Hyperosmolarity Complicating Management of Intracranial Hypertension

Abstract

Reye Syndrome, an acute encephalopathy associated with hepatic microvesicular fat accumulation and mitochondrial disruption, has had a reported mortality rate between 30 and 70%. The 21 Reye Syndrome patients whose intracranial pressure was continuously monitored at our institution were divided into survivors, early deaths, and late deaths. Early deaths showed acute deterioration and evidence of cerebral herniation on admission so that all forms of treatment were ineffective. Of interest to us, however, was a comparison between the survivor group and the late deaths. The most immediately apparent differences were the significantly higher admission and peak serum osmolalities in the late death group. The complicating effects of hyperosmolarity on therapy for intracranial hypertension and its role in multiorgan failure are considered.