A Prospective Study on Hyponatremia in Traumatic Brain Injury

Abstract

Background?Hyponatremia is the commonest electrolyte imbalance in traumatic brain injury (TBI) with a reported incidence of 15 to 20%. Methodology?A prospective observational analytical study was conducted from January 2015 to December 2015. Mild and moderate TBI patients aged between 13 and 65 years, with no comorbid conditions were included in the study. Patients were monitored for hyponatremia, and etiology was found out using standard investigation protocol. Results?A total of 153 patients were included in the study. Incidence of hyponatremia was 21.6% (33/153). Cerebral salt wasting syndrome was more common than syndrome of inappropriate secretion of antidiuretic hormone. Incidence was higher in patients with low Glasgow coma scale score (p?=?0.001) and in patients with parenchymal contusions (p?=?0.008). Incidence correlated well with Marshal computed tomography (CT) score (p?=?0.013). No significant difference of incidence was noted in relation to age or gender. Patients with hyponatremia had significantly prolonged intensive care unit (p?<?0.001) and hospital stay (p?<?0.001). Outcome at discharge was worse in patients with hyponatremia (p?=?0.002), whereas both groups had similar outcome at 3-month follow-up (p?=?0.087). Conclusions?Hyponatremia is a very common electrolyte imbalance in patients of TBI. Marshal CT grading and initial Glasgow coma scale score correlate well with the incidence of hyponatremia. More aggressive sodium monitoring may be required in parenchymal contusions in view of increased chance of development of hyponatremia. Hyponatremia adversely affect the immediate outcome in TBI, while long term outcome is usually unaffected.

Differentiating between SIADH and CSW Using Fractional Excretion of Uric Acid and Phosphate: A Narrative Review

“…If treatment was delayed, if sodium levels were corrected too quickly (resulting in osmotic demyelination), or if the incorrect treatment was implemented (as in the restriction of fluids for a patient with CSW rather than SIADH), then the risk of mortality due to sequelae significantly increases. Failure to accurately diagnose these conditions and implement the correct treatment results in an increased mortality risk, a longer length of stay in the hospital, and an increase in the cost of hospitalization [2] [3].…”

“…Prompt recognition is imperative so that the appropriate treatment can be implemented. SIADH and CSW appear very similar clinically, however the treatments for both are not only different, but implementing the wrong treatment has been shown to increase the risk of mortality, increase the length of stay in the intensive care unit (ICU) and the hospital, and result in an increased cost of hospitalization [2] [3].…”