Gangguan Natrium pada Pasien Bedah Saraf
Abstract
Gangguan pada susunan saraf pusat (SSP) akan mengakibatkan gangguan pada fungsi axis hipotalamus hipofise, yang akan menyebabkan gangguan pada keseimbangan cairan dan elektrolit. Selain karena lesi neurologis primer yang terjadi pada SSP, penyebab kelainan elektrolit ini juga disebabkan oleh tindakan pembedahan atau iatrogenik, tindakan perawatan pascabedah di intensive care unit (ICU) akibat dari tindakan medis, misalnya obat-obatan dan pemberian cairan intravena, pemberian diuretik, pemberian steroid dan mannitol. Gangguan elektrolit paling banyak terjadi pada natrium. Dua kondisi dengan klinis hiponatremi adalah SIADH dan CSWS, yang penataksanaan keduanya sangat berbeda. Hampir 62% pasien bedah saraf dengan hiponatremia (kadar natrium < 135 mmol/L) disebabkan oleh SIADH, sedangkan sisanya 16,6% karena penggunaan obat-obatan dan 4,8% karena CSWS. Gangguan natrium dengan gambaran klinis hipernatremi adalah diabetes insipidus (DI). DI terjadi sekitar 3,8 % pada pasien bedah saraf. Kondisi keseimbangan cairan dan elektrolit pada pasien dengan kelainan SSP yang dilakukan tindakan anestesi dan operasi merupakan tantangan khusus bagi dokter anestesi dan intensivist. Pasien pasien bedah saraf biasanya mendapatkan terapi diuretik sebagai salah satu manajemen edema otak dan untuk mengurangi tekanan intrakranial. Di sisi lain efek diuresis dari lesi pada otak dan penggunaan teknik hipotermi juga akan menambah kondisi diuresis pada pasien bedah saraf. Efek diuresis yang berlebihan menyebabkan kehilangan natrium.
Sodium Disturbance in Neurosurgical Patient
Disturbance of the central nerve system (CNS) will lead to interference with the function of the hypothalamus pituitary axis and will cause disruption of fluids and electrolytes balance as well. In addition to its primary neurological lesions occurring in the CNS, the cause of electrolyte abnormalities are also due to surgical procedure or iatrogenic, postoperative medical treatment in ICU such as administration of drugs and intravenous fluids, diuretics, steroids and mannitol. The most frequent electrolyte disorder is sodium. Two clinical conditions related to hyponatremia are SIADH and CSWS which the management can be totally different, respectively. Nearly 62% of neurosurgical patients with hyponatremia (sodium levels <135 mmol / L) is caused by SIADH, while the remaining 16.6% patient is due to the use of drugs and 4.8% patient is due to CSWS. Sodium disorder clinically referred to as hypernatremia is diabetes insipidus (DI). DI occurs around 3.8% in neurosurgical patients. The condition of fluid and electrolyte balance in patients with CNS disorders undergoing anesthesia and surgery is a particular challenge for anesthesiologists and intensivists. The patients usually receive diuretic therapy to manage brain edema and to reduce intracranial pressure. On the other hand, diuresis effects due to brain lesions and the use of hypothermia technique will also increase diuresis condition in neurosurgical patients. Excessive diuresis effect will cause loss of sodium.
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DOI: https://doi.org/10.24244/jni.vol3i1.132
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