Abstract
Hyperosmotic therapy is commonly used to treat intracranial hypertension in traumatic brain injury patients. Unfortunately, hyperosmolality also affects other organs. An increase in plasma osmolality may impair kidney, cardiac, and immune function, and increase blood–brain barrier permeability. These effects are related not only to the type of hyperosmotic agents, but also to the level of hyperosmolality. The commonly recommended osmolality of 320 mOsm/kg H2O seems to be the maximum level, although an increase in plasma osmolality above 310 mOsm/kg H2O may already induce cardiac and immune system disorders. The present review focuses on the adverse effects of hyperosmolality on the function of various organs.
Highlights
Hyperosmotic therapy has been recommended for treatment of cerebral edema (CE)and increased intracranial pressure (ICP) in patients with traumatic brain injury (TBI) and other cerebral diseases [1,2]
Mannitol and hypertonic saline (HTS) have only been recommended for the treatment of intracranial hypertension (ICH) and cerebral edema, and the final goal of hyperosmotic therapy is the achievement of plasma osmolality not higher than 320 mOsm/kg H2 O [1,2,7]
Hyperosmotic therapy is based on osmosis—a phenomenon in which the water molecules migrate through a semi-permeable barrier from a solution rich in osmotically active molecules to a solution poor in the concentration of these agents
Summary
Increased intracranial pressure (ICP) in patients with traumatic brain injury (TBI) and other cerebral diseases [1,2]. The main purpose of increasing the plasma osmolality is to force the shift of water from the brain to the vascular space through the blood–brain barrier (BBB) [2]. According to the Monroe–Kellie doctrine, the sum of the volumes of intracerebral blood, cerebrospinal fluid (CSF), and brain is constant, a decrease of water from the interstitial space of the brain reduces cerebral volume and cerebral edema, which may improve cerebral perfusion [3,4]. Mannitol and hypertonic saline (HTS) have only been recommended for the treatment of intracranial hypertension (ICH) and cerebral edema, and the final goal of hyperosmotic therapy is the achievement of plasma osmolality not higher than 320 mOsm/kg H2 O [1,2,7]. ICH [8,9]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
