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Related Concept Videos

Increased Intracranial Pressure l: Introduction01:14

Increased Intracranial Pressure l: Introduction

Intracranial hypertension is a sustained elevation of intracranial pressure (ICP) above 22 mm Hg. In supine adults, normal ICP is ~7–15 mm Hg.The rigid, nonexpandable cranium contains three components—brain tissue, blood, and cerebrospinal fluid (CSF)—that total ~1,700 mL in a typical adult: 1,400 mL brain (~80%), 150 mL blood (~10%), and 150 mL CSF (~10%). According to the Monro–Kellie doctrine, total intracranial volume is effectively fixed. When one component expands, CSF and venous blood...
Increased Intracranial Pressure ll: Pathophysiology01:29

Increased Intracranial Pressure ll: Pathophysiology

Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins with...
Cerebral Edema l: Introduction01:19

Cerebral Edema l: Introduction

Cerebral edema is a pathological increase in brain water content that disrupts intracranial pressure regulation and impairs neurological function. Because the cranial vault is rigid, even modest increases in tissue volume can compromise cerebral perfusion, distort neural structures, and initiate secondary injury. Cerebral edema develops through four principal mechanisms: vasogenic, cytotoxic, interstitial, and ionic.Vasogenic EdemaVasogenic edema arises from disruption of the blood–brain...
Osmosis and Osmotic Pressure of Solutions02:40

Osmosis and Osmotic Pressure of Solutions

A number of natural and synthetic materials exhibit selective permeation, meaning that only molecules or ions of a certain size, shape, polarity, charge, and so forth, are capable of passing through (permeating) the material. Biological cell membranes provide elegant examples of selective permeation in nature, while dialysis tubing used to remove metabolic wastes from blood is a more simplistic technological example. Regardless of how they may be fabricated, these materials are generally...
Cytotoxic Edema: Pathophysiology01:21

Cytotoxic Edema: Pathophysiology

Cytotoxic edema is a form of cerebral edema characterized by intracellular swelling of neurons, astrocytes, and other glial cells. It develops when the mechanisms responsible for maintaining ionic gradients across the cell membrane become impaired. Under normal physiological conditions, the sodium–potassium ATPase actively transports sodium ions out of the cell and potassium ions into the cell, preserving osmotic balance and enabling electrical signaling. This pump requires a continuous supply...
Cerebral Edema ll: Pathophysiology01:22

Cerebral Edema ll: Pathophysiology

Vasogenic edema is a major form of cerebral edema characterized by abnormal accumulation of fluid in the brain’s extracellular space due to disruption of the blood–brain barrier (BBB). The BBB is a specialized structure composed of endothelial cells connected by tight junctions, supported by astrocytic endfeet and a basement membrane. Under normal conditions, it tightly regulates the movement of ions, proteins, and solutes between the bloodstream and brain parenchyma. When this barrier loses...

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Related Experiment Video

Updated: Jun 24, 2026

A Detailed Protocol for Physiological Parameters Acquisition and Analysis in Neurosurgical Critical Patients
05:01

A Detailed Protocol for Physiological Parameters Acquisition and Analysis in Neurosurgical Critical Patients

Published on: October 17, 2017

[Intracranial pressure and hypotonic infusion solutions].

R Zander1

  • 1Physioklin, Luisenstr. 17, 55124, Mainz, Deutschland. zander@physioklin.de

Der Anaesthesist
|March 28, 2009
PubMed
Summary

Infusing hypotonic fluids can dangerously increase intracranial pressure (ICP), especially in patients with brain injuries. Maintaining isotonic fluids is crucial for patient safety and managing neurological conditions.

Area of Science:

  • Physiology
  • Neurosurgery
  • Intensive Care Medicine

Context:

  • Plasma osmolality is a critical physiological parameter, normally 288+/-5 mOsmol/kgH2O.
  • In vitro measurements may not reflect in vivo effects, as seen with 5% dextrose solution (D5W).
  • Intracranial pressure (ICP) is highly sensitive to changes in plasma osmolality.

Purpose:

  • To highlight the importance of fluid osmolality in clinical practice.
  • To emphasize the risks associated with administering hypotonic infusion solutions.
  • To provide guidance on appropriate fluid selection for patients, particularly those at risk of increased ICP.

Summary:

  • Physiological plasma osmolality is approximately 288 mOsmol/kgH2O.
  • Hypotonic solutions, like Ringer's lactate (256 mOsmol/kgH2O), shift water intracellularly.

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Last Updated: Jun 24, 2026

A Detailed Protocol for Physiological Parameters Acquisition and Analysis in Neurosurgical Critical Patients
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  • A mere 3% decrease in plasma osmolality can elevate ICP by 15 mmHg, underscoring the danger of hypotonic infusions.

    • Impact:

    • Avoidance of hypotonic fluid infusions is critical to prevent dangerous elevations in intracranial pressure (ICP).
    • Understanding the in vivo effects of infusion fluids is paramount for patient management, especially in neurocritical care.
    • Maintaining isotonicity (290+/-10 mOsmol/kgH2O) of infusion fluids is essential for neurological stability and patient safety.