitative measurement of
bleeding following hypertonic saline therapy in “uncontrolled”
hemorrhagic shock. J Trauma.1989
;29:79–
83.
62.
Soreide E, Deakin CD. Pre-hospital fluid therapy in the critically
injured patient: a clinical update. Injury.2005
;36:1001–
1010.
63.
Schortgen F, Lacherade JC, Bruneel F, et al. Effects of
hydroxyethylstarch and gelatin on renal function in severe sepsis: a
multicentre randomised study. Lancet.2001
;357:911–
916.
64.
Strauss RG, Pennell BJ, Stump DC. A randomized, blinded trial
comparing the hemostatic effects of pentastarch versus hetastarch.
Transfusion.2002
;42:27–
36.
65.
Human albumin administration in critically ill patients: systematic
review of randomised controlled trials: Cochrane Injuries Group Albumin
Reviewers. BMJ.1998
;317:235–
240.
66.
Velanovich V. Crystalloid versus colloid fluid resuscitation: a
meta-analysis of mortality. Surgery.1989
;105:65–
71.
67.
Wilkes MM, Navickis RJ. Patient survival after human albumin
administration: a meta-analysis of randomized, controlled trials.
Ann Intern Med.2001
;135:149–
164.
68.
Vincent JL, Sakr Y, Reinhart K, et al. Is albumin administration in
the acutely ill associated with increased mortality? Results of the SOAP
study. Crit Care.2005
;9:R745–
R754.
69.
Finfer S, Bellomo R, Boyce N, et al. A comparison of albumin and
saline for fluid resuscitation in the intensive care unit. N Engl J
Med.2004;350:2247–
2256.
70.
Barron ME, Wilkes MM, Navickis RJ. A systematic review of the
comparative safety of colloids. Arch Surg.2004
;139:552–
563.
71.
Zygun DA, Steiner LA, Johnston AJ, et al. Hyperglycemia and brain
tissue pH after traumatic brain injury. Neurosurgery.2004
;55:877–
882.
72.
McCowen KC, Malhotra A, Bistrian BR. Stress-induced hyperglycemia.
Crit Care Clin.2001
;17:107–
124.
73.
Marsh WR, Anderson RE, Sundt TM Jr. Effect of hyperglycemia on
brain pH levels in areas of focal incomplete cerebral ischemia in monkeys.
J Neurosurg.1986
;65:693–
696.
74.
Kushner M, Fieschi C, Alavi A, Silver F, Chawluk J, Reivich M.
Local cerebral metabolic changes in acute ischemic strokes.
Gerontology.1987
;33:265–
267.
75.
Garg R, Chaudhuri A, Munschauer F, Dandona P. Hyperglycemia,
insulin, and acute ischemic stroke: a mechanistic justification for a trial of
insulin infusion therapy. Stroke.2006
;37:267–
273.
76.
D'Alecy LG, Lundy EF, Barton KJ, Zelenock GB. Dextrose containing
intravenous fluid impairs outcome and increases death after eight minutes of
cardiac arrest and resuscitation in dogs. Surgery.1986
;100:505–
511.
77.
de Courten-Myers G, Myers RE, Schoolfield L. Hyperglycemia enlarges
infarct size in cerebrovascular occlusion in cats.
Stroke.1988;19:623–
630.
78.
Pulsinelli WA, Waldman S, Rawlinson D, Plum F. Moderate
hyperglycemia augments ischemic brain damage: a neuropathologic study in the
rat. Neurology.1982
;32:1239–
1246.
79.
Pentelenyi T, Kammerer L. Changes in blood glucose after head
injury and its prognostic significance. Injury.1977
;8:264–
268.
80.
Pentelenyi T, Kammerer L, Stutzel M, Balazsi I. Alterations of the
basal serum insulin and blood glucose in brain-injured patients.
Injury.1979;10:201–
208.
81.
Deloof T, Berre J, Genette F, Van de Steene A, Mouawad E.
Disturbances of the carbohydrate metabolism in acute head trauma.
Acta Neurochir Suppl (Wien).1979
;28:113–
114.
82.
Merguerian PA, Perel A, Wald U, Feinsod M, Cotev S. Persistent
nonketotic hyperglycemia as a grave prognostic sign in head-injured patients.
Crit Care Med.1981
;9:838–
840.
83.
Young B, Ott L, Dempsey R, Haack D, Tibbs P. Relationship between
admission hyperglycemia and neurologic outcome of severely brain-injured
patients. Ann Surg.1989
;210:466–
473.
84.
van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin
therapy in the critically ill patients. N Engl J Med.2001
;345:1359–
1367.
85.
Van den Berghe G, Schoonheydt K, Becx P, Bruyninckx F, Wouters PJ.
Insulin therapy protects the central and peripheral nervous system of
intensive care patients. Neurology.2005
;64:1348–
1353.
86.
Van den Berghe G, Wilmer A, Hermans G, et al. Intensive insulin
therapy in the medical ICU. N Engl J Med.2006
;354:449–
461.
87.
Vespa P, Boonyaputthikul R, McArthur DL, et al. Intensive insulin
therapy reduces microdialysis glucose values without altering glucose
utilization or improving the lactate/pyruvate ratio after traumatic brain
injury. Crit Care Med.2006
;34:850–
856.
88.
Cole CD, Gottfried ON, Liu JK, Couldwell WT. Hyponatremia in the
neurosurgical patient: diagnosis and management. Neurosurg
Focus.2004
;16(E9):1–
10.
89.
Diringer MN. Sodium disturbances frequently encountered in a
neurologic intensive care unit. Neurol India.2001
;49(suppl 1):S19–
S30.
Riggs JE. Neurologic manifestations of electrolyte disturbances.
Neurol Clin.2002
;20:227–
239, vii.
92.
Lien YH, Shapiro JI, Chan L. Study of brain electrolytes and
organic osmolytes during correction of chronic hyponatremia: implications for
the pathogenesis of central pontine myelinolysis. J Clin
Invest.1991;88:303–
309.
93.
Miller M. Syndromes of excess antidiuretic hormone release.
Crit Care Clin.2001
;17:11–
23, v.
94.
Oster JR, Singer I. Hyponatremia, hyposmolality, and hypotonicity:
tables and fables. Arch Intern Med.1999
;159:333–
336.
95.
Van Amelsvoort T, Bakshi R, Devaux CB, Schwabe S. Hyponatremia
associated with carbamazepine and oxcarbazepine therapy: a review.
Epilepsia.1994
;35:181–
188.
96.
No authors listed. Conivaptan (Vaprisol) for hyponatremia.
Med Lett Drugs Ther.2006
;48(1237):51–
52.
97.
Nelson PB, Seif SM, Maroon JC, Robinson AG. Hyponatremia in
intracranial disease: perhaps not the syndrome of inappropriate secretion of
antidiuretic hormone (SIADH). J Neurosurg.1981
;55:938–
941.
98.
Sivakumar V, Rajshekhar V, Chandy MJ. Management of neurosurgical
patients with hyponatremia and natriuresis.
Neurosurgery.1994
;34:269–
274.
99.
Wijdicks EF, Vermeulen M, van Brummelen P, van Gijn J. The effect
of fludrocortisone acetate on plasma volume and natriuresis in patients with
aneurysmal subarachnoid hemorrhage. Clin Neurol
Neurosurg.1988;90:209–
214.
100.
Donati-Genet PC, Dubuis JM, Girardin E, Rimensberger PC. Acute
symptomatic hyponatremia and cerebral salt wasting after head injury: an
important clinical entity. J Pediatr Surg.2001
;36:1094–
1097.
101.
Harrigan MR. Cerebral salt wasting syndrome. Crit Care
Clin.2001;17:125–
138.
102.
Ishikawa SE, Saito T, Kaneko K, Okada K, Kuzuya T. Hyponatremia
responsive to fludrocortisone acetate in elderly patients after head injury.
Ann Intern Med.1987
;106:187–
191.
103.
Dooling E, Winkelman C. Hyponatremia in the patient with
subarachnoid hemorrhage. J Neurosci Nurs.2004
;36:130–
135.
104.
Maghnie M. Diabetes insipidus. Horm Res.2003
;59(suppl 1):42–
54.
Agha A, Thornton E, O'Kelly P, Tormey W, Phillips J, Thompson CJ.
Posterior pituitary dysfunction after traumatic brain injury. J
Clin Endocrinol Metab.2004
;89:5987–
5992.
107.
Blevins LS Jr, Wand GS. Diabetes insipidus. Crit Care
Med.1992;20:69–
79.
108.
Singer I, Oster JR, Fishman LM. The management of diabetes
insipidus in adults. Arch Intern Med.1997
;157:1293–
1301.
109.
Kim RJ, Malattia C, Allen M, Moshang T Jr, Maghnie M. Vasopressin
and desmopressin in central diabetes insipidus: adverse effects and clinical
considerations. Pediatr Endocrinol Rev.2004
;2(suppl 1):115–
123.
110.
Kapic E, Becic F, Todic M. Modern approach in treatment of diabetes
insipidus. Bosn J Basic Med Sci.2005
;5:38–
42.
111.
Cernak I, Savic VJ, Kotur J, Prokic V, Veljovic M, Grbovic D.
Characterization of plasma magnesium concentration and oxidative stress
following graded traumatic brain injury in humans. J
Neurotrauma.2000;17:53–
68.
112.
Sibbald WJ, Sardesai V, Wilson RF. Hypocalcemia and nephrogenous
cyclic AMP production in critically ill or injured patients. J
Trauma.1977;17:677–
684.
113.
Cooper DJ, Walley KR, Dodek PM, Rosenberg F, Russell JA. Plasma
ionized calcium and blood lactate concentrations are inversely associated in
human lactic acidosis. Intensive Care Med.1992
;18:286–
289.
114.
Burchard KW, Gann DS, Colliton J, Forster J. Ionized calcium,
parathormone, and mortality in critically ill surgical patients.
Ann Surg.1990
;212:543–
550.
115.
Siesjo BK. Historical overview: calcium, ischemia, and death of
brain cells. Ann N Y Acad Sci.1988
;522:638–
661.
116.
Tymianski M, Tator CH. Normal and abnormal calcium homeostasis in
neurons: a basis for the pathophysiology of traumatic and ischemic central
nervous system injury. Neurosurgery.1996
;38:1176–
1195.
117.
Weber JT. Calcium homeostasis following traumatic neuronal injury.
Curr Neurovasc Res.2004
;1:151–
171.
118.
Chinopoulos C, Adam-Vizi V. Calcium, mitochondria and oxidative
stress in neuronal pathology: novel aspects of an enduring theme.
FEBS J.2006;273:433–
450.
119.
Zipfel GJ, Babcock DJ, Lee JM, Choi DW. Neuronal apoptosis after
CNS injury: the roles of glutamate and calcium. J
Neurotrauma.2000;17:857–
869.
120.
Koike T, Martin DP, Johnson EM Jr. Role of Ca2+ channels in the
ability of membrane depolarization to prevent neuronal death induced by
trophic-factor deprivation: evidence that levels of internal Ca2+ determine
nerve growth factor dependence of sympathetic ganglion cells. Proc
Natl Acad Sci U S A.1989;86:6421–
6425.
121.
Zipfel GJ, Lee JM, Choi DW. Reducing calcium overload in the
ischemic brain. N Engl J Med.1999
;341:1543–
1544.
122.
Harders A, Kakarieka A, Braakman R. Traumatic subarachnoid
hemorrhage and its treatment with nimodipine: German tSAH Study Group.
J Neurosurg.1996
;85:82–
89.
123.
European Study Group on Nimodipine in Severe Head Injury. A
multicenter trial of the efficacy of nimodipine on outcome after severe head
injury: the European Study Group on Nimodipine in Severe Head Injury.
J Neurosurg.1994
;80:797–
804.
124.
Murray GD, Teasdale GM, Schmitz H. Nimodipine in traumatic
subarachnoid haemorrhage: a re-analysis of the HIT I and HIT II trials.
Acta Neurochir (Wien).1996
;138:1163–
1167.
125.
Saatman KE, Murai H, Bartus RT, et al. Calpain inhibitor AK295
attenuates motor and cognitive deficits following experimental brain injury in
the rat. Proc Natl Acad Sci U S A.1996
;93:3428–
3433.
126.
Vink R, Cernak I. Regulation of intracellular free magnesium in
central nervous system injury. Front Biosci.2000
;5:D656–
D665.
127.
Oppelt WW, MacIntyre I, Rall DP. Magnesium exchange between blood
and cerebrospinal fluid. Am J Physiol.1963
;205:959–
962.
128.
Pollay M. Transport mechanisms in the choroid plexus.
Fed Proc.1974;33:2064–
2069.
129.
Seelig MS. Consequences of magnesium deficiency on the enhancement
of stress reactions: preventive and therapeutic implications (a review).
J Am Coll Nutr.1994
;13:429–
446.
130.
Joborn H, Akerstrom G, Ljunghall S. Effects of exogenous
catecholamines and exercise on plasma magnesium concentrations.
Clin Endocrinol (Oxf).1985
;23:219–
226.
131.
Flink EB, Brick JE, Shane SR. Alterations of long-chain free fatty
acid and magnesium concentrations in acute myocardial infarction.
Arch Intern Med.1981
;141:441–
443.
132.
Lin JY, Chung SY, Lin MC, Cheng FC. Effects of magnesium sulfate on
energy metabolites and glutamate in the cortex during focal cerebral ischemia
and reperfusion in the gerbil monitored by a dual-probe microdialysis
technique. Life Sci.2002
;71:803–
811.
133.
Hoffman DJ, Marro PJ, McGowan JE, Mishra OP, Delivoria-Papadopoulos
M. Protective effect of MgSO4 infusion on NMDA receptor binding
characteristics during cerebral cortical hypoxia in the newborn piglet.
Brain Res.1994
;644:144–
149.
134.
Heath DL, Vink R. Optimization of magnesium therapy after severe
diffuse axonal brain injury in rats. J Pharmacol Exp
Ther.1999;288:1311–
1316.
135.
Vink R, O'Connor CA, Nimmo AJ, Heath DL. Magnesium attenuates
persistent functional deficits following diffuse traumatic brain injury in
rats. Neurosci Lett.2003
;336:41–
44.
136.
McIntosh TK, Vink R, Yamakami I, Faden AI. Magnesium protects
against neurological deficit after brain injury. Brain
Res.1989;482:252–
260.
137.
Miura K. [Changes in Mg++ concentration of CSF after subarachnoid
hemorrhage and Mg++–effects on the contractions of bovine cerebral
artery]. No Shinkei Geka.1988
;16:1251–
1259.
138.
Pyne GJ, Cadoux-Hudson TA, Clark JF. Magnesium protection against
in vitro cerebral vasospasm after subarachnoid haemorrhage.
Br J Neurosurg.2001
;15:409–
415.
139.
van den Bergh WM, Zuur JK, Kamerling NA, et al. Role of magnesium
in the reduction of ischemic depolarization and lesion volume after
experimental subarachnoid hemorrhage. J Neurosurg.2002
;97:416–
422.
140.
Ram Z, Sadeh M, Shacked I, Sahar A, Hadani M. Magnesium sulfate
reverses experimental delayed cerebral vasospasm after subarachnoid hemorrhage
in rats. Stroke.1991
;22:922–
927.
141.
Chi OZ, Pollak P, Weiss HR. Effects of magnesium sulfate and
nifedipine on regional cerebral blood flow during middle cerebral artery
ligation in the rat. Arch Int Pharmacodyn Ther.1990
;304:196–
205.
142.
Izumi Y, Roussel S, Pinard E, Seylaz J. Reduction of infarct volume
by magnesium after middle cerebral artery occlusion in rats. J
Cereb Blood Flow Metab.1991
;11:1025–
1030.
143.
Yang Y, Li Q, Ahmad F, Shuaib A. Survival and histological
evaluation of therapeutic window of post-ischemia treatment with magnesium
sulfate in embolic stroke model of rat. Neurosci Lett.2000
;285:119–
122.
144.
Tsuda T, Kogure K, Nishioka K, Watanabe T. Mg2+ administered up to
twenty-four hours following reperfusion prevents ischemic damage of the Ca1
neurons in the rat hippocampus. Neuroscience.1991
;44:335–
341.
145.
van den Bergh WM, Algra A, van der Sprenkel JW, Tulleken CA, Rinkel
GJ. Hypomagnesemia after aneurysmal subarachnoid hemorrhage.
Neurosurgery.2003
;52:276–
282.
146.
Polderman KH, van Zanten AR, Girbes AR. The importance of magnesium
in critically ill patients: a role in mitigating neurological injury and in
the prevention of vasospasms. Intensive Care Med.2003
;29:1202–
1203.
147.
Lampl Y, Geva D, Gilad R, Eshel Y, Ronen L, Sarova-Pinhas I.
Cerebrospinal fluid magnesium level as a prognostic factor in ischaemic
stroke. J Neurol.1998
;245:584–
588.
148.
Feldman Z, Gurevitch B, Artru AA, et al. Effect of magnesium given
1 hour after head trauma on brain edema and neurological outcome. J
Neurosurg.1996;85:131–
137.
149.
Memon ZI, Altura BT, Benjamin JL, Cracco RQ, Altura BM. Predictive
value of serum ionized but not total magnesium levels in head injuries.
Scand J Clin Lab Invest.1995
;55:671–
677.
150.
Kahraman S, Ozgurtas T, Kayali H, Atabey C, Kutluay T, Timurkaynak
E. Monitoring of serum ionized magnesium in neurosurgical intensive care unit:
preliminary results. Clin Chim Acta.2003
;334:211–
215.
151.
Thordstein M, Bagenholm R, Thiringer K, Kjellmer I. Scavengers of
free oxygen radicals in combination with magnesium ameliorate perinatal
hypoxic-ischemic brain damage in the rat. Pediatr Res.1993
;34:23–
26.
152.
Schmid-Elsaesser R, Zausinger S, Hungerhuber E, Baethmann A, Reulen
HJ. Neuroprotective effects of combination therapy with tirilazad and
magnesium in rats subjected to reversible focal cerebral ischemia.
Neurosurgery.1999
;44:163–
172.
153.
Iseri LT, French JH. Magnesium: nature's physiologic calcium
blocker. Am Heart J.1984
;108:188–
193.
154.
Wolf FI, Cittadini A. Magnesium in cell proliferation and
differentiation. Front Biosci.1999
;4:D607–
D617.
155.
Muir KW. New experimental and clinical data on the efficacy of
pharmacological magnesium infusions in cerebral infarcts. Magnes
Res.1998;11:43–
56.
156.
Zhu HD, Martin R, Meloni B, et al. Magnesium sulfate fails to
reduce infarct volume following transient focal cerebral ischemia in rats.
Neurosci Res.2004
;49:347–
353.
157.
Muir KW, Lees KR, Ford I, Davis S. Magnesium for acute stroke
(Intravenous Magnesium Efficacy in Stroke Trial): randomised controlled trial.
Lancet.2004;363:439–
445.
158.
Saver JL, Kidwell C, Eckstein M, Starkman S. Prehospital
neuroprotective therapy for acute stroke: results of the Field Administration
of Stroke Therapy-Magnesium (FAST-MAG) pilot trial.
Stroke.2004;35:e106–
e108.
159.
Veyna RS, Seyfried D, Burke DG, et al. Magnesium sulfate therapy
after aneurysmal subarachnoid hemorrhage. J Neurosurg.2002
;96:510–
514.
160.
van den Bergh WM, Algra A, van Kooten F, et al. Magnesium sulfate
in aneurysmal subarachnoid hemorrhage: a randomized controlled trial.
Stroke.2005;36:1011–
1015.
161.
Canavero S, Bonicalzi V, Narcisi P. Safety of magnesium-lidocaine
combination for severe head injury: the Turin lidomag pilot study.
Surg Neurol.2003
;60:165–
169.
162.
Brewer RP, Parra A, Borel CO, Hopkins MB, Reynolds JD. Intravenous
magnesium sulfate does not increase ventricular CSF ionized magnesium
concentration of patients with intracranial hypertension. Clin
Neuropharmacol.2001;24:341–
345.
163.
Fuchs-Buder T, Tramer MR, Tassonyi E. Cerebrospinal fluid passage
of intravenous magnesium sulfate in neurosurgical patients. J
Neurosurg Anesthesiol.1997
;9:324–
328.
164.
Shackford SR, Bourguignon PR, Wald SL, Rogers FB, Osler TM, Clark
DE. Hypertonic saline resuscitation of patients with head injury: a
prospective, randomized clinical trial. J Trauma.1998
;44:50–
58.
165.
Worthley LI, Cooper DJ, Jones N. Treatment of resistant
intracranial hypertension with hypertonic saline: report of two cases.
J Neurosurg.1988
;68:478–
481.
166.
Fisher B, Thomas D, Peterson B. Hypertonic saline lowers raised
intracranial pressure in children after head trauma. J Neurosurg
Anesthesiol.1992;4:4–
10.
167.
Hartl R, Ghajar J, Hochleuthner H, Mauritz W. Treatment of
refractory intracranial hypertension in severe traumatic brain injury with
repetitive hypertonic/hyperoncotic infusions. Zentralbl
Chir.1997;122:181–
185.
168.
Schatzmann C, Heissler HE, Konig K, et al. Treatment of elevated
intracranial pressure by infusions of 10% saline in severely head injured
patients. Acta Neurochir Suppl.1998
;71:31–
33.
169.
Simma B, Burger R, Falk M, Sacher P, Fanconi S. A prospective,
randomized, and controlled study of fluid management in children with severe
head injury: lactated Ringer's solution versus hypertonic saline.
Crit Care Med.1998
;26:1265–
1270.
170.
Horn P, Munch E, Vajkoczy P, et al. Hypertonic saline solution for
control of elevated intracranial pressure in patients with exhausted response
to mannitol and barbiturates. Neurol Res.1999
;21:758–
764.
171.
Khanna S, Davis D, Peterson B, et al. Use of hypertonic saline in
the treatment of severe refractory posttraumatic intracranial hypertension in
pediatric traumatic brain injury. Crit Care Med.2000
;28:1144–
1151.
172.
Peterson B, Khanna S, Fisher B, Marshall L. Prolonged hypernatremia
controls elevated intracranial pressure in head-injured pediatric patients.
Crit Care Med.2000
;28:1136–
1143.
173.
Qureshi AI, Suarez JI, Castro A, Bhardwaj A. Use of hypertonic
saline/acetate infusion in treatment of cerebral edema in patients with head
trauma: experience at a single center. J Trauma.1999
;47:659–
665.
