Timing of the Effects of Mannitol, Furosemide, and Mannitol + Furosemide on Plasma Osmolality, Serum Sodium Concentration, and Brain Water Content after Closed Head Trauma

Abstract A 68-year-old man underwent pancreaticoduodenectomy with lymph nodes dissection for carcinoma of the ampulla of Vater. The patient had anxiety neurosis and had been treated with a selective serotonin reuptake inhibitor (SSRI). Postoperatively, SSRI was resumed on postoperative day 2. His serum sodium concentration gradually decreased, and the patient was given a sodium supplement. However, 11 days after the operation, laboratory findings included serum sodium concentration of 117 mEq/L, serum vasopressin of 2.0 pg/mL, plasma osmolality of 238 mOsm/kg, urine osmolality of 645 mOsm/kg, urine sodium concentration of 66 mEq/L, serum creatinine concentration of 0.54 mg/dL, and serum cortisol concentration of 29.1 μg/dL. With a diagnosis of syndrome of inappropriate secretion of antidiuretic hormone (SIADH), the antianxiety neurosis medication was changed from the SSRI to another type of drug. After switching the medication, the patient made a satisfactory recovery with normalization of serum sodium by postoperative day 20.

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Plasma Osmolality and Brain Water Content in a Rat Glioma Model

Neurosurgery ◽

10.1097/00006123-199403000-00017 ◽

1994 ◽

Vol 34 (3) ◽

pp. 505???511 ◽

Cited By ~ 1

Author(s):

Thomas D. Hansen ◽

David S. Warner ◽

Vincent C. Traynelis ◽

Michael M. Todd

Keyword(s):

Water Content ◽

Plasma Osmolality ◽

Brain Water Content ◽

Rat Glioma ◽

Glioma Model ◽

Brain Water

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Brain Uptake of Myoinositol after Exogenous Administration

Journal of the American Society of Nephrology ◽

10.1681/asn.v1351255 ◽

2002 ◽

Vol 13 (5) ◽

pp. 1255-1260

Author(s):

Stephen M. Silver ◽

Barbara M. Schroeder ◽

Richard H. Sterns

Keyword(s):

Hypertonic Saline ◽

Serum Sodium ◽

Sodium Concentration ◽

Serum Sodium Concentration ◽

Organic Osmolytes ◽

Time Period ◽

Acute Increase ◽

The Brain ◽

Brain Water ◽

Water Contents

ABSTRACT. An acute increase in plasma tonicity results in an adaptive increase in brain organic osmolyte content, but this process requires several days to occur. Slow reaccumulation of brain organic osmolytes may contribute to osmotic demyelination. It was investigated whether administration of intravenous myoinositol in rats could speed entry of the osmolyte into the brain. Two groups of animals were studied: normonatremic animals and animals with hyponatremia (105 mmol/L) of 3–d duration. Animals were intravenously administered either 1 M NaCl to induce a 25 to 28 mM increase in serum sodium concentration over 200 min or an infusate that maintained serum sodium concentration. In some animals, myoinositol was administered intravenously over the same time period to raise plasma myoinositol levels by 5 to 10 mM. Brain myoinositol, electrolyte, and water contents were determined at the end of the infusions. In both normonatremic and hyponatremic rats, infusion of hypertonic saline without myoinositol or infusion of myoinositol without hypertonic saline did not increase brain myoinositol levels above control levels. In normonatremic animals, concurrent infusion of hypertonic saline and myoinositol increased brain myoinositol levels by about 50% above control levels. Brain myoinositol content in animals with uncorrected hyponatremia was about 50% of that found in normonatremic controls; concurrent infusion of hypertonic saline and myoinositol increased brain myoinositol to levels similar to those found in normonatremic controls. Intravenous infusion of myoinositol did not alter brain water content compared with animals not infused with myoinositol. In conclusion, systemic infusion of myoinositol can rapidly increase brain myoinositol content, but only when plasma tonicity is concomitantly increased.

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Effect of Mannitol and Furosemide on Plasma Osmolality and Brain Water

Anesthesiology ◽

10.1097/00000542-200202000-00029 ◽

2002 ◽

Vol 96 (2) ◽

pp. 416-421 ◽

Cited By ~ 42

Author(s):

Kokila Thenuwara ◽

Michael M. Todd ◽

Johnny E. Brian

Keyword(s):

Water Content ◽

Plasma Osmolality ◽

Dry Weight ◽

Potential Interaction ◽

Interactive Effects ◽

Brain Water Content ◽

Mechanically Ventilated ◽

Physiologic Parameters ◽

Normal Rat ◽

Brain Water

Background Mannitol and furosemide are used to reduce increased intracranial pressure (ICP) and to reduce brain bulk during neurosurgery. One mechanism by which these changes might occur is via a reduction in brain water content. Although mannitol and furosemide are commonly used in combination, there has been no formal evaluation of the interactive effects of these two drugs on brain water. The effect of mannitol and furosemide alone and in combination on water content of normal rat brain was examined. Methods The lungs of rats anesthetized with halothane were mechanically ventilated to maintain normal physiologic parameters. After baseline measurement of plasma osmolality, mannitol (1, 4, or 8 g/kg), furosemide (2, 4, or 8 mg/kg), or a combination of furosemide (8 mg/kg) and mannitol (1, 4, or 8 g/kg) was administered intravenously over approximately 15 min. One hour later, plasma osmolality was measured, the animals were killed, and brain water content was determined by wet and dry weight measurements. Results Mannitol produced a dose-dependent increase in plasma osmolality and reduction of brain water content. There was a linear relation between plasma osmolality and brain water content. Furosemide alone did not affect plasma osmolality or brain water at any dose. The combination of furosemide with mannitol resulted in a greater increase in plasma osmolality than seen with mannitol alone and a greater decrease in brain water at 4 and 8 g/kg of mannitol. Conclusions The doses of mannitol and furosemide utilized were much larger than clinically applicable doses and were selected to maximize the ability to detect effect on brain water. The combination of mannitol and furosemide resulted in greater reduction of brain water content than did mannitol alone. Furosemide enhanced the effect of mannitol on plasma osmolality, resulting in a greater reduction of brain water content. Potential interaction (if any) of smaller, clinically used doses of mannitol and furosemide cannot be surmised from the current study.

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Plasma Osmolality and Brain Water Content in a Rat Glioma Model

Neurosurgery ◽

10.1227/00006123-199403000-00017 ◽

1994 ◽

Vol 34 (3) ◽

pp. 505-511 ◽

Cited By ~ 8

Author(s):

Thomas D. Hansen ◽

David S. Warner ◽

Vincent C. Traynelis ◽

Michael M. Todd

Keyword(s):

Water Content ◽

Plasma Osmolality ◽

Brain Water Content ◽

Rat Glioma ◽

Glioma Model ◽

Brain Water

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Effects of Closed Head Trauma and Lipopolysaccharide on Body Temperature, Brain Tissue Water Content, and PGE2 Production in Rats

Journal of Neurosurgical Anesthesiology ◽

10.1097/00008506-199804000-00005 ◽

1998 ◽

Vol 10 (2) ◽

pp. 94-100 ◽

Cited By ~ 3

Author(s):

Yoram Shapira ◽

Daniel Talmor ◽

Alan A. Artru ◽

Mazal Rubin ◽

Alexander Holkuvski ◽

...

Keyword(s):

Body Temperature ◽

Water Content ◽

Brain Tissue ◽

Head Trauma ◽

Pge2 Production ◽

Tissue Water Content ◽

Tissue Water ◽

Closed Head ◽

Closed Head Trauma

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Influence of Mannitol and Furosemide, Alone and in Combination, on Brain Water Content after Fluid Percussion Injury

Anesthesiology ◽

10.1097/00000542-200612000-00017 ◽

2006 ◽

Vol 105 (6) ◽

pp. 1176-1181 ◽

Cited By ~ 24

Author(s):

Michael M. Todd ◽

Johann Cutkomp ◽

Johnny E. Brian

Keyword(s):

Water Content ◽

Plasma Osmolality ◽

Control Group ◽

Brain Water Content ◽

Fluid Percussion ◽

Fluid Percussion Injury ◽

Injured Brain ◽

The Impact ◽

Reduced Water ◽

Brain Water

Background Furosemide and mannitol are used to reduce intracranial pressure, but the impact of furosemide on edema of injured brain is unclear. The authors examined the effects of furosemide and mannitol, alone and in combination, on brain water content in brain-injured rats. Methods Anesthetized rats were subjected to a 2.2-atm left hemispheric fluid percussion injury. Two and three-quarters hours later, animals received 0.5, 1, 4, or 8 g/kg mannitol; 8 mg/kg furosemide; a combination of 4 g/kg mannitol plus 4 mg/kg furosemide; or 8 g/kg mannitol plus 8 mg/kg furosemide. One hour later (4 h after injury), plasma osmolality was measured, and hemispheric water content was determined by drying. Other animals were subjected to injury without drug treatment (impact only) or did not undergo injury (control). Pairwise group comparisons regarding the effects of mannitol and furosemide were restricted to only four groups: impact only, 8 g/kg mannitol, 8 mg/kg furosemide, and 8 g/kg mannitol plus 8 mg/kg furosemide. Results The water content of both hemispheres in the impact-only group was greater than in the control group (left greater than right). Mannitol, 8 g/kg, increased osmolality from 306 +/- 4 to 351 +/- 6 mOsm/kg (mean +/- SD) and reduced water content in the left hemisphere from 80.06 +/- 0.84% (impact only) to 78.24 +/- 0.73%. Furosemide, 8 mg/kg, had no effect on osmolality or water content. Brain water in animals treated with 8 g/kg mannitol plus 8 mg/kg furosemide did not differ from that seen with 8 g/kg mannitol alone. Conclusions Mannitol increased plasma osmolality and reduced water content of the injured and contralateral hemispheres, whereas the authors observed no effect of furosemide when given either alone or in combination with mannitol.

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