الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Disorders of sodium and water homeostasis are common in critically ill neurologic patients. A high index of suspicion should therefore be maintained in this patient group. Proper management necessitates an accurate diagnosis of the type of dysnatremia.
The study illustrates common and important treatment problems in the dysnatraemic patients. The optimal treatment of hyponatremia is controversial, but appropriate treatment must be determined according to the osmolality and volume status of the patient. If left untreated, serious CNS complications and adverse outcomes, including an increased risk of death, can occur.
Asymptomatic patients can be managed successfully with a logical approach to diagnosis and a period of close monitoring. Treatment should be restricted to acute symptomatic patients in whom the associated mortality is significantly higher than the normal population.
In most cases, hyponatremia is associated with hypotonicity, which causes water to move into the brain. Adaptive responses limit the impact of cerebral edema in chronic hyponatremia, but CNS symptoms and death may occur in response to rapid or large decreases in serum [Na+]. The prompt correction of serum [Na+] is mandatory in symptomatic patients, but overly rapid correction must be avoided to limit the risk of myelinolysis.
In hyponatraemic patients, any correction exceeding 10 mmol/l/day must be avoided to reduce the risk of OD. In neurologic disorders, euvolemic hyponatremia (usually caused by the syndrome of inappropriate secretion of antidiuretic hormone) must be distinguished from hypovolemic states such as cerebral salt wasting because the treatment of the 2 conditions differs.
On the other hand ,Regarding patients developing hypernatraemia in the ICU , pivotal is treatment of the underlying diseases and restoration of the distorted water and salt balances based on knowledge of what determines P-[Na+].
Multiple combined mechanisms are common and must be identified. Reduction of P-[Na+]/plasma tonicity in hypernatraemia is important, but should not exceed 10 mmol/l/day to reduce the risk of rebounding brain oedema.
Prudent selection of therapeutic strategies and diligent monitoring are important steps to preventing potentially fatal consequences as a result of contrasting treatment strategies for the various types of sodium disorders.