Hypertonicity

Aperture impedance measurements of cell volume must take into account the osmolaUty and pH of the medium. A hypotonic medium causes cells to swell a hypertonic medium causes them to shrink. Some manufacturers of aperture impedance counters deHberately provide hypertonic electrolytic media for red blood cell measurements. The shmnken red cells not only become more nearly spherical and thus less affected by orientation, but also less deformable than cells in isotonic media and thus less affected by differences in hemoglobin content. 

Administration of oxytocin may result in fetal bradycardia, uterine rupture, uterine hypertonicity, nausea, vomiting, cardiac arrhythmias, and anaphylactic reactions. Serious water intoxication (fluid overload, fluid volume excess) may occur, particularly when the drug is administered by continuous infusion and the patient is receiving fluids by mouth. When used as a nasal spray, adverse reactions are rare. 

Oxytocin is contraindicated in patients with known hypersensitivity to the drug, cephalopelvic disproportion, unfavorable fetal position or presentation, in obstetric emergencies, situations of fetal distress when delivery is not imminent, severe toxemia (preeclampsia, eclampsia), hypertonic uterus, during pregnancy (intranasal administration), when there is total placenta previa, or to induce labor when vaginal delivery is contraindicated. Oxytocin is not expected to be a risk to the fetus when administered as indicated. When oxytocin is administered with vasopressors, severe hypertension may occur. 

If contractions are frequent, prolonged, or excessive, die infusion is stopped to prevent fetal anoxia or trauma to die uterus. Excessive stimulation of die uterus can cause uterine hypertonicity and possible uterine rupture. The nurse places die patient on her side and provides supplemental oxygen. The effects of die drug diminish rapidly because oxytocin is short acting. 

A substrate is a substance that is the basic component of an organism. Protein substrates are amino acids, which are essential to life Protein substrates are amino acid preparations that act to promote the production of proteins (anabolism). Amino acids are necessary to promote synthesis of structural components, reduce the rate of protein breakdown (catabolism), promote wound healing, and act as buffers in the extracellular and intracellular fluids. Crystalline amino acid preparations are hypertonic solutions of balanced essential and nonessential amino acid concentrations that provide substrates for protein synthesis or act to conserve existing body protein. 

The most common adverse reaction associated with the administration of fat emulsion is sepsis caused by administration equipment and thrombophlebitis caused by vein irritations from concurrently administering hypertonic solutions. Less frequently occurring adverse reactions include dyspnea, cyanosis, hyperlipidemia, hypercoagulability, nausea, vomiting, headache flushing, increase in temperature sweating, sleepiness, chest and back pain, slight pressure over the eyes, and dizziness. 

Very large doses can cause vomiting, diarrhea, and prostration. Dehydration and congestion occur in most internal organs. Hypertonic solutions can produce violent inflammatory reactions in the gastrointestinal tract. 

Meryman, H.T. (1970). The exceeding of a minimum tolerable cell volume in hypertonic suspension as a cause of freezing injury. In The Frozen Cell, Ciba Foundation Symposium (Wolstenholme, G.E.W. O Connor, M., eds.), pp. 51-64, Churchill, London. 

Cardiac arrhythmia Hypertonic crisis Pulmonary embolus Capillary leak syndrome... 

Some types of injections must be made iso-osmotic with blood serum. This applies particularly to large-volume intravenous infusions if at all possible hypotonic solutions cause lysis of red blood corpuscles and thus must not be used for this purpose. Conversely, hypertonic solutions can be employed these induce shrinkage, but not lysis, of red cells which recover their shape later. Intraspinal injections must also be isotonic, and to reduce pain at the site of injection so should intramuscular and subcutaneous injections. Adjustment to isotonicity can be determined by the following methods. 

Osmotherapy employs agents such as mannitol, glycerol, and hypertonic saline to create an osmotic gradient between the brain (optimally, the edematous infarcted tissue) and the bloodstream, such that water is drawn out from the brain, thereby reducing edema. Each of these agents has been shown to be effective, and may be used alone or in combination with a diuretic, such as furosemide. Their action, however, depends upon an intact blood-brain barrier (BBB), and concerns have been raised for possible paradoxical worsening when one is absent. In this hypothesis, mannitol extravasates from the vessel into the interstitial tissue and water follows a new osmotic... 

Hypertonic sahne is actively excluded from an intact BBB and also acts to draw water into the intravascular space by the creation of a sodium gradient. Various concentrations have been evaluated, with continuous sodium chloride infusions ranging from 3% to 9%, and bolus infusions up to 23.4% administered over 20 minutes in a 30 mL solution. When a continuous infusion is used, the serum sodium is typically titrated to the 155-160 range. Sodium levels above this range raise the concern for seizures and other toxic side effects. Hypertonic saline may hold an advantage over mannitol, as it has been found in animal models to decrease edema in both... 

Hypertonic Reduces brain water 23.4% NaCl IV bolus over Serum Na, Osm Do not Renal failure... 

Schwarz S, Schwab S, Bertram M, Aschoff A, Hacke W. Effects of hypertonic saline hydroxyethyl starch solution and mannitol in patients with increased intracranial pressure after stroke. Stroke 1998 29(8) 1550-1555. 

Toung TJ, Hum PD, Traystman RJ, Bhardwaj A. Global brain water increases after experimental focal cerebral ischemia effect of hypertonic sahne. Crit Care Med 2002 30(3) 644-649. 

Qureshi A, Suarez JI. Use of hypertonic saline solutions in treatment of cerebral edema and intracranial hypertension. Crit Care Med 2000 28(9) 3301-3313. 

Lee K, Melinosky C, Cacciola J, Bodock M, Guanci M, Rordorf G, Badjatia N. Hypertonic sahne therapy for intracranial hypertension refractory to mannitol. Neurology 2005 64 S305. 

Flores, J., Dibona, D.R., Beck, C.H. and Leaf, A. (1972). The role of ceU sweUing in ischaemic renal damage and the protective effect of hypertonic solute. J. Clin. Invest. 51, 118-126. 

HBBS Hank s balanced salt solution HCA Hypertonic citrate H-CAM Hyaluronic acid cell adhesion molecule HDC Histidine decarboxylase... 

All infants developed deviant neurobehavioral symptoms within the first 24 hours of life. Most commonly, the neonates were found to have symptoms of irritability, tremors, and hypertonicity. Bizarre eye movements and staring spells were seen in 25 percent of infants. Poor sucking, lethargy, diarrhea, and facial twitching, symptoms commonly associated with prenatal opiate exposure, were seen infrequently in these PCP-addicted infants. 

Myoclonus (inducible or spontaneous), muscular hypertonicity, shivering, tremor, akathesia, tachycardia, mydriasis, and ocular clonus... 

Example, sodium-rich medications, sodium bicarbonate, hypertonic IV fluids, nutrition, enemas, dialysis, plasma products (sodium citrate content)... 

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