Francesca Morelli, H De Geus and M van der Jagt
Erasmus University Medical Center, The Netherlands
Posters & Accepted Abstracts: J Neurol Neurophysiol
Once traumatic brain injury (TBI) has occurred, management at the Intensive Care Unit aims to reduce intracranial hypertension and cerebral edema and improve cerebral perfusion. Medical treatment for raised intracranial pressure (ICP) includes hyperosmolar therapy, which shifts fluids from the cerebral-to the vascular compartment. Next to the effect of osmotic agents on sodium and water balance, TBI itself can lead to sodium disorders, mainly due to pituitary dysfunction. Since both hypo- and hypernatremia are associated with increased morbidity and mortality, prompt recognition and adequate treatment are mandatory. Actually, management of dysnatremia in TBI patients can be challenging. Firstly, osmotic therapy makes interpretation of clinical and laboratory findings uncertain. Secondly, sodium fluctuation after treatment may worsen cerebral injury. In order to discuss these diagnostic and therapeutic dilemmas, we present the emblematic case of a young woman with severe TBI. While on high dose Mannitol, patient developed severe hypernatremia and polyuria. In this setting, osmotic diuresis and diabetes insipidus were difficult to recognize. Later on during admission hyponatremia occurred, probably due to syndrome of inappropriate antidiuretic hormone secretion (SIAD) or glucocorticoid insufficiency. This case clearly shows how challenging sodium disorders can be, especially in the delicate phase of post-TBI management.
Francesca Morelli was born in 1983 in a small town in Tuscany (Italy). She grew up nearby the sea and after Classical studies; she graduated at the Medical School of Pisa in 2008. She then moved to The Netherlands and started her Internal Medicine Residency, at the Erasmus Medical Center, Rotterdam. During this residency, she has been working for 5 months at the Department of Infectious Diseases of Tygerberg Hospital, Cape Town. In 2017 she started a fellowship Intensive Care at the Erasmus Medical Center, which she will conclude in April this year. Nowadays, she is moving to Trento with her partner and their son, to enjoy the beauty and calm of the Dolomites.
E-mail: francescamorelli1ju@gmail.com
