Which of the following diuretics would be most useful in patient with cerebral edema?
Loop diuretics (Furosemide) can be used as an adjunct. Furosemide (0.7 mg/kg) has been shown to prolong the reversal of blood brain osmotic gradient established with the osmotic agents by preferentially excreting water over solute [1].
What type of diuretics is being used to treat cerebral edema?
Mannitol. A potent osmotic diuretic, mannitol has been the mainstay of therapy to treat or prevent cerebral oedema and increased ICP, and improve CPP in patients with cerebral disease or injury.
How is osmotherapy done?
This is accomplished by intravenous administration of osmotic agents which increase serum osmolality in order to shift excess fluid from intracellular or extracellular space of the brain to intravascular compartment. The resulting brain shrinkage effectively reduces intracranial volume and decreases ICP.
What is the treatment for cerebral edema?
Treatment for cerebral edema targets the underlying cause and any life-threatening complications. Treatments include hyperventilation, osmotherapy, diuretics, corticosteroids, and surgical decompression.
What is the goal of osmotherapy?
The primary purpose of osmotherapy is to improve elasticity and decrease intracranial volume by removing free water, accumulated as a result of cerebral edema, from brain’s extracellular and intracellular space into vascular compartment by creating an osmotic gradient between the blood and brain.
What is vasogenic edema?
Vasogenic edema is defined as extracellular accumulation of fluid resulting from disruption of the blood-brain barrier (BBB) and extravasations of serum proteins, while cytotoxic edema is characterized by cell swelling caused by intracellular accumulation of fluid.
How does dexamethasone reduce edema?
Although corticosteroids decrease capillary permeability in the tumor itself, it has been found in animal models that dexamethasone may act differently and decrease edema by effects on bulk flow away from the tumor (Molnar, Lapin, & Goothuis, 1995).
What is the site of action of the diuretic mannitol?
Mannitol is the prototype of these diuretics. The mechanism by which mannitol produces diuresis is that it increases the osmotic pressure within the lumen of the proximal tubule and the loop of Henle. This causes enhanced water diuresis and, to a lesser extent, sodium and potassium excretion.
