[Fluid and nutritional management in severe head injuries]

Fluid management, electrolyte balance and nutritional support had been examined for 14 days in 39 patients of severe head injury under intracranial pressure (ICP) monitoring. When ICP value exceeded 25 mmHg, barbiturate was administered in addition to the conventional therapy. Restriction of fluid administration should depend upon ICP values. When the ICP value was 20 mmHg or less and basal cisterns or ventricular systems were not obliterated in serial CT scan, fluid administration was not restricted in most patients. Mean urine volume was measured 2500 ml/day and mean water balance was measured about 0 to 700 ml/day with large deviation. Urine output and specific gravity was checked every hour and water balance was evaluated every day. When excess urine output or dehydration was recognized, additional fluid was given to keep within 500 ml/day in water balance. Through the examination, no patients of dehydration nor azotemia were experienced. Out of 39, 22 were survived and 17 were expired. In expired patients, 13 patients was recognized dead or brain death within 72 hours of injury. In two patients (one is suffered from severe brainstem injured patient with corpus callosal hemorrhage and another patient with post operative cerebral swelling) cerebral herniation was recognized about 72 hour after injury. Remaining 2 patients died after 7 days. Patients with hypernatremia were recognized 3 (13.7%) out of 22 survivals, and 14 (82.4%) out of 17 expired patients. It was recognized more common within 3 days of injury. Hypernatremia more than 160 mEq/l was accounted 5 (29.4%) in expired patients, but non in survivals.(ABSTRACT TRUNCATED AT 250 WORDS)