Potentially Detrimental Effects of Hyperosmolality in Patients Treated for Traumatic Brain Injury

• Main Authors: Wojciech Dabrowski, Dorota Siwicka-Gieroba, Chiara Robba, Magdalena Bielacz, Joanna Sołek-Pastuszka, Katarzyna Kotfis, Romuald Bohatyrewicz, Andrzej Jaroszyński, Manu L. N. G. Malbrain, Rafael Badenes
• Format: Article
• Language: English
• Published: MDPI AG 2021-09-01
• Series: Journal of Clinical Medicine
• Subjects: osmolality; traumatic brain injury (TBI); hypertonic saline; mannitol; osmolar gap
• Online Access: https://www.mdpi.com/2077-0383/10/18/4141

Hyperosmotic therapy is commonly used to treat intracranial hypertension in traumatic brain injury patients. Unfortunately, hyperosmolality also affects other organs. An increase in plasma osmolality may impair kidney, cardiac, and immune function, and increase blood–brain barrier permeability. These effects are related not only to the type of hyperosmotic agents, but also to the level of hyperosmolality. The commonly recommended osmolality of 320 mOsm/kg H₂O seems to be the maximum level, although an increase in plasma osmolality above 310 mOsm/kg H₂O may already induce cardiac and immune system disorders. The present review focuses on the adverse effects of hyperosmolality on the function of various organs.