Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række
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Tidsskr. Nor. Laegeforen. · Jan 2008
Case Reports[An 83-year-old woman with coma and severe hypernatremia].
Several cases of hypernatremia due to salt intoxication have been described. Paediatric patients and individuals with dementia or mental illness are those most commonly affected. It is a condition with a poor prognosis and a high mortality rate. ⋯ On the basis of elevated serum sodium and urine sodium, normovolemia and normal diuresis, we concluded that hypernatremia was caused by salt intoxication. Our patient died a few hours after admittance. Recommended treatment is to maintain adequate diuresis with a loop diuretic, to and replace the ongoing fluid loss. Haemodialysis is an alternative if diuresis is inadequate. There is no consensus regarding type of replacement fluid or optimal rate of fluid replacement for hypernatremia due to salt intoxication.
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Massive hemispheric brain infarctions are associated with high mortality, due to cerebral oedema, increased intracranial pressure, distortion of the brain stem and herniation. Decompressive craniectomy involves opening of the dura mater to give more space for the brain. This review describes hemicraniectomy and discusses its usefulness, especially in massive cerebral infarctions. ⋯ Hemicraniectomy for massive supratentorial brain infarction has been insufficiently documented. Hemicraniectomy performed within 48 hours of stroke onset has recently been compared to medical management alone in three randomized studies. A pooled analysis of patients (93 patients aged < 60 years) with massive infarction in the arteria cerebral media territory, indicated a significantly lower one-year mortality and a significantly larger proportion with a one-year outcome of mRS <3 after hemicraniectomy than after medical management alone. The following key questions still need to be answered: surgical timing, the relevance of hemispheric dominance, the extension of infarcted brain, and whether the reduced mortality justifies the morbidity among survivors (particularly in older age groups). Even though increased survival has now been documented, the decision to perform hemicraniectomy in patients with massive brain infarction must still be made on an individual basis.
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Accommodation of patients in hospital hallways has been practiced in Norway for a long time. Provision of adequate patient care in a hospital corridor is challenging; both patients and staff suffer from this practice. Numerous analyses and interventions have been initiated, but have not improved the situation. ⋯ Hallway accommodation of patients is very profitable for hospital owners within the current financing system, and it is unlikely that this practice will be eliminated without strong financial stimuli.