The effect of hypertonic sodium chloride on intracranial pressure in patients with acute liver failure

@article{Murphy2004TheEO,
  title={The effect of hypertonic sodium chloride on intracranial pressure in patients with acute liver failure},
  author={Nicholas Murphy and Georg Auzinger and William Bernel and Julia A. Wendon},
  journal={Hepatology},
  year={2004},
  volume={39}
}
Acute liver failure (ALF) is a rare condition characterized by the development of encephalopathy in the absence of chronic liver disease. Cerebral edema occurs in up to 80% of patients with Grade IV encephalopathy. In the current prospective randomized controlled clinical trial, we examined the effect of induced hypernatremia on the incidence of intracranial hypertension (IH) in patients with ALF. Thirty patients with ALF and Grade III or IV encephalopathy were randomized. Patients in Group 1… 
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308 Citations
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Methods Citations
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308 Citations

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TLDR
It is concluded that CHS administration in patients with severe injuries is safe as long as sodium levels are carefully monitored, and there was a significant risk of developing hypernatremia.
Therapeutic Hypothermia for Acute Liver Failure: Toward a Randomized, Controlled Trial in Patients with Advanced Hepatic Encephalopathy
TLDR
A randomized, controlled trial comparing the management of ALF patients under normothermic and hypothermic conditions is a logical extension of preliminary observations and considers the many difficulties which will be encountered in the design of such a trial in patients with ALF at high risk of developing cerebral edema.
Early continuous hypertonic saline infusion in patients with severe cerebrovascular disease
TLDR
Early and continuous infusion of hypertonic saline in patients with severe cerebrovascular disease and impending intracranial hypertension is safe and might reduce the frequency of intrac Cranial pressure crises and mortality rate.
Encephalopathy and Cerebral Edema in the Setting of Acute Liver Failure: Pathogenesis and Management
TLDR
Treatment should be focused at optimizing liver function and regenerative capacity and minimizing the inflammatory milieu, and the use of cooling in the management of patients with acute liver failure and raised intracranial pressure is developed.
Therapeutic hypernatremia management during continuous renal replacement therapy with elevated intracranial pressures and respiratory failure
TLDR
Maintaining plasma hypertonicity in the setting of increased ICP and acute kidney injury could prevent the worsening of ICP during renal replacement therapy by minimizing the osmotic gradient across the blood-brain barrier and maximizing cardiovascular stability.
Acute liver failure: current management and future prospects.
  • R. Jalan
  • Medicine
    Journal of hepatology
  • 2005
Keeping cool in acute liver failure: rationale for the use of mild hypothermia.
A multicentre randomized controlled trial of moderate hypothermia to prevent intracranial hypertension in acute liver failure.
Intracranial pressure monitoring in acute liver failure. A procedure with clear indications
TLDR
The best answer to the challenge is, when possible, to prevent the sometimes avoidable aggravating, or accelerating, factors of encephalopathy in patients with acute liver disease and severe coagulopathy but still without neurological symptoms.
Therapeutic hypothermia for acute liver failure
TLDR
Although an ample body of experimental and human data provides a rationale for the use of therapeutic Hypothermia in patients with acute liver failure, multicenter, randomized, controlled clinical trials are needed to confirm that hypothermia secures brain viability and improves survival without causing harm.
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References

SHOWING 1-10 OF 41 REFERENCES
Use of hypertonic saline in the treatment of severe refractory posttraumatic intracranial hypertension in pediatric traumatic brain injury
TLDR
An increase in serum sodium concentration significantly decreases ICP and increases CPP andHypertonic saline is an effective agent to increase serum sodium concentrations and hyperosmolarity are safely tolerated in pediatric patients with traumatic brain injury.
Subclinical Seizure Activity and Prophylactic Phenytoin Infusion in Acute Liver Failure: A Controlled Clinical Trial
TLDR
It is recommended that patients with ALF, on reaching the stage of grade III or IV encephalopathy, should be routinely monitored for subclinical seizure activity, and prophylaxis with phenytoin reduced the frequency of such seizure activity and its effects, and proved to be safe with the regimen used.
Controlled trial of dexamethasone and mannitol for the cerebral oedema of fulminant hepatic failure.
A controlled trial of 44 patients was undertaken to evaluate the use of dexamethasone (32 mg stat, 8 mg qds) in preventing, and intravenous mannitol (1 g/kg) in reversing the cerebral oedema of…
Dissociated cerebral vasoparalysis in acute liver failure. A hypothesis of gradual cerebral hyperaemia.
The safety and value of extradural intracranial pressure monitors in fulminant hepatic failure.
Cerebral herniation in patients with acute E liver failure is correlated with arterial ammonia concentration
TLDR
In ALF in humans, vast amounts of ammonia escape hepatic metabolism, leading to high arterial ammonia concentrations, which in turn is associated with increased cerebral ammonia uptake and CH.
Cerebral blood flow and metabolism in fulminant liver failure
TLDR
The depressed cerebral metabolic rate for oxygen in patients with fulminant liver failure is inappropriate to metabolic requirements, as demonstrated by both cerebral lactate production and the increase in cerebral oxygen consumption after improvement in cerebral blood flow.
Treatment of hyponatraemic seizures with intravenous 29.2% saline.
Five patients with severe hyponatraemia and epileptiform seizures were given 50 ml of 29.2% saline (250 mmol) through a central venous catheter over 10 minutes to control seizures rapidly, reduce…
Use of hypertonic saline solutions in treatment of cerebral edema and intracranial hypertension
TLDR
Hightonic saline demonstrates a favorable effect on both systemic hemodynamics and intracranial pressure in both laboratory and clinical settings, and preliminary evidence supports the need for controlled clinical trials evaluating its use as resuscitative fluid in brain-injured patients with hemorrhagic shock.
Chronic hyponatremia exacerbates ammonia-induced brain edema in rats after portacaval anastomosis.
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