Matthew E Fink1. 1. Weill Cornell Medical College, Department of Neurology and Neuroscience, 525 East 68th Street, F-610, New York, NY 10065, USA. mfink@med.cornell.edu
Abstract
PURPOSE OF REVIEW: Hyperosmolar therapy is one of the core medical treatments for brain edema and intracranial hypertension, but controversy exists regarding the use of the most common agents, mannitol, and hypertonic saline. This article describes the relative merits and adverse effects of these agents using the best available clinical evidence. RECENT FINDINGS: Mannitol is effective and has been used for decades in the treatment of traumatic brain injury, but it may precipitate acute renal failure if serum osmolarity exceeds 320 mOsm/L. Hypertonic saline appears to be safe, and serum sodium has been elevated to as high as 180 mEq/L in clinical settings without significant neurologic, cardiac, or renal injury. In small comparative trials both agents are effective and no clinically significant difference has been noted, but a properly powered trial has not yet been performed. SUMMARY: Both mannitol and hypertonic saline are effective and have an acceptable risk profile for use in the treatment of elevated intracranial pressure secondary to brain edema.
PURPOSE OF REVIEW: Hyperosmolar therapy is one of the core medical treatments for brain edema and intracranial hypertension, but controversy exists regarding the use of the most common agents, mannitol, and hypertonicsaline. This article describes the relative merits and adverse effects of these agents using the best available clinical evidence. RECENT FINDINGS:Mannitol is effective and has been used for decades in the treatment of traumatic brain injury, but it may precipitate acute renal failure if serum osmolarity exceeds 320 mOsm/L. Hypertonicsaline appears to be safe, and serum sodium has been elevated to as high as 180 mEq/L in clinical settings without significant neurologic, cardiac, or renal injury. In small comparative trials both agents are effective and no clinically significant difference has been noted, but a properly powered trial has not yet been performed. SUMMARY: Both mannitol and hypertonicsaline are effective and have an acceptable risk profile for use in the treatment of elevated intracranial pressure secondary to brain edema.
Authors: Liza Victoria S Escobedo; Joseph Habboushe; Haytham Kaafarani; George Velmahos; Kaushal Shah; Jarone Lee Journal: World J Emerg Med Date: 2013
Authors: Alain Goriely; Marc G D Geers; Gerhard A Holzapfel; Jayaratnam Jayamohan; Antoine Jérusalem; Sivabal Sivaloganathan; Waney Squier; Johannes A W van Dommelen; Sarah Waters; Ellen Kuhl Journal: Biomech Model Mechanobiol Date: 2015-02-26