Osmole gap in neurologic-neurosurgical intensive care unit: Its normal value, calculation, and relationship with mannitol serum concentrations

Garcia-Morales, Edgar; Cariappa, Rohit; Parvin, Curtis A.; Scott, Mitchell G.; Diringer, Michael N.

doi:10.1097/01.ccm.0000120057.04528.60

Cited by 84 publications

(50 citation statements)

References 27 publications

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“…As mannitol is often initiated under emergent conditions, baseline osmolality was not measured in a significant proportion of patients before administration of the first dose. Furthermore, we have shown that serum sodium, when measured immediately prior to a mannitol dose, correlates closely with serum osmolality (19), making the change in sodium an accurate surrogate of the osmotic response to mannitol.…”

Section: Groupsmentioning

confidence: 98%

Variation in Osmotic Response to Sustained Mannitol Administration

Keyrouz

Dhar²,

Diringer³

2008

Neurocrit Care

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Section: Groupsmentioning

confidence: 98%

Variation in Osmotic Response to Sustained Mannitol Administration

Keyrouz

Dhar²,

Diringer³

2008

Neurocrit Care

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“…Por outro lado, pacientes comatosos com sinais de hipertensão intracraniana podem se beneficiar de medidas, como elevação da cabeceira a 30 graus, analgesia, sedação, doses moderadas de manitol a 20%, solução salina hipertônica e hiperventilação para atingir PaCO 2 entre 28 e 32 mmHg. Entretanto, não há evidências definitivas sobre o benefício do uso destas terapias para pacientes com HIC até o momento [81][82][83][84] . Um estudo que avaliou o uso de corticosteróides (dexametasona) em pacientes com HIC não mostrou benefícios e revelou um aumento no risco de infecções 85 .…”

Section: Hipertensão Intracranianaunclassified

Diretrizes para o manejo de pacientes com hemorragia intraparenquimatosa cerebral espontânea

Pontes-Neto¹,

Oliveira‐Filho²,

Valiente³

et al. 2009

Arq. Neuro-Psiquiatr.

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Resumo -A hemorragia intraparenquimatosa cerebral (HIC) é o subtipo de AVC de pior prognóstico e com tratamento ainda controverso em diversos aspectos. O comitê executivo da Sociedade Brasileira de Doenças Cerebrovasculares, através de uma revisão ampla dos artigos publicados em revistas indexadas, elaborou sugestões e recomendações que são aqui descritas com suas respectivas classificações de níveis de evidência. Estas diretrizes foram elaboradas com o objetivo de prover o leitor de um racional para o manejo apropriado dos pacientes com HIC, baseado em evidências clínicas.PALAVRAS-CHAVE: hemorragia intraparenquimatosa cerebral, recomendações, tratamento. Brazilian guidelines for the manegement of intracerebral hemorrhageAbstract -Among the stroke subtypes, intracerebral hemorrhage (ICH) has the worst prognosis and still lacks a specific treatment. The present manuscript contains the Brazilian guidelines for the management of ICH. It was elaborated by the executive committee of the Brazilian Cerebrovascular Diseases Society and was based on a broad review of articles about the theme. The text aims to provide a rational for the management of patients with an acute ICH, with the diagnostic and therapeutic resources that are available in Brazil.

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“…Monitoring serum osmolarity in these patients does not appear to predict the development or risk of acute renal failure [calculated osmolality formula: 2(Na) + glucose/18 + blood urea nitrogen/2.8] [58,59]. Withholding mannitol should also be considered if the serum osmolality exceeds 320 mOsm/L, although little evidence exists to support this number as the upper limit.…”

Section: Hyperosmolar Therapymentioning

confidence: 99%

Measurement and Management of Increased Intracranial Pressure

Sadoughi

Rybinnik

Cohen

2013

TOCCMJ

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Increased intracranial pressure (ICP) is a serious complication of a variety of neurologic injuries and is a major challenge in intensive care units. The most common causes of increased ICP are: traumatic brain injury (TBI), stroke, neoplasms, hydrocephalus, hepatic encephalopathy, CNS venous return impairment, encephalitis, and abscesses. Prompt diagnosis and intensive monitoring and therapy of this condition are essential for successful management of this potentially devastating condition. Recent technical innovations in neuromonitoring may allow for improvement in morbidity and mortality rates attributable to elevated ICP. Normal ICP ranges from 3-15 mmHg. In routine intensive care unit (ICU) practice, the goal of ICP management is to maintain levels below 20 mmHg. Noninvasive and metabolic monitoring of ICP including imaging-clinical examination has been studied and suggested to be as efficient as the care based on invasive ICP monitoring; however its application in clinical practice is to be established. Raised intracranial pressure correlates with decreased survival and is often the only remediable element of brain pathology. While elimination of the cause of elevated ICP remains the definitive approach, there are maneuvers that should be used to decrease ICP urgently. Surgical decompression of mass effect may rapidly improve ICP elevation. Osmolar therapy, maintenance of euvolemia, cerebral metabolic suppression, and temperature control are part of the advanced management of elevated ICP.

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Osmole gap in neurologic-neurosurgical intensive care unit: Its normal value, calculation, and relationship with mannitol serum concentrations

Abstract: The osmole gap correlates better with mannitol serum concentrations than osmolality, and although it cannot predict a specific mannitol serum concentration, a normal osmole gap concentration, as we find at trough times, indicates sufficient clearance for a new mannitol dose.

Cited by 84 publications

References 27 publications

Variation in Osmotic Response to Sustained Mannitol Administration

Variation in Osmotic Response to Sustained Mannitol Administration

Diretrizes para o manejo de pacientes com hemorragia intraparenquimatosa cerebral espontânea

Measurement and Management of Increased Intracranial Pressure

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