What would happen if a patient with cerebral edema was given a hypotonic IV solution?
Answers
Large amounts of hypo-osmolar or hypotonic fluids reduce plasma osmolality, drive water across the blood brain barrier (BBB), and increase cerebral water content and ICP. ... Therefore , hypo-osmolar crystalloids (0.45% NaCl or D5W) should be avoided in neurosurgical patients [50].
When the plant cell is placed in a hypotonic solution , it takes up water by osmosis and starts to swell, but the cell wall prevents it from bursting. The plant cell is said to have become "turgid" i.e. swollen and hard. The pressure inside the cell rises until this internal pressure is equal to the pressure outside.
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Movement of water between the brain and the intravascular space is dependent on osmotic gradients, which may be established by the acute administration of either hyper- or hypo-osmolar solutions. Mannitol, a hypertonic crystalloid solution, is commonly used to decrease brain water content and reduce intracranial pressure (ICP). Hypertonic saline solutions also decrease brain water and ICP while temporarily increasing systolic blood pressure and cardiac output. Hypo-osmolar solutions, such as 5% dextrose in water, reduce serum sodium and increase brain water and ICP. Colloid solutions exert little influence on either variable. Fluid restriction minimally affects cerebral edema and, if pursued to excess, may result in episodes of hypotension, which may increase ICP and are associated with worse neurologic outcome. Although there is no single best fluid for patients with traumatic brain injury, isotonic crystalloids are widely used and can be justified on a scientific basis.
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