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Fluid-Electrolyte Imbalances and Extracorporeal Therapy in the Neurosurgical Setting

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Abstract

Fluid-electrolyte imbalances are important causes of morbidity and mortality in neurocritical care. Hyponatremia is common, and awareness of volume status can differentiate cerebral salt wasting from syndrome of inappropriate antidiuretic hormone secretion and guide management. Hypernatremia in this population may occur from central diabetes insipidus due to damage of the hypothalamic-pituitary region. Cerebral perfusion is crucial in neurocritical care and can be improved by maintaining serum sodium at 145–155 mmol/L with hypertonic saline. Management of blood pressure (BP) and autonomic issues differs based on the underlying neurological condition, and guidelines for management exist for the most common conditions. Acute kidney injury occurs at variable rates in this setting, and many medications used in care of these patients have nephrotoxic effects. When needed, continuous renal replacement therapy (RRT) is preferred in the neurocritical care setting due to the importance of volume and hemodynamic control in preventing cerebral ischemia.

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Author information

Authors and Affiliations

  1. Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, C1102 UPMC Presbyterian Hospital, 200 Lothrop Street, Pittsburgh, PA, 15213, USA

    Kelly Liang MD

  2. Department of Critical Care Medicine, University of Pittsburgh Medical Center, 3550 Terrace Street, Scaife Hall, Rm 646C, Pittsburgh, PA, 15261, USA

    Lori Shutter MD, FCCM, FNCS

Authors
  1. Kelly Liang MD
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  2. Lori Shutter MD, FCCM, FNCS
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Corresponding author

Correspondence to Lori Shutter MD, FCCM, FNCS .

Editor information

Editors and Affiliations

  1. Division of Nephrology and Hypertension, University of Cincinnati, Cincinnati, Ohio, USA

    Charuhas V. Thakar

  2. Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA

    Chirag R. Parikh

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Liang, K., Shutter, L. (2015). Fluid-Electrolyte Imbalances and Extracorporeal Therapy in the Neurosurgical Setting. In: Thakar, C., Parikh, C. (eds) Perioperative Kidney Injury. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1273-5_17

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  • DOI: https://doi.org/10.1007/978-1-4939-1273-5_17

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1272-8

  • Online ISBN: 978-1-4939-1273-5

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