Bedeutung von Störungen des Elektrolyt- und Wasserhaushaltes in der neurologischen Intensivmedizin

Zusammenfassung

Die Bedeutung von Störungen des Wasser- und Elektrolythaushaltes für die Neurologie und insbesondere die Intensivmedizin ergibt sich aus der Häufigkeit dieser Veränderungen und der Tatsache, dass diese Veränderungen sowohl Folge einer neurologischen Grunderkrankung sein können, als auch Ursache neurologischer Symptome. Es werden Grundlagen des Wasser- und Elektrolythaushaltes kurz rekapituliert. Besonderes Gewicht wird auf die Hyponatriämie gelegt. Mechanismen der hyponatriämischen Enzephalopathie und der zentralen Myelinolyse werden dargelegt. Die derzeitig gültigen Therapieempfehlungen der akuten Hyponatriämie führen zu einem protrahierten Natriumausgleich (< 0,5 mmol Serumnatrium/h, < 12 mmol/ 24 h und < 24 mmol/48 h). Chronische Hyponatriämien sollten noch langsamer und vorsichtiger ausgeglichen werden. Auch Hypernatriämien sind bedrohlich und können eine Myelinolyse und Enzephalopathie erzeugen, wobei v. a. der osmotische Stress (Wechsel von Hyponatriämie zu Hypernatriämie) wichtig ist. Weitere Elektrolytstörungen, wie Hypo- und Hyperkaliämie, Hypo- und Hyperkalziämie, Hypo- und Hypermagnesiämie und Hypo- und Hyperphosphatämien werden in ihren neurologischen Auswirkungen und Therapiemöglichkeiten besprochen.

The Importance of Disturbed Electrolyte and Fluid Balance in Neurological Intensive-Care Medicine

Fluid and electrolyte disturbances are frequently seen in neurological patients, and especially in neurological intensive-care patients. The importance of these changes is underlined by the possible link to a neurological disease. Neurological symptoms may also occur as a consequence of a fluid or electrolyte imbalance. The pathophysiological base of the understanding of the fluid and electrolyte system is summarised. The emphasis of this review is on the most frequent electrolyte disorder, namely, hyponatremia. The mechanisms of hyponatremic encephalopathy and central pontine myelinolysis are discussed. The actual therapeutic recommendations point to a slow normalisation of acute hyponatremia (< 0.5 mmol serum sodium/1h, < 12 mmol/24 h, < 24 mmol/48 h). Hyponatremia caused by chronical changes may need even less active treatment. Hypernatremia may also cause an encephalopathy and myelinolysis. This seems to be rather an effect of osmotic stress (especially in hypernatremia subsequent to hyponatremia). A brief overview concerning the following electrolyte disorders relevant in neurological intensive care management is given: hypo- and hyperkalemia, hypo- and hypercalciemia, hypo- and hypermagnesiemia, and hypo- and hyperphosphatemia.

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