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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Is Comatose State With Skull Fracture And Water Loss Life Threatening?

Mr. Gutteman a 70-year olod male, was brought into the ER in a comatose state and has yet to come out of it. It is obvious that he suffered severe head trama, his scalp was badly lacerated, and he has an impacted skull fracture. His initial lab test (blood and uring) were within normal limits. His fracture was repaired.
On the second day of his hospitalization, the aide reports that Mr. GUtteman is breathing irregularly, his skin is dry and flaccid, and that she has emptied his urinary bladder several times during the day. Upon receiving this info, hte phsician ordered: Blood and urine tests for the presence of sugar and ketones, strict fluid intake and output Mr. Gutteman is found to be losing huge amounts of water in urine and the volume losr is being routinely replace (via IV line). Mr. Gutteman's blood and urine tests are negative for sugar and keytones. What would you say Mr. Gutteman;s hormonal problem is and what do you think caused it? Is it life threatening? (explain)
Fri, 9 Jan 2015
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Neurologist,  's  Response
I read your question and I understand your concern.

You must understand that the fact that the patient is in a coma means that there has been serious injury to the brain so even without the other issues in his other tests the simple fact that he is in a coma means that it is life threatening.
The types of endocrine complication with water loss in traumatic brain injury are either cerebral salt wasting or diabetes insipidus. The first is related to impaired kidney function due to neural influence on renal tubules with inability to conserve salt hence loss of salt and water, while the second to direct traumatic injury to the area of the brain producing the antidiuretic hormone.
Another cause could be medically induced by the use of Mannitol solution by the doctors.
To make more accurate assessments more then the lab tests it would be useful to know about his brain CT findings which would directly assess brain injury.

I hope to have been of help.
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Is Comatose State With Skull Fracture And Water Loss Life Threatening?

I read your question and I understand your concern. You must understand that the fact that the patient is in a coma means that there has been serious injury to the brain so even without the other issues in his other tests the simple fact that he is in a coma means that it is life threatening. The types of endocrine complication with water loss in traumatic brain injury are either cerebral salt wasting or diabetes insipidus. The first is related to impaired kidney function due to neural influence on renal tubules with inability to conserve salt hence loss of salt and water, while the second to direct traumatic injury to the area of the brain producing the antidiuretic hormone. Another cause could be medically induced by the use of Mannitol solution by the doctors. To make more accurate assessments more then the lab tests it would be useful to know about his brain CT findings which would directly assess brain injury. I hope to have been of help.