Certified Neuroscience Registered Nurse (CNRN) Practice Exam

Why should glucose-containing intravenous fluids be avoided in patients with traumatic brain injury (TBI)?

1. They can lead to hypoglycemia

2. They contribute to neurotoxic acidosis

3. They increase intracranial pressure

4. They induce seizures

The correct answer is: They contribute to neurotoxic acidosis

The correct answer highlights that glucose-containing intravenous fluids can contribute to neurotoxic acidosis, particularly in patients with traumatic brain injury (TBI). When these patients are administered glucose, it can increase the metabolic demand in an already compromised brain environment, leading to the production of lactic acid. This excess lactic acid contributes to a state of acidosis, which can be neurotoxic and worsen the patient's cerebral condition. In the context of TBI, managing the metabolic and physiological state of the brain is crucial. Neurotoxic acidosis may exacerbate secondary brain injury by disrupting cell homeostasis and promoting inflammation, making it even more critical to avoid glucose in these cases. Other options, while they may have some relevance in different contexts, do not specifically encapsulate the primary concern with glucose-containing fluids in patients with TBI. For instance, hypoglycemia is generally less of a concern when administering glucose, intracranial pressure can be influenced by a variety of factors, and while seizures can occur in TBI patients, they are not directly induced by glucose-containing fluids.