Related disorders that occur in severe cranio-cerebral trauma - Fluid and electrolyte balance disorders

More than half of patients with severe cranio-cerebral trauma disorders shows fluid and electrolyte balance. These disorders occur especially in patients in coma for more than 24 hours. Some of these desechilibre occur as a result of established treatment for cranio-cerebral trauma.In any patient will be monitored by mounting a fluid loss and a urine probes naso-gastric probe. If urine output increase and decrease the density of urine in the context of head trauma, diabetes insipidus should be suspect.Diabetes insipidus is due to lower contentratiei antidiuretic hormone (ADH or vasopressin), which is produced by the pituitary gland. Specifically, vasopressin (or ADH) is produced by neurons magnocelulari the nuclei of the hypothalamus and paraventriculari supraoptici and then stored in the posterior lobe of the pituitary gland. Hormone and protein that transports you pass the systemic circulation through a mechanism of calcium-dependent exocytosis.Vasopressin exerts its action in causing the renal distal tubule water reabsorption, leading to changes in osmolality and urine output. In severe head injuries, this hormone can be produced in insufficient quantities, because the kidneys will not be able to retain water and sodium, these elements eliminating urine.Moreover, vasopressin is responsible for arterial and arteriolar smooth muscle contraction, maintaining blood pressure at optimal levels.If vasopressin secretion decreases and remains low for longer, hypotension may occur with decreased renal perfusion, which will result in the occurrence of acute renal failure. In mild cases, replacement of fluid losses often proves sufficient. If you do not get the desired effect (that is reducing urine flow to normal value) then given vasopressin.Also, cardiac output must be maintained at normal levels, so will avoid increasing serum osmolality than 310-320 mosmol / L.Vasopressin secretion and osmotic pressure variation depends on variations in circulating blood volume. In case of mild cranio-cerebral trauma, the body reacts to stress situation by increasing the release of ADH and aldosterone (adrenal product) and so the kidneys retain water and sodium in the body.It may appear mild hyponatremia hypervolaemia by increasing intravascular volume of water. If ADH is secreted in large quantities, then hypervolaemia will worsen hyponatremia.Excessive secretion of ADH is found in the base of skull fractures, intracranial hypertension or the result of prolonged mechanical ventilation.