Wasting
By Tracy Merrill MD
Feb 24, 2003
CEREBRAL ARTERI
Otak disuplai darah bersih oleh arteri utama. Ada 4 arteri
utama yang mensuplai darah ke otak al;
1. Right Common carotid arteri
2. Left common carotid artery
3. Right vertebral artery
4. Left vertebral artery
Dua cabang utama common carotid mensuplai kedaerah
otak bagian depan/anterior.
Dua vertebral arteri mensuplai ke daerah
belakang/posterior.
Dalam pemeriksaan Radiography Neck vessel dan seluruh
peredaran darah otak dikenal dengan four vessel
angiogram sebab vessel tersebut secara bersamaan
dilakukan dengan memberikan suntikan kontras media.
CABANG ARCUS AORTA
CIRCLE WILLIS
Merupakan penyatuan 5 buah arteri atau cabang yang dibentuk dari
Internal carotida dan Vertebral arteri.
Kelima (5) Cabang tersebut adalah :
1. Anterior Communicating artery
2. Anterior cerebral arteri
3. Cabang dari Internal Carotid Arteri
4. Posterior Communicating Artery
5. Posterior Cerebral Artery
SIADH:
Head trauma
Brain neoplasms
Congenital CNS defects
CNS infections
CNS hypoxia
ADH secretion also decreased by certain
drugs: EtOh, demerol, MSO4, dilantin,
barbiturates, glucocorticoids
DI:
Polyuria
Dehydration, may not be readily apparent
b/c of hyper-osmolarity, fluid shifts from
cells to intravascular spaces and maintains
blood pressure, CVP
Weight loss is a better measure of fluid
status
Central DI: Lab values
Hypernatremia, Na >150-160
High serum osmolality (normal 270)
Urine Na < 20 mmol/L
Low urine osmolality (very dilute urine)
Central DI: treatment
Signs/symptoms:
Polyuria
Wt loss
Dehydration/hypovolemia
Hypotension
Low CVP
Cerebral Salt Wasting
Lab values:
Hyponatremia due to excessive renal Na loss
High urine Na, > 20 mmol/L
Increased plasma ANP, atrial natriuretic
peptide, b/c of low volume status
Inappropriately normal or low aldosterone and
ADH levels despite high ANP
Cerebral Salt Wasting
Treatment:
Volume for volume replacement of urine Na
losses
When dcd from hospital, most will still need
oral Na supplementation for a period of time
DI SIADH CSW
Urine Output polyuric decreased polyuric