Treatment of acute hyponatremia: ensuring the excretion of a predictable amount of electrolyte-free water.

Abstract:

BACKGROUND:Hypertonic saline is the recommended therapy to shrink swollen brain cells in patients with acute hyponatremia accompanied by seizures. OBJECTIVES:In the absence of hypertonic saline, hypertonic mannitol will shrink the cell volume. Because mannitol is excreted rapidly, our aim was to ensure that it would be excreted with electrolyte-free water (EFW) and to evaluate the renal mechanisms responsible for EFW excretion. DESIGN:A randomized, prospective, placebo-controlled study in rats was carried out in a research laboratory. SUBJECTS:Adult male Wistar rats. INTERVENTIONS:The control group of rats (n = 6) was administered hypotonic saline, a loop diuretic, vasopressin, and glucose by the intraperitoneal route; in the experimental group (n = 6), glucose was replaced with mannitol. Plasma electrolytes were measured at 0 and 210 mins, and balances for water, sodium, and potassium were obtained from 0 to 90 mins and from 90 to 210 mins. MEASUREMENTS AND MAIN RESULTS:Virtually 100% of the administered mannitol was excreted within 210 mins, and half was excreted in the first 90 mins. The urine contained EFW only in the mannitol group because of a larger volume in the first 90 mins (EFW, 3.7 mL) and to a lower excretion of NaCl in the next 120 mins (EFW, 3.5 mL). CONCLUSIONS:The combined use of mannitol and a loop diuretic caused the excretion of a predictable volume of EFW because the urine was iso-osmotic to plasma and contained all the administered mannitol. The calculated decrease in intracellular fluid volume was equivalent when mannitol was retained or excreted.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

Porzio P,Halberthal M,Bohn D,Halperin ML

doi

10.1097/00003246-200006000-00037

subject

Has Abstract

pub_date

2000-06-01 00:00:00

pages

1905-10

issue

6

eissn

0090-3493

issn

1530-0293

journal_volume

28

pub_type

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