Hyponatremia and brain injury: absence of alterations of serum brain natriuretic peptide and vasopressin

Abstract

-Objective: To study any possible relation between hyponatremia following brain injury and the presence of cerebral salt-wasting syndrome (CSWS) or the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), and if vasopressin, brain natriuretic peptide (BNP) and aldosterone have a role in its mechanism. Method: Patients with brain injury admitted to the intensive care unit were included and had their BNP, aldosterone and vasopressin levels dosed on day 7. Results: Twenty six adult patients were included in the study. Nine (34.6%) had hyponatremia and presented with a negative water balance and higher values of urinary sodium, serum potassium and diuresis than patients with normonatremia. The serum levels of BNP, aldosterone, and vasopressin were normal and no relation was observed between plasma sodium and BNP, aldosterone or vasopressin. Conclusion: The most likely cause of hyponatremia was CSWS and there was no correlation between BNP, aldosterone and vasopressin with serum sodium level.Key WorDS: hyponatremia, brain injury, natriuretic peptide, aldosterone, vasopressin.Hiponatremia e traumatismo cranioencefálico: ausência de alteração sanguínea do peptídeo natriurético cerebral e hormônio antidiurético resumo -Objetivo: estudar a possível relação entre a hiponatremia seguindo traumatismo cranioencefálico e a presença da síndrome cerebral perdedora de sal (SCPS) ou a síndrome da secreção inapropriada do hormônio antidiurético (SSIHAD), e se a vasopressina, peptídeo natriurético cerebral (BNP) e aldosterona têm um papel nesse mecanismo. Método: Foram incluídos pacientes com traumatismo cranioencefálico admitidos na unidade de terapia intensiva e foram dosados no sétimo dia seguindo o trauma, BNP, aldosterona e vasopressina. Resultados: Vinte e seis pacientes foram incluídos no estudo. Nove (34,6%) tiveram hiponatremia e apresentaram um balanço hídrico mais negativo e altos valores de sódio urinário, potássio sérico e diurese quando comparados com o grupo que apresentou normonatremia. os níveis séricos de BNP, aldosterona e vasopressina foram normais e não foi observada relação entre o sódio sérico e BNP, aldosterona e vasopressina. Conclusão: A causa mais provável da hiponatremia foi a SCPS e não houve correlação entre BNP, aldosterona e vasopressina com o nível sérico de sódio.

Prevalence of Hyponatremia in Intensive Care Unit Patients With Brain Injury in Shahid Beheshti Hospital of Kashan During 2012

“…According to the results, early days in the second week of hospitalization are the most probable time for development of hyponatremia in patients. In a study on 26 brain injury patients hospitalized during 2004 - 2005 in the intensive care unit in Brazil, Karina et al observed a 34.6% prevalence of hyponatremia in the patients, which was quite consistent with that of ours (2). Sherlock et al directed a study on 1695 patients undergoing brain surgery in Beaumont hospital, Ireland, in 2009 in which 11% of the patients with brain tumor, hemorrhage, and brain tumor had sodium excretion of less than 130.…”

“…Sodium disorders are associated with considerable morbidity and mortality (2). Hyponatremia (plasma sodium concentration, less than 135 meq/L) is characterized by decreased osmolality.…”

Serum sodium: A useful prognostic factor for non-severe traumatic brain injury in children?

“…A study by Costa KN showed that the most common cause of Hyponatremia In the brain lesions was Sodium excretion secondary to brain natriuretic hormone and there was no clear relationship between brain natriuretic hormone, aldosterone and vasopressin with serum sodium [12].…”

The value of Serum BNP for diagnosis of intracranial injury in minor head trauma

“…Costa et al reported that serum BNP levels did not increase in patients with head injury and it had no correlation with cerebral salt-wasting syndrome [12]. Kavalci et al reported that serum BNP might be useful in evaluation of head trauma [13].…”