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Water-electrolyte imbalance and endocrine disorders make the problem of maintaining patients with severe traumatic brain injury (TBI) more difficult.
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Non-penetrating TBI, is much more difficult to assess, as injuries may not be visible or located precisely.
This clearly makes control of cerebral glucose based on plasma glucose much more difficult to achieve, particularly when significant metabolic heterogeneity exists after TBI, as reported by Abate and colleagues [ 6].
In the case of patients with TBI the interpretation of the relation between high serum Na levels and outcome is made even more difficult by the presence of peculiar interfering factors – such as for example CDI, as previously discussed – and the use of hypertonic saline to control cerebral edema and elevated ICP [ 5, 33, 37- 43].
Zone is more difficult.
Meat was more difficult.
More difficult decisions".
That is more difficult.
But it is more difficult.
Ocean negotiates more difficult territory.
This is much more difficult.
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