Prognosis of the Neurological Complications of Acute Hypernatræmia

Morris‐Jones, P. H.; Houston, I. B.; Evans, Richard C.

doi:10.1016/s0140-6736(67)93022-x

Cited by 134 publications

(51 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Plasma Na+ levels associated with brain damage in hypernatraemic patients have been in the range 160-190 mm (Zierler, 1958;Finberg, Kiley & Luttrell, 1963;Morris-Jones, Houston & Evans, 1967; Snyder, Feigal & Arieff, 1987). Previous studies on animals from both our laboratory and others suggest that central nervous system damage or death can occur as a consequence of untreated hypernatraemia (Finberg et al 1963;Morris-Jones et al 1967;De Villota, Cavanilles & Stein, 1973; Simmons, Adcock, Bard & Battaglia, 1974;Snyder et al 1987), but the mechanisms responsible are unclear.Improper therapy of hypernatraemia can also produce brain dysfunction, neurological deterioration and death (Lutrell & Finberg, 1959;Hogan, Dodge & Gill, 1969 …”

mentioning

confidence: 99%

“…In the UK, there are multiple reports of death or permanent brain damage as a consequence of lack of knowledge of definitive therapy for the disorder in children (e.g. Morris-Jones et al 1967;Macaulay & Watson, 1967).…”

mentioning

confidence: 99%

“…Some anatomical abnormalities, cerebral haemorrhage or thrombosis, have been reported in the brains of patients and animals who have died with hypernatraemia (Finberg, Luttrell & Redd, 1959; Morris-Jones et al 1967). There is information in the literature suggesting that hypernatraemia can induce demyelinative lesions in humans (Ayus, Krothapalli & Arieff, 1987;McKee, Winkelman & Banker, 1988;Clark, 1992).…”

mentioning

confidence: 99%

See 2 more Smart Citations

Effects of hypernatraemia in the central nervous system and its therapy in rats and rabbits.

Ayus

Armstrong

Arieff

1996

The Journal of Physiology

View full text Add to dashboard Cite

1. We studied the effects of acute (1 or 4 h) and chronic (1 week) hypernatraemia (plasma [Na+], 170-190 mM) on brain histology, and brain water and solute contents in rats and rabbits. 2. In rabbits with acute hypernatraemia, there was significant loss of intracelluar brain water, with increases in brain [Na+ + K+], amino acid concentration, and undetermined solute (idiogenic osmole). After 1 week of recovery, brain intracellular water content had returned to normal. 3. In hypernatraemic rats there was myelinolysis of brain white matter, with karyorrhexis and necrosis of neurons.4. Hypernatraemic rabbits were treated with 77 mm NaCl (i.v.) to normalize plasma [Nae] over 4-24 h intervals. Therapy of either acute or chronic hypernatraemia resulted in significant brain oedema because brain osmolality failed to decrease at the same rate as plasma osmolality. 5. It is concluded that: (a) untreated hypernatraemia results in brain lesions demonstrating myelinolysis and cellular necrosis; (b) normalization of hypernatraemia over 4-24 h results in cerebral oedema, due primarily to failure of brain amino acids and idiogenic osmoles to dissipate as plasma [Na+] is decreased to normal.Hypernatraemia is a common clinical condition which tends to affect individuals at the extremes of age -children and the elderly -and frequently leads to central nervous system damage or death. Plasma Na+ levels associated with brain damage in hypernatraemic patients have been in the range 160-190 mm (Zierler, 1958;Finberg, Kiley & Luttrell, 1963;Morris-Jones, Houston & Evans, 1967; Snyder, Feigal & Arieff, 1987). Previous studies on animals from both our laboratory and others suggest that central nervous system damage or death can occur as a consequence of untreated hypernatraemia (Finberg et al. 1963;Morris-Jones et al. 1967;De Villota, Cavanilles & Stein, 1973; Simmons, Adcock, Bard & Battaglia, 1974;Snyder et al. 1987), but the mechanisms responsible are unclear.Improper therapy of hypernatraemia can also produce brain dysfunction, neurological deterioration and death (Lutrell & Finberg, 1959;Hogan, Dodge & Gill, 1969 METHODS Studies in rabbitsThe experimental protocol was approved by the Animal Studies Subcommittee (Veterans Administration Medical Center, San Francisco, CA, USA). Rabbits were used to study the effects of hypernatraemia on brain water and solute content because in this species grey matter can be readily isolated, and also because of our substantial experience in brain analysis using rabbit models of fluid and electrolyte disorders (Arieff, Doerner, Zelig & Massry, 1974a;Arieff, Kleeman, Keushkerian & Bagdoyan, 1974b). Studies were carried out on New Zealand White rabbits (3-4 kg) of both genders, in which hypernatraemia was induced either acutely for periods of 1 or 4 h, or chronically for 7 days. Hypernatraemic rabbits were then treated over intervals of 4-24 h, to return the plasma [Na+] to normal values (below 150 mM). The following goups of rabbits were studied. Group I: effects of acute untreated hypernatraem...

show abstract

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Effects of hypernatraemia in the central nervous system and its therapy in rats and rabbits.

Ayus

Armstrong

Arieff

1996

The Journal of Physiology

View full text Add to dashboard Cite

show abstract

“…Neurologic sequelae are described among children with hypernatremia (15). Moreover, a recent prospective study revealed abnormal neurological development in more than half the infants admitted due to breastfeedingassociated hypernatremia (16).…”

Section: Discussionmentioning

confidence: 99%

Severe hypernatremic dehydration in a breastfed infant

2016

View full text Add to dashboard Cite

Objective -To report a rare case of hypernatremic dehydration in an exclusively breastfed infant. Case report -We present a term newborn, 14-day-old boy, exclusively breastfed, who was lethargic and severely dehydrated upon admission (35% birth weight loss). The newborn was found to have severe hypernatremic dehydration (Na + 197 mmol/l), acute renal insufficiency (Creatinine 273 µmol/l) and metabolic acidosis. Also, the blood culture result was positive. Intravenous rehydration and antibiotic therapy were started. After 22 days of hospitalization, the infant was discharged home in a good general condition. Now the child is 13 months old, he is healthy and no neurologic sequelae are noticed. Conclusion -Hypernatremic dehydration in newborns is a rare complication, which is dangerous, but also preventable. Prevention consists in educating mothers about successful breastfeeding techniques, and also early newborn reassessment after discharge from the hospital is mandatory.

show abstract

“…Pre-operative serum hyperkalaemia and hypokalaemia did not show any increased risk in adverse outcome whilst postoperative hyperkalaemia had a slightly increased risk however this was not statistically significant (p=0.659). Studies carried out by Morris-Jones et al and Arieff et al, have shown that sodium imbalance can cause confusion, seizures, cerebral bleeding and death 28,29 . Potassium imbalance may cause arrhythmias and cardiac arrest which may lead to death 29 , however none were reported in this study.…”

Section: Serum Electrolyte Levelsmentioning

confidence: 99%

Factors Influencing Outcome of Sigmoid Volvulus in Northern Uganda. A Prospective Observational Study

Wismayer¹

2017

East. Cent. Afr. J. Surg.

View full text Add to dashboard Cite

Introduction: Sigmoid volvulus (SV) is one of the commonest causes of intestinal obstruction inUganda. The purpose of this study was to determine the factors influencing the outcome of SV in Northern Uganda. Methodology: A prospective observational study was conducted on 103 sigmoid volvulus patients admitted between January 2012 to December 2012 and surgically managed in 19 hospitals in Northern Uganda and followed up postoperatively for 30 days. Surgical management was by resection and primary anastomosis or Hartmann's procedure or double barrel colostomy. Patients 13 years and above with sigmoid volvulus and who had consented/Assented were included in the study and followed up to the 30 th postoperative day. Ethical approval for the study was obtained from the Institutional Review Committee of Gulu University and Uganda National Council for Science and Technology. Data analysis was carried out using STATA/IC version 12.1. The outcome events were uneventful recovery, morbidity and mortality. Results: Eighteen(17.48%) patients developed complications including wound sepsis 10 (9.7%); wound dehiscence 8(7.7%) and anastomotic leak 8(7.7%). There were 8 deaths, giving a mortality rate of 7.7%. The factors associated with a high risk of adverse outcome were hypernatraemia (RR=14.9; 95% CI: 1.46-152.9) and ileo-sigmoid knotting (RR = 4.94; 95% CI: 1.30-18.78). Resection and primary anastomosis had a better outcome compared to Hartmann's procedure (RR=0.15; 95% CI: 0.02-0.099). Conclusion: The risk factors associated with morbidity and mortality were preoperative hypernatraemia and ileo-sigmoid knotting. Colostomy was associated with a higher risk of morbidity and mortality than resection and primary anastomosis.

show abstract

Prognosis of the Neurological Complications of Acute Hypernatræmia

Cited by 134 publications

References 20 publications

Effects of hypernatraemia in the central nervous system and its therapy in rats and rabbits.

Effects of hypernatraemia in the central nervous system and its therapy in rats and rabbits.

Severe hypernatremic dehydration in a breastfed infant

Factors Influencing Outcome of Sigmoid Volvulus in Northern Uganda. A Prospective Observational Study

Contact Info

Product

Resources

About