- Discussion:
    - fluid resuscitation should be conducted with the knowledge that excessive replacement may cause cerebral edema;
    - expanded intravascular volume in absence of abnormality in serum Na does not predispose to brain swelling, and hence, fluid restriction
         is not indicated in the head injury;
    - hypertonic saline (which temporarily reduces intracranial pressure) and Ringer's lactate are the fluids of choice until cross-matched whole 
         blood is available;
    - systolic arterial pressure should be maintained above 80 mm Hg to ensure adequate cerebral blood flow;
    - w/ intravascular volume stabilized, fluid intake should be restricted to maintenance requirements;
    - strict temperature control is maintained to limit fluid requirements and prevent pernicious increases in brain metabolic activity;
- Labs:
    - Hyponatremia:
         - occurrence of SIADH or diabetes insipidus renders pt with head injury prone to serious electrolyte abnormality;
         - hyponatremia resulting from SIADH or overzealous fluid replacement is particularly harmful, as sodium levels beloww 130 mEq/L
              promote cerebral edema and can precipitate seizures;
    - Osmolarity:
         - serum osmolarity above 320 mosm/L is avoided because of cardiopulmonary and renal complications

Contribution of increased cerebral blood volume to posttraumatic intracranial hypertension.

An analysis of the relationship between fluid and sodium administration and intracranial pressure after head injury.

Hypertonic Fluid Resuscitation Improves Cerebral Oxygen Delivery and Reduces Intracranial Pressure After Hemorrhagic Shock.

The Deleterious Effects of Intraoperative Hypotension on Outcome in Patients With Severe Head Injuries.