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By admin / March 15, 2015

Health Evaluation (APACHE) II scores at admission in both groups.Statistics.

Student’s t-test for unpaired results and, where necessary, Fisher’s

Exact test were used for comparison between groups 1 and 2.RESULTS

Mean age in group 1 was 42.3 ± 28.1 (range, 17-86) yrs. The average GCS at

Admission to our hospital was 6.2 ± 4.6 (range, 3-12). Two patients in group 1

Used medication that can be associated with loss of Mg and/or P (loop diuretic

And Thiazide diuretic, respectively). No preexisting risk factors for

Electrolyte loss were present in the other patients in group 1. The average age

In group 2 was 41.7 ± 20.1 yrs (range, 19-77). None of the patients in group 2

Used medication associated with electrolyte disorders.

Electrolyte levels at admission in group 1 vs. Group 2 were as follows (mean

± SD): Mg, 0.57 ± 0.17 (range, 0.24-0.85) vs.

0.88 ± 0.21 (range, 0.66-1.42 mmol/L; p <.01). P, 0.56 ± 0.17

(range, 0.20-0.92) vs. 1.11 ± 0.15 (range, 0.88-1.44 mmol/L; p <.01).

In group 1, 12/18 patients had Mg levels <0.70 mmol/L vs. 2/19 patients in

Group 2 ( p <.01); in group 1, 11/18 patients had P levels <0.60

Mmol vs. 0/19 patients in group 2 ( p <.01). Nine patients in group 1

Had received a single dose of mannitol (50-100 mg) before assessment of

Electrolytes The average time interval between mannitol administration and

Electrolyte assessment was <60 mins.

K levels were also lower in group 1 than in group 2 (3.54 ± 0.59 [range,

2.4-4.8[ vs. 4.07 ± 0.45 [range, 3.6-4.8] mmol/L; p <.02. Moderate

Hypokalemia (K levels below 3.6 mmol/L) was present in 8/18 patients in group 1

Vs. 1/19 patients in group 2 ( p <.01). Severe hypokalemia (K levels

Equal or lower than 3.0) was present in 4/18 patients in group 1 vs. 0/19

Patients in group 2 ( p <.05). Na levels were 146.2 ± 9.1 vs. 138.1

± 5.8 in groups 1 and 2, respectively. Six of 18 patients in group 1 had Na

Levels of 150 mmol/L or higher vs. 0/19 in group 2 ( p <.05). Ca

Levels were 2.02 ± 0.24 (range, 1.45-2.51) vs. 2.14 ± 0.20 (range, 1.88-2.46)

For groups 1 and group 2, respectively ( p =.1).

Fluid resuscitation in group 1 consisted of infusion of saline (nacl, 0.9%)

In 15 patients and of Na 0.45%/glucose 2.5% in three patients Average volume

Infused before ICU admission was 1060 ml. Two patients had also received blood

Transfusions. Of the patients in group 2, 12 received infusion of saline (nacl,

0.9%) and seven received Na 0.45%/glucose 2.5%. Average volume infused before

ICU admission was 860 ml. The difference in volume infused between groups 1 and

2 was not significant. Four patients also received blood transfusions before ICU

Admission. No hypertonic saline was used in our head injury patients.

Urine production in group 1 before admission was measured using a Foley

Catheter. The average residual urine volume upon insertion of the catheter was

1260 ml in group 1 vs. 380 ml in group 2 ( p <.01). The average urine

Production after catheter insertion but before ICU admission was 360 ml/hr in

Group 1 vs. 110 ml/hr in group 2 ( p <.01). Average urine output in

The first 3 hrs of ICU admission was 410 ml/hr in group 1 vs. 90 ml/hr in group

  1. This difference was also statistically significant ( p <.01). Urine

Excretion of Na in the first 3 hrs after ICU admission was higher in group 1 (34

Vs. 16 mmol/L for groups 1 and 2, respectively).

APACHE II scores were significantly higher in group 1 than in group 2 (22.4

± 7.8 vs. 6.1 ± 2.1), reflecting differences in GCS as well as other factors,

Such as tachycardia and tachycardic arrhythmias, episodes of low or high blood

Pressure, and electrolyte disorders (high Na levels and low K) present in group

  1. There were no differences in the presence of chronic diseases between groups

1 and 2. In-hospital mortality was significantly higher in group 1 (72% vs.

10.5%; p <.01). Treatment with one or more antiarrhythmic agents in

The course of their stay in the ICU was initiated in 15/18 patients in group 1

Vs. 5/19 patients in group 2 ( p <.01).DISCUSSION

Our results clearly demonstrate that patients with severe head injury are at

A high risk for the development of hypomagnesemia, hypophosphatemia,

Hypokalemia, and to a lesser extent, hypocalcemia when cerebral injury is

Present. Hypomagnesemia was associated with hypokalemia in most patients.