Effects of hypernatremia on organic brain osmoles.

Lien, Yeong‐Hau H.; Shapiro, Joseph I.; Chan, Laurence

doi:10.1172/jci114587

Cited by 321 publications

(175 citation statements)

References 23 publications

(28 reference statements)

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“…The Cho resonance contains contributions from phosphocholine and glycerophosphorylcholine; available evidence suggests that glycerophosphorylcholine, which comprises at least half of the MR-visible peak (Miller et al, 1996), is a cerebral osmolyte (Lien et al, 1990;Videen et al, 1995). Chronic renal failure, for example, associated with a prolonged hyerposmotic state, demonstrates a positive correlation between MRS-derived Cho and serum osmotic pressure (Sasaki et al, 2006).…”

Section: Discussionmentioning

confidence: 99%

A Mechanism of Rapidly Reversible Cerebral Ventricular Enlargement Independent of Tissue Atrophy

Zahr

Mayer

Rohlfing

et al. 2013

Neuropsychopharmacol

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Ventricular enlargement, a common in vivo marker of aging, disease, and insult, is presumed to reflect atrophy of surrounding brain regions. Pathological mechanisms underlying ventricular enlargement, however, are likely specific to the condition under investigation. Here, multimodal imaging, incorporating structural magnetic resonance imaging (MRI), MR spectroscopy (MRS), and diffusion weighted imaging (DWI), was used in rats exposed to binge ethanol (EtOH) to provide insight into a mechanism of reversible ventricular enlargement. During intoxication, MRI revealed expansion of ventricles, but volume changes in dorsal or ventral hippocampi, caudateputamen, or thalamus were not detectible. MRS of whole-brain parenchyma showed decreases in N-acetylasparate (NAA) and tissue water T2, and increases in choline-containing compounds (Cho). DWI showed decreased diffusivity selective to the thalamus. All MR parameters returned to baseline with 7 days of recovery. Rapid recovery of ventricular volume and the absence of detectable tissue volume reductions in brain regions adjacent to ventricles argue against atrophy as a mechanism of ventricular expansion. Decreased tissue water T2 and decreased thalamic diffusivity suggest lower tissue water content and a role for both NAA and Cho, as osmolytes is proposed. Together, these data support a model of fluid redistribution during acute EtOH intoxication and recovery to account for rapid ventricular volume changes.

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Section: Discussionmentioning

confidence: 99%

A Mechanism of Rapidly Reversible Cerebral Ventricular Enlargement Independent of Tissue Atrophy

Zahr

Mayer

Rohlfing

et al. 2013

Neuropsychopharmacol

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show abstract

“…16,17 In response to brain shrinkage induced by hypernatremia, the human brain initiates an adaptive response to form idiogenic osmoles that increase intracellular sodium concentrations and restore lost water. [18][19][20] This phenomenon increases the susceptibility of the brain to cellular edema and hemorrhage. 15,20 Baraton et al reported that changes in serum sodium levels of more than 13 meq l À1 was significantly associated with the development of impaired functional outcomes after adjustment for GA, as well as perinatal and neonatal hospitalization characteristics.…”

Section: Discussionmentioning

confidence: 99%

Hypernatremia and grade III/IV intraventricular hemorrhage among extremely low birth weight infants

et al. 2010

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Objective: To identify the risk factors contributing to intraventricular hemorrhage (IVH) in extremely low birth weight infants during early postnatal life, after appropriate matching for gestational age (GA) and birth body weight (BBW).Study Design: A case-control retrospective study was designed to evaluate preterm infants with a GA p26 weeks and a BBW p1000 g admitted to our hospital during a 7.5-year period. From a cohort of 347 preterm infants, 36 infants (10.7%) had severe IVH (grades III and/or IV). We selected a control group of 36 preterm infants without IVH who were closely matched for GA ( ± 1 week) and body weight ( ± 100 g). Univariate and multivariate logistic regression analyses were performed to identify risk factors for severe IVH. Result:The GA and BBW of the IVH and control groups were 24.6 ± 1weeks and 764.4 ± 118.5 g, and 24.8 ± 0.9 weeks and 771.5 ± 125.9 g, respectively. Vaginal delivery, male sex, resuscitation in the delivery room, high sodium serum levels (meq l À1 ) (162.6 vs 148.8), fluctuation of serum sodium (meq l À1 ) (17.3 vs 6.2), pH, PaCO 2 , hemoglobin and platelet counts were associated with an increased risk of severe IVH. Multivariate logistic regression indicated that sodium fluctuations >13 meq l À1 , vaginal delivery, male sex and hemoglobin fluctuations are strongly associated with the development of severe IVH.Conclusion: Hypernatremia and fluctuations of sodium seem to be related to early severe IVH among preterm infants; however, further studies are required to clarify the causal relationship.

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“…(41) Chronic hypernatremia is associated with increased concentration of organic osmolytes in the brain as a protective mechanism. (6,42) The most important of these osmolytes can be quantified with proton nuclear magnetic resonance (NMR) spectroscopy in the brain of humans in vivo. (43,44) This was suggested to be valuable in guiding the therapy of hypernatremic patients.…”

Section: Resultsmentioning

confidence: 99%