Increased intracranial pressure

SAFETY PROFILE Poison by intraperitoneal and intravenous routes. Moderately toxic by ingestion. A drug much used for motion sickness. Human systemic effects by ingestion arrhythmias, convulsions, distorted perceptions, hallucinations, intracranial pressure increase. Mutation data reported. When heated to decomposition it emits very toxic fiimes of NOx and Cl". See also AMINES. 

SAFETY PROFILE Poison by ingestion, intravenous, intraperitoneal, and subcutaneous routes. Human systemic effects mydriasis (pupillary dilation), hallucinations, distorted perceptions, pulse rate increase, intracranial pressure increase. An experimental teratogen. Experimental reproductive effects. When heated to decomposition it emits toxic fumes of NO and HCl. 

Increased intracranial pressure increased vagal tone from straining during defecation, vomiting, intubation, or mechanical ventilation sick sinus syndrome hypothyroidism and inferior-wall Ml. 

The narcotic antitussives are used cautiously in patients with head injury and increased intracranial pressure, acute abdominal disorders, convulsive disorders, hepatic or renal impairment, prostatic hypertrophy, and asthma or other respiratory conditions. 

When a patient taking mannitol for increased intracranial pressure is being assessed, which of the following finding would be most important for the nurse to report ... 

Cbnvulsions, steroid-induced catatonia, increased intracranial pressure with papilledema (usually after treatment is discontinued), vertigo, headache, neuritis or paresthesia, steroid psychosis, insomnia... 

The energy substrates are contraindicated in patients with hypersensitivity to any component of the solution. Dextrose solutions are contraindicated in patients with diabetic coma with excessively high blood sugar. Concentrated dextrose solutions are contraindicated in patients with increased intracranial pressure, delirium tremens (if patient is dehydrated), hepatic coma, or glucose-galactose malabsorption syndrome Alcohol dextrose solutions are contraindicated in patients with epilepsy, urinary tract infections, alcoholism, and diabetic coma... 

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. 

Lyons MK, Meyer FB. Cerebrospinal fluid physiology and the management of increased intracranial pressure. Mayo Clinic Proc 1990 65(5) 684—707. 

Acute complications of stroke include cerebral edema, increased intracranial pressure, seizures, and hemorrhagic conversion. In the acute setting, several supportive interventions and treatments to prevent acute complications should be initiated. 

Children treated with GH replacement therapy rarely experience significant adverse effects, whereas adults are more susceptible to dose-related adverse effects. Treatment with GH may mask underlying hypothyroidism. GH-induced symptoms, such as edema, arthralgia, myalgia, and carpal tunnel syndrome, are common and necessitate dose reductions in up to 40% of adults. Benign increases in intracranial pressure may occur with GH therapy and generally are reversible with discontinuation of treatment. Often, GH therapy can be restarted with smaller doses without symptom recurrence. 

Acute neurologic events, such as stroke, will require hospitalization and close monitoring. Patients should have physical and neurologic examinations every 2 hours.27 Acute treatment may include exchange transfusion or simple transfusion to maintain hemoglobin at around 10 g/dL (100 g/L or 6.2 mmol/L) and HbS concentration at less than 30%. Patients with a history of seizure may need anticonvulsants, and interventions for increased intracranial pressure should be initiated if necessary. Children with a history of stroke should be initiated on chronic transfusion therapy. Adults presenting with ischemic stroke should be considered for thrombolytic therapy if it has been less than 3 hours since the onset of symptoms.6,27... 

Corticosteroids play a key role in the management of SVCS, particularly in cases of lymphoma, because these tumors inherently respond to corticosteroid therapy. They are also helpful in the setting of respiratory compromise. Corticosteroids benefit patients who are receiving radiation therapy by reducing local radiation-induced inflammation and increased intracranial pressure. Dexamethasone 4 mg intravenously or by mouth every 6 hours is a frequently used regimen. The dosage should be tapered on completion of radiation therapy or resolution of symptoms. 

Papilledema Edema of the optic disc typically associated with increased intracranial pressure. 

With disruption of this barrier, molecules such as albumin freely enter the brain and ions and water follow. Because the brain lacks a well-developed lymphatic system, clearance of plasma constituents is slow, edema occurs, and intracranial pressure rises. At lower levels of exposure, subtle dysfunction of the blood-brain barrier may contribute to neurobehavioral deficits in children (Bressler and Goldstein 1991 Goldstein 1993). The particular vulnerability of the fetus and infant to the neurotoxicity of lead may be due in part to immaturity of the blood-brain barrier and to the lack of the high-affinity leadbinding protein in astroglia, which is discussed later in this section. Results of measurements of transendothelial electrical resistance across the blood-brain barrier from mice of various ages showed that lead potentiates cytokines-induced increase in ion permeability of the blood-brain barrier (Dyatlov et al. 

Osmotics Increasing urine flow, decreasing intracranial pressure... 

The answer is c (HardmanT pp 695-697.) Mannitol increases serum osmolarity and therefore pulls water out of cells, cerebrospinal fluid (C5F), and aqueous humor. This effect can be useful in the treatment of elevated intraocular or intracranial pressure. However, by expanding the intravascular volume, mannitol can exacerbate CHF... 

If uncontrolled, hyponatremia may cause increased intracranial pressure, brain herniation and death 595... 

Ovarian hormones influence fluid intake by interaction with the brain renin-angiotensin system and it has been shown that gonadal steroids affect brain fluid-electrolyte balance by interactions with vasopressin. Both hyperos-molarity and increased intracranial pressure stimulate vasopressin release and intraperitoneal administration of vasopressin antagonists decrease brain volume. 

The combination of hypoxia and hypercapnia in pulmonary insufficiency results in cerebral vasodilation and increased CBF and may lead to increased intracranial pressure. Arteriovenous differences for oxygen across the brain generally decrease as a function of increased CBF, leaving CMR02 unchanged [6]. 

Brain edema, often associated with increased intracranial pressure, may accompany the acute phase of metabolic decompensation in the aminoacidurias 671... 

The presence of blood in the brain parenchyma causes damage to surrounding tissue through a mass effect and the neurotoxicity of blood components and their degradation products. Compression of tissue surrounding hematomas may lead to secondary ischemia. Much of the early mortality of hemorrhagic stroke is due to an abrupt increase in intracranial pressure that can lead to herniation and death. 

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