Diuretics

Rapid and dramatic reductions of most forms of cerebral edema may be accomplished with the use of osmotic diuresis. Osmotic diuretics elevate intravas-cular osmolarity, minimizing or reversing the osmotic pressure gradients that may participate in cerebral edema formation. Considerable integrity of the BBB is required because extravasation of osmotic agents across this interface may diminish their beneficial effect and potentially cause unintended fluid flux into the brain. Mannitol may also increase cerebral blood flow by reducing blood viscosity, leading to vasoconstriction and a resultant reduction in ICP. Other potentially effective osmotic diuretic agents include urea, glycerol, and hypertonic glucose or saline. However, excessive urea enters cells and causes an unwanted rebound increase in ICP. Chronic or excessive hyperosmolar states may precipitate renal injury. Loop diuretics including furosemide may also be beneficial, although hypovolemia may worsen neurologic outcome. Acetazolamide lowers ICP by decreasing production of CSF. Chronic use of acet-azolamide is not recommended because this therapy may result in systemic acidosis.

Conquering Fear In The 21th Century

Conquering Fear In The 21th Century

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