Mannitol/sodium chloride
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Polyuria with multiple complications: case report A 32-year-old man developed polyuria, complicated by hypokalaemia, hypophosphataemia, rhabdomyolysis, acute kidney injury (AKI) and rebound hyperkalaemia, during treatment with mannitol and sodium chloride for elevated intracranial pressure following a subarachnoid haemorrhage. The man, who was admitted to the ICU with near-complete thrombosis of a ruptured left P2-3 junction posterior cerebral aneurysm following a subarachnoid haemorrhage, developed elevated intracranial pressure. He started receiving mannitol and sodium chloride [hypertonic saline; routes and dosages not stated], which resulted in marked polyuria [durations of treatments to reaction onset not stated]. The man received potassium chloride and potassium phosphate over 48h; however, he developed severe hypokalaemia and hypophosphataemia. He developed septic shock secondary to ventilator-associated pneumonia, which required treatment with norepinephrine. Also, he developed rhabdomyolysis due to hypokalaemia-induced regional muscular ischaemia and hypophosphataemia-induced adenosine triphosphate depletion; along with stage III AKI. Later, he developed rebound hyperkalaemia, and he started receiving continuous renal replacement therapy, which failed to control the hyperkalaemia. Therefore, he required intermittent haemodialysis. The renal function was observed to have recovered on hospital day 27, and he was moved out of the ICU on hospital day 30. On day 38, he was discharged to a rehabilitation facility. He underwent successful deferred aneurysm intervention, with a sequela of the right homonymous hemianopsia at the time of the report. Potassium homoeostasis was noted to be normal. Author comment: "Elevated intracranial pressure was managed with mannitol and hypertonic saline, resulting in marked polyuria. Severe hypokalemia and hypophosphatemia followed". "Rhabdomyolysis was due to hypokalemia-induced regional muscular ischemia and hypophosphatemia-induced adenosine triphosphate depletion." Alvarez B, et al. Subarachnoid hemorrhage and rhabdomyolysis: Understanding critical electrolyte derangements. Critical Care Medicine 47 (Suppl. 1): 700 abstr. 1448, No. 1, Jan 2019. Available from: URL: http:// 803432026 doi.org/10.1097/01.ccm.0000552192.99784.9b [abstract] - USA
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Reactions 9 Nov 2019 No. 1778
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