Valor prognostico dos teores de potassio e sodio no liquido cefalorraquiano e no sangue de doentes em coma: estudo de 55 casos

Gagliardi, Rubens Jose

doi:10.1590/S0004-282X1982000300003

Resumos

Trata-se de um estudo prospective) com 55 doentes, tomados ao acaso, independentemente da idade, sexo, grau de coma ou da sua etiologia. Foi medida a concentração do potássio e do sódio no LCR e no soro sangüíneo destes doentes, visando a um critério auxiliar de avaliação prognostica. Os resultados mostraram que as taxas elevadas de potássio no LCR são indicativo de mau prognóstico. No texto são abordados os aspectos fisiopatológicos dos achados.

This is a prospective study, with 55 patients in coma, in which wasn't chosen sex, age, intensity of coma or etiology. It was measured the concentration of the potassium and the sodium in cerebrospinal fluid, (CSF) and in the serum, to find an auxiliary way to value the prognostic. It is know that the potassium in the CSF is extremely stable, and it mantains the tax without alterations, even when the potassium in CSF is rapid and intensity raised after death. Experimental studies show the potassium raised in CSF in serious damaged brain. Our results show, in patients who recovered consciousness, normal values (means 2,61 mEq/1) of potassium in CSF. The mean of values of potassium in CSF in the group of patients who had bad evolution (they died) show index estatisticaly up of normal values (2,97 mEq/1) and this shows a serious damaged brain and/or irreversible, able to affect the stability of CSF potassium. These index are present in some kind of coma or etiology, showing that raised potassium in CSF, indicates bad prognostic, in some kind of coma. With the sodium, the results show that this ion don't serve to this finality, because its concentrations ins't stable in CSF, and change with the blood alterations of natremia.

Valor prognostico dos teores de potassio e sodio no liquido cefalorraquiano e no sangue de doentes em coma: estudo de 55 casos

Value of prognosis on the avarage of potassium and sodium on cerebrospinal fluid in patients in coma

Rubens Jose Gagliardi

Prof. Instrutor, Departamento de Medicina, disciplina de Neurologia da Faculdade de Medicina da Santa Casa de São Paulo

RESUMO

Trata-se de um estudo prospective) com 55 doentes, tomados ao acaso, independentemente da idade, sexo, grau de coma ou da sua etiologia. Foi medida a concentração do potássio e do sódio no LCR e no soro sangüíneo destes doentes, visando a um critério auxiliar de avaliação prognostica. Os resultados mostraram que as taxas elevadas de potássio no LCR são indicativo de mau prognóstico. No texto são abordados os aspectos fisiopatológicos dos achados.

SUMMARY

This is a prospective study, with 55 patients in coma, in which wasn't chosen sex, age, intensity of coma or etiology. It was measured the concentration of the potassium and the sodium in cerebrospinal fluid, (CSF) and in the serum, to find an auxiliary way to value the prognostic. It is know that the potassium in the CSF is extremely stable, and it mantains the tax without alterations, even when the potassium in CSF is rapid and intensity raised after death. Experimental studies show the potassium raised in CSF in serious damaged brain. Our results show, in patients who recovered consciousness, normal values (means 2,61 mEq/1) of potassium in CSF. The mean of values of potassium in CSF in the group of patients who had bad evolution (they died) show index estatisticaly up of normal values (2,97 mEq/1) and this shows a serious damaged brain and/or irreversible, able to affect the stability of CSF potassium. These index are present in some kind of coma or etiology, showing that raised potassium in CSF, indicates bad prognostic, in some kind of coma.

With the sodium, the results show that this ion don't serve to this finality, because its concentrations ins't stable in CSF, and change with the blood alterations of natremia.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Resumo de dissertação de mestrado, apresentado à Faculdade de Medicina da USP, área de Neurologia, em 25-11-1980.

Faculdade de Medicina da Santa Casa de São Paulo - Departamento de Medicina, Disciplina de Neurologia - Rua Cesário Mota Jr. 112 - 01221 São Paulo - Brasil.

1. BEKAERT, J. & DEMEESTER, G. - Influence of the potassium concentration of the blood on the potassium level of the cerebrospinal fluid. Experimental Medicine and Surgery. 12:480, 1954.
2. BOLWIG, T. G.; ASTRUP, J. & CHRISTOFFERSEN, G. R. J. - EEG and extracellular K+ in rat brain during pentylenetetrazol seizures and during respiratory arrest. Biomedicine 22:99, 1977.
3. BRADBURY, M. W. B. & DAVSON, H. - The transport of potassium between blood cerebrospinal fluid and brain. J. Physiol., 181:151, 1965.
4. BRADBURY, M. W. B. & STULCOVA, B. - Efflux mechanism contributing to the potassium concentratium in cerebrospinal fluid. J. Physiol. 208:415, 1970.
5. COOPER, E. S.: LECHNER, E. & BELLET, S. - Relation between serum and cerebrospinal fluid electrolytes under normal and abnormal conditions. Am. J. Med., 18:613, 1955.
6. CURRAN, P. F. & SCHULZ, S. G. - Some thermodynamic and kinetic principles governing solvent transport across membranes. In: BREENER, B. M. & RECTOR, F. C. - The Kidney. W. B., Saunders, Philadelphia, 1976. p. 104.
7. DOMER, F. R. - Effects of diuretcs on cerebrospinal fluid formation and potassium movement. Experimental Neurology, 24:54, 1969.
8. DULIÈRE, W. L. - Donnés expérimentales sur la répartition du potassium dans le sang extravasé; comparaison entre la concentration physiologique dans le plasma et la concentration dans le liquide céphalorachidien. C. R. Soc. Biol. (Paris) 108:416, 1931.
9. FERTZIGER, A. P. & RANCK, J. B. - Potassium accumulation in interstitial space during epileptiform seizures. Experimental Neurology, 26:571, 1970.
10. FISH, S. A.; MORRISON, J. C; BOCOVAZ, E. T.; WISER, W. L. & WHYBREW, W. D. - Cerebral spinal fluids studies in eclampsia. Am. J. Obstet. Gynec, 112:502, 1972.
11. GIUDICE, C. R. - El potássio en el líquido cefalorraquídeo normal y patológico. Rev. neurol. Buenos Aires, 11:105, 1942.
12. HANSEN, A. J. - Extracellular potassium concentration in juvenile and adult rat brain cortex during anoxia. Acta physiol. scand., 99:412, 1977.
13. HANSEN, A. J. - The extracellular potassium concentration in brain cortex following ischemia in hypo-and hyperglycemic rats. Act physiol. scand., 102:324, 1978.
14. HANSEN, A. J. & NORDSTROM, C. H. - Brain extracellular potassium and energy metabolism during ischemia in juvenile rats after exposure to hipoxia for 24 hours. J. Neurochem, 32:915, 1979.
15. HELMSWORTH, J. A. & CINCINNATI, O. - Potassium content of normal cerebrospinal fluid. J. Labor Clin. Med. 32:1486, 1947.
16. KATZMAN, R.; GRAZIANI, L.; KAPLAN, R. & ESCRIVA, A. - Exchange of cerebrospinal fluid potassium with blood and brain. Arch. Neurol. (Chicago) 13:513, 1965.
17. KATZMAN, R. & PAPPIUS, U. M. - Brain Electrolytes and Fluid Metabolism. Williams & Wilkins, Baltimore, 1973.
18. LUX, H. D. - The kinetics of extracellular potassium: relation to epileptogenesis Epilepsia 15:375, 1974.
19. MALNIC, G. & MARCONDES, M. - Fisiologia Renal. Editora Edart, São Paulo, 1977, pp. 31.
20. MASON, J. K.; KLYNE, W. & LENNOX, B. - Potassium levels in the cerebrospinal fluid after death. J. clin. Path. 4:231, 1951.
21. MESTREZAT, W. - Dosage des Mctaux Alcalins: potassium et sodium. In: Le Liquide céphalo-rachidien normal et pathologique. A. Maloine, Paris, 1912, pp. 43.
22. MEYER, J. S.; KANDA, T.; SHINOHARA, Y. & FUKUUCHI, Y. - Effects of anoxia on cerebrospinal fluid sodium and potassium concentrations. Neurology (Minneapolis) 21:889, 1971.
23. NAUMANN, H. N. - Cerebrospinal fluid eletrolytes after death. Proc. Soc. exper. Biol. Med. 98:16, 1958.
24. SALMINEN, S. & LUOM ANMÄKI, K. - Distribuition of sodium and potassium in serum, cerebrospinal fluid and serum ultrafiltrate in some diseases. Scand. J. clin. Lab. Invest., 14:425, 1962.
25. SANVITO, W. L. - Os comas na Prática Médica. Ed. Manole, São Paulo, 1978, pp. 73-75.
26. SHIBATA, S.; HODGE, C. & PAPPIUS, H. M. - Effect of experimental ischemia on cerebral water and electrolytes. J. Neurosurg., 41:146, 1974.
27. SIEMKOWICZ, E., CHRISTIANSEN, I. & SORENSEN, S. C. - Changes in cisternal fluid potassium concentration following cardiac arrest. Acta neurol. scand., 55:137, 1977.
28. SPINA-FRANÇA, A. - Líquido Cefallorraquiano. In: TOLOSA, A. & CANELAS, H. M.: - Propedêutica Neurológica. Procienx, São Paulo, 1975, pp. 405.
29. WILKINSON, H. L.; DEEDS, D. G.; SULLIVAN, L. P. & WELLING. D. J. - Effects of ouabain on potassium transport in the perfused bullfrog kidney. Am. J. Physiol., 236:175, 1979.

Datas de Publicação

Publicação nesta coleção
16 Ago 2012
Data do Fascículo
Set 1982

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. BEKAERT, J. & DEMEESTER, G. - Influence of the potassium concentration of the blood on the potassium level of the cerebrospinal fluid. Experimental Medicine and Surgery. 12:480, 1954.

[2] 2. BOLWIG, T. G.; ASTRUP, J. & CHRISTOFFERSEN, G. R. J. - EEG and extracellular K+ in rat brain during pentylenetetrazol seizures and during respiratory arrest. Biomedicine 22:99, 1977.

[3] 3. BRADBURY, M. W. B. & DAVSON, H. - The transport of potassium between blood cerebrospinal fluid and brain. J. Physiol., 181:151, 1965.

[4] 4. BRADBURY, M. W. B. & STULCOVA, B. - Efflux mechanism contributing to the potassium concentratium in cerebrospinal fluid. J. Physiol. 208:415, 1970.

[5] 5. COOPER, E. S.: LECHNER, E. & BELLET, S. - Relation between serum and cerebrospinal fluid electrolytes under normal and abnormal conditions. Am. J. Med., 18:613, 1955.

[6] 6. CURRAN, P. F. & SCHULZ, S. G. - Some thermodynamic and kinetic principles governing solvent transport across membranes. In: BREENER, B. M. & RECTOR, F. C. - The Kidney. W. B., Saunders, Philadelphia, 1976. p. 104.

[7] 7. DOMER, F. R. - Effects of diuretcs on cerebrospinal fluid formation and potassium movement. Experimental Neurology, 24:54, 1969.

[8] 8. DULIÈRE, W. L. - Donnés expérimentales sur la répartition du potassium dans le sang extravasé; comparaison entre la concentration physiologique dans le plasma et la concentration dans le liquide céphalorachidien. C. R. Soc. Biol. (Paris) 108:416, 1931.

[9] 9. FERTZIGER, A. P. & RANCK, J. B. - Potassium accumulation in interstitial space during epileptiform seizures. Experimental Neurology, 26:571, 1970.

[10] 10. FISH, S. A.; MORRISON, J. C; BOCOVAZ, E. T.; WISER, W. L. & WHYBREW, W. D. - Cerebral spinal fluids studies in eclampsia. Am. J. Obstet. Gynec, 112:502, 1972.

[11] 11. GIUDICE, C. R. - El potássio en el líquido cefalorraquídeo normal y patológico. Rev. neurol. Buenos Aires, 11:105, 1942.

[12] 12. HANSEN, A. J. - Extracellular potassium concentration in juvenile and adult rat brain cortex during anoxia. Acta physiol. scand., 99:412, 1977.

[13] 13. HANSEN, A. J. - The extracellular potassium concentration in brain cortex following ischemia in hypo-and hyperglycemic rats. Act physiol. scand., 102:324, 1978.

[14] 14. HANSEN, A. J. & NORDSTROM, C. H. - Brain extracellular potassium and energy metabolism during ischemia in juvenile rats after exposure to hipoxia for 24 hours. J. Neurochem, 32:915, 1979.

[15] 15. HELMSWORTH, J. A. & CINCINNATI, O. - Potassium content of normal cerebrospinal fluid. J. Labor Clin. Med. 32:1486, 1947.

[16] 16. KATZMAN, R.; GRAZIANI, L.; KAPLAN, R. & ESCRIVA, A. - Exchange of cerebrospinal fluid potassium with blood and brain. Arch. Neurol. (Chicago) 13:513, 1965.

[17] 17. KATZMAN, R. & PAPPIUS, U. M. - Brain Electrolytes and Fluid Metabolism. Williams & Wilkins, Baltimore, 1973.

[18] 18. LUX, H. D. - The kinetics of extracellular potassium: relation to epileptogenesis Epilepsia 15:375, 1974.

[19] 19. MALNIC, G. & MARCONDES, M. - Fisiologia Renal. Editora Edart, São Paulo, 1977, pp. 31.

[20] 20. MASON, J. K.; KLYNE, W. & LENNOX, B. - Potassium levels in the cerebrospinal fluid after death. J. clin. Path. 4:231, 1951.

[21] 21. MESTREZAT, W. - Dosage des Mctaux Alcalins: potassium et sodium. In: Le Liquide céphalo-rachidien normal et pathologique. A. Maloine, Paris, 1912, pp. 43.

[22] 22. MEYER, J. S.; KANDA, T.; SHINOHARA, Y. & FUKUUCHI, Y. - Effects of anoxia on cerebrospinal fluid sodium and potassium concentrations. Neurology (Minneapolis) 21:889, 1971.

[23] 23. NAUMANN, H. N. - Cerebrospinal fluid eletrolytes after death. Proc. Soc. exper. Biol. Med. 98:16, 1958.

[24] 24. SALMINEN, S. & LUOM ANMÄKI, K. - Distribuition of sodium and potassium in serum, cerebrospinal fluid and serum ultrafiltrate in some diseases. Scand. J. clin. Lab. Invest., 14:425, 1962.

[25] 25. SANVITO, W. L. - Os comas na Prática Médica. Ed. Manole, São Paulo, 1978, pp. 73-75.

[26] 26. SHIBATA, S.; HODGE, C. & PAPPIUS, H. M. - Effect of experimental ischemia on cerebral water and electrolytes. J. Neurosurg., 41:146, 1974.

[27] 27. SIEMKOWICZ, E., CHRISTIANSEN, I. & SORENSEN, S. C. - Changes in cisternal fluid potassium concentration following cardiac arrest. Acta neurol. scand., 55:137, 1977.

[28] 28. SPINA-FRANÇA, A. - Líquido Cefallorraquiano. In: TOLOSA, A. & CANELAS, H. M.: - Propedêutica Neurológica. Procienx, São Paulo, 1975, pp. 405.

[29] 29. WILKINSON, H. L.; DEEDS, D. G.; SULLIVAN, L. P. & WELLING. D. J. - Effects of ouabain on potassium transport in the perfused bullfrog kidney. Am. J. Physiol., 236:175, 1979.