Fluids and nutrition

Early enteral nutritional support should be attempted. Owing to gastric stasis, oro- or nasojejunal feeding may facilitate absorption and decrease aspiration. Enteral feeding is less invasive and carries a lower risk of infection than parenteral nutrition. Hyperglycemia, which worsens cerebral acidosis under ischemic conditions, is reduced when patients are fed enterally.

Protein loss should be prevented by caloric analysis and supplementation when deficient. Crystalloid solutions can be given to prevent prolonged cellular dehydration and maintain a normal serum sodium level, thereby ensuring a normal osmotic gradient across the blood-brain barrier.

Brainstem dysfunction can cause diabetes insipidus, which is characterized biochemically by hypernatremic dehydration in these patients when there is inadequate fluid replacement of urinary losses. Up to 4 pg of deamino-D-arginine vasopressin (DDAVP) intravenously can be used in the patient who has no other obvious cause of diuresis and is producing abundant dilute urine (specific gravity below 1005).

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