par Brihaye, Jean
Référence Neurocirugía - Sociedad Luso-Española de Neurocirugía, 31, 1-2, page (100-102)
Publication Publié, 1973
Article révisé par les pairs
Résumé : This concise review deals with fluid and electrolyte unbalance and the metabolic disturbances seen in head injuries. The most important factor in the production of these is the severity of the injury. Generally parallel to the severity of the injury is the occurrence of hyperthermia which especially produces metabolic disturbance through the consumption of energy and the elevation of blood pressure with acceleration of heart rate. The author advises the use of the 'lytic cocktail' and if necessary the hypothermic blanket but not the routine use of hypothermia. An inadequate airway predisposes to post contusional acidosis. This can be recognized by determination of pCO 2, pO 2, and pH in the spinal fluid. If the use of hyperventilation is not adequate, tracheotomy and hyperventilation with air plus O 2 are sufficient to maintain a level of pO 2 above 90 mm Hg and of pCO 2 between 25 and 28 mm Hg. The syndromes of 'cerebral salt wasting' due to inappropriate secretion of antidiuretic hormone and of diabetes insipidus due to lack of antidiuretic hormone are contrasted. Hypernatremia is rare compared to hyponatremia but disturbances of potassium balance are usually not important. Negative nitrogen balance is often temporarily present because of increased protein catabolism but usually adjusts itself. The early determination of blood electrolytes and urea will reveal these disturbances and successive determinations are likewise essential as long as the patient's clinical condition remains serious. Hyperglycemic states are more common than generally realized and are related to hypersecretion of cortical hormone. All these metabolic difficulties seem due to biological stress and to some degree to the specific brain injury. It is believed that physiological doses of steroids are of value in cerebral contusions and at least 16 mg of dexamethasone in divided doses in 24 hr are routinely given. (Voris - Chicago, Ill.)