Perubahan Osmolaritas Plasma dan Gambaran Funduskopi setelah Pemberian Manitol pada Pasien Edema Serebri

Abstract

Background: Cerebral edema is a condition of excess fluid accumulation in the brain parenchyma. Cerebral edema and increased intracranial pressure are the main causes of morbidity and mortality in patients with head injuries, intracranial tumors, cerebral infarction, or intracerebral hemorrhage. Mannitol is the most widely used osmotic agent to reduce intracranial pressure. Mannitol has the benefit of reducing ICP but can increase plasma osmolarity which can increase the risk of kidney disorders in patients with cerebral edema. Funduscopy examination is one of the examinations in ICP evaluation. Purpose: To determine changes in plasma osmolarity and funduscopic appearance after administration of mannitol in patients with cerebral edema. Method: This is a Pre-Experimental Study with a one group pretest-posttest design. Research subjects were taken from the patient population of H. Adam Malik General Hospital Medan and Network Hospitals. Determination of research subjects was carried out according to the non-random sampling method consecutively and obtained as many as 32 research samples. To determine changes in plasma osmolarity, a paired t-test was performed and to determine changes in funduscopic appearance, the Wilcoxon test was performed. Results: The mean osmolarity before mannitol administration was 303.74±11.59 mOsm/L and after mannitol administration was 307.01±14.83 mOsm/L, with an average change in osmolarity was 3.27±12.19 mOsm/L. Before administration of mannitol, the majority of patients early papilledema (36.1%) and papilledema (36.1%), and after administration of mannitol, the majority of patients had normal funduscopic appearance (78.1%). Conclusion: There was a difference in mean plasma osmolarity before and after administration of mannitol but not significant (p=0.139). There were differences in the funduscopic appearance after mannitol administration and were statistically significant (p<0.001).