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The Impact of Serum Sodium on Tardive Diabetes Insipidus after Severe Traumatic Brain Injury

Author: ZhanShuangFeng
Tutor: LiaoYongShi
School: Nanhua University
Course: Surgery
Keywords: Serum sodiumion Craniocerebral injury Diabetes insipidus Plasma arginine vasopressin(AVP)
CLC: R651.15
Type: Master's thesis
Year: 2011
Downloads: 30
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Purpose: It is to study the impact of serum Na+abnormality on tardive diabetesinsipidus after severe traumatic brain injury, then proceede to explore the types of thepatients with the tardive diabetes insipidus after severe traumatic brain injuryaccompaning with Na+abnormality.Methods:1.50healthy local people were randomly choosen to be tested serumarginine vasopressin (AVP).2.So were261patients with severe traumatic brain injury in our hospital from July2009to July2011. Each patient was routinely examined serum Na+every day for14days, continuously, AVP every two days,altogether seven days.3.Then, those patients of tardive diabetes insipidus would be divided into three groupsaccording to Na+disorder occurred before diabetes insipidus: risen serum Na+group,decreased serum Na+group and normal serum Na+group. Risen serum Na+group,according to the level, falled into severe one and light one; to the occurrence time,acute one and chronic one; to the lenghth of time, temprory one and continious one.We comparatively analysed morbidity of tardive diabetes insipidus patients andanalysed Na+disorder type of patients with tardive diabetes insipidus after severetraumatic brain injury.4. Evaluate the GCS and do statistics of the gender, age, way of treatment and types ofinjury.5.Follow up the urine of the patients with diabetes insipidus after severe traumaticbrain injury for4months.Results:1.AVP standard of50healthy objects is27.3±8.13pg/ml.2. Among261cases of severe traumatic brain injury,96cases with hyponatremia inthe early period,32patients with hypernatremia,133cases of normal serum sodium, occur within one week after injury, decreased levels of AVP and two cases of acutediabetes insipidus after8~14days of injury with AVP level decreased and delayeddiabetes insipidus occurred in26cases.26cases of late-onset diabetes insipidus withearly correction of sodium imbalance, recurrence of sodium disorders, including8cases of hyponatremia and3patients of hypernatremia.3.In low-sodium group, AVP level in8cases decreased to12.6±6.1pg/ml,emerged symptoms of diabetes insipidus and the incidence rate was8.33%; Inhigh-sodium group, AVP level in12cases decreased to11.2±5.6pg/ml, emergedsymptoms of diabetes insipidus, the incidence rate was37.50%; Among normalsodium patients,6cases of AVP level decreased to10.8±5.3pg/ml, emerged ofsymptoms of diabetes insipidus as well, and the incidence rate was4.51%. Afterstatistical analysis, the incidence of diabetes insipidus had a significant difference (χ2=31.75, P <0.05). Between high-sodium group and the low sodium group, theincidence of diabetes insipidus had a significant difference (χ2=15.48, P <0.05) aswell as in high-sodium group and the normal sodium group.(χ2=28.88, P <0.05).But between low-sodium group and normal group,delayed diabetes insipidusincidence had non-significant difference (χ2=1.42, P>0.05).4.32cases of hypernatremia included23cases of mild high sodium,9cases of lighthigh sodium. In mild high sodium group,6patients continued to have decreased AVPlevel and the emergence of symptoms of diabetes insipidus, the incidence rate was26.08%. In severe high-sodium group,6patients had decreased AVP level, theemergence of symptoms of diabetes insipidus, the incidence rate was66.66%. Theincidence of diabetes insipidus were significantly different (P <0.05).5.32cases of acute hypernatremia patients with high sodium,10cases of chronichigh-sodium,22cases of acute high-sodium group,3patients’ AVP level decreased,emerged the symptoms of diabetes insipidus, the incidence rate was30.00%. while inslow high-sodium group,9patients had decreased AVP level, and emerged thesymptoms of diabetes insipidus, the incidence rate was40.90%. There was nosignificant difference between two groups.(P>0.05).6. Among32cases of hypernatremia, there were14cases of short-term high sodium and18cases of persistent high sodium. In short-term high-sodium group,2patients’AVP level decreased, emerged symptoms of diabetes insipidus, the incidence ratewas14.28%. In the high sodium group,10cases’ AVP level decreased, the symptomsof diabetes insipidus occurred and the incidence rate was55.56%. There weresignificant difference between the two groups.7.For severe traumatic brain injury patients, surgery or not, injury type, differences ofage, differences of gender in the incidence of late-onset diabetes insipidus had nosignificant difference (P>0.05) in the incidence of diabetes insipidus.But GCSaffected the incidence diabetes insipidus significantly (P <0.05).8.After severe traumatic brain injury, most patients only had temporary diabetesinsipidus and can be cured within two months.Conclusion:1.Hyperlipidemia is an important predisposing factor of delayeddiabetes insipidus after severe traumatic brain injury.2.Delayed diabetes insipidus after severe traumatic brain injury was positivelycorrelated with high sodium level, hypernatremia duratio. No correlation related withthe occurrence time.3.Severe traumatic brain injury complicated by diabetes insipidus not only becomplicated by hypernatremiabut also by hyponatremia.4. The occurrence of diabetes insipidus after injury related with GCS score level butno relation with age, gende, surgery or not and the type of injury.

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CLC: > Medicine, health > Surgery > Of surgery > Head and Neurosurgery > Brain > Traumatic brain injury
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