Abnormal serum concentrations of electrolytes, hormones, and glucose are common throughout donor care. The organ procurement coordinator must properly interpret and plan treatment for these changes to prevent intracellular dysfunction in donor organs. This article describes abnormalities in magnesium, phosphorous, calcium, sodium, potassium, and glucose levels; polyuria; and thyroid and pituitary changes. Their potential consequences are discussed, and recommendations for treatment options are presented.
References
1.
MuhlbergJWagnerWRohlingRLinkJNuemeyerHH. Hemodynamic and metabolic problems in preparation for organ donation. Transplant Proc.1986;18:391–393.
2.
RiouBKalfonPArockMGoarinJPSaadaMViarsP. Cardiovascular consequences of severe hypophosphatemia in brain-dead patients. Br J Anaesth.1995;74:424–429.
3.
JastremskiMPownerDJSnyderJVSmithJGrenvikA. Problems in brain death determination. Forensic Sci.1978; 11:201–212.
4.
DebelakLPollakRRichardC. Arginine vasopressin versus desmopressin for the treatment of diabetes insipidus in the brain dead organ donor. Transplant Proc.1990;22:351–352.
5.
AritaKUozumiTOkiSKurisuKOhtaniMMikamiT. The function of the hypothalamus-pituitary axis in brain dead patients. Acta Neurochir (Wien). 1993;123:64–75.
6.
GrammHJMeinholdHBicketU. Acute endocrine failure after brain death. Transplantation.1992;54:851–857.
7.
HowlettTAKeoghAMPerryLTouozelRReesLH. Anterior and posterior pituitary function in brain-stem-dead donors. Transplantation.1989;47:828–834.
8.
CarrollHJOhME. Electrolyte physiology and body composition. In: CarrollHJOhME. Water, Electrolyte and Acid-Base Metabolism.Cambridge, Mass: JB Lippincott; 1989:1–24.
9.
KumarSBerlT. Sodium. Lancet.1998;352:220–228.
10.
OsterJRSingerI. Hyponatremia, hypoosmolality and hypotonicity. Arch Intern Med.1999;159:333–336.
11.
NovitzkyD. Selection and management of cardiac allograft donors. Curr Opin Cardiol.1996;11:174–182.
12.
PownerDJHendrichALaglerRGNgRHMaddenRL. Hormonal changes in brain dead patients. Crit Care Med.1990;18:702–708.
13.
WeisingerJRBellorin-FontE. Magnesium and phosphorous. Lancet.1998;352:391–396.
14.
FiserRTTorresAButchAWValentineJL. Ionized magnesium concentrations in critically ill children. Crit Care Med.1998;26:2048–2052.
GennariFJ. Hypokalemia. N Engl J Med.1998;339:451–458.
19.
Van Da WalkerSG. The effects of donor sodium levels on recipient liver graft function. J Transplant Coordination.1998;8:205–208.
20.
YoshidaHHiraideAYoshiokaTSugimotoT. Transient suppression of pancreatic endocrine function in patients following brain death. Clin Transplant.1996;10:28–33.
21.
AmadoJALopez-EspadasFVazquez-BarqueroA. Blood levels of cytokines in brain-dead patients: Relationship with circulatory hormones and acute-phase reactants. Metabolism.1995;44:812–816.
22.
CumminsRO, ed. Textbook of Advanced Cardiac Life Support.American Heart Association; 1997:7-1–7-21.
23.
HirschlMMMatznerMPHuberWO. Effect of desmopressin substitution during organ procurement on early renal allograft function. Neph Dialysis Transplant.1996;11:173–176.
24.
GuesdeRBarrouBLeblancI. Administration of desmopressin in brain-dead donors and renal function in kidney recipients. Lancet.1998;352:1178–1181.
