Disturbances of Sodium in Critically Ill Adult Neurologic Patients

Tisdall, Martin; Crocker, Matthew; Watkiss, Jonathan; Smith, Martin

doi:10.1097/01.ana.0000191280.05170.0f

Cited by 140 publications

(121 citation statements)

References 59 publications

(72 reference statements)

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“…the incidence of csWs among all the patients was greater than that of sIADH, which is in agreement with reports from various other authors, who also observed a greater prevalence of csWs, compared to sIADH in neurological patients 1,2,4,5,10,18,30 . the coexistence of DI and csWs (mixed syndrome) observed in our patients has also been described by yamaki et al 17 , who studied two patients postoperatively following surgery for pituitary tumor and observed the presence of severe natriuresis and hyponatremia in a study patient who developed DI (fluid loss >2.36 ml/kg/h), which led the authors to conclude that hyponatremia resulting from csWs in intracranial diseases may develop in patients with DI.…”

Section: Discussionsupporting

confidence: 93%

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Syndromes related to sodium and arginine vasopressin alterations in post-operative neurosurgery

Cardoso

Dragosavac

Araújo

et al. 2007

Arq. Neuro-Psiquiatr.

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-Background: cerebral salt wasting syndrome (csWs), syndrome of inappropriate antidiuretic hormone secretion (sIADH) and diabetes insipidus (DI) are frequently found in postoperative neurosurgery. Purpose: to identify these syndromes following neurosurgery. Method: the study included 30 patients who had been submitted to tumor resection and cerebral aneurysm clipping. sodium levels in serum and urine and urine volume were measured daily up to the 5 th day following surgery. Plasma arginine vasopressin (AVP) was measured on the first, third and fifth days post-surgery. Results: csWs was found in 27/30 patients (90%), in 14 (46.7%) of whom it was associated with a reduction in the levels of plasma AVP (mix syndrome). sIADH was found in 3/30 patients (10%). there was no difference between the two groups of patients. Conclusion: csWs was the most common syndrome found, and in half the cases it was associated with DI. sIADH was the least frequent syndrome found.Key WorDs: cerebral salt wasting syndrome, syndrome of inappropriate antidiuretic hormone secretion, diabetes insipidus, mixed syndrome, neurosurgery.Síndromes relacionadas com alterações de sódio e arginina-vasopressina no pós-operatório de neurocirurgia resUMo -Introdução: A síndrome perdedora de sal (sPs), síndrome da secreção inapropriada do hormô-nio antidiurético (sIADH) e diabetes insipidus (DI) são freqüentemente encontradas no pós-operatório de neurocirurgia. Objetivo: Identificar essas síndromes relacionadas à neurocirurgia. Método: Foram estudados 30 pacientes submetidos à ressecção de tumor (n=19) e clipagem de aneurisma (n=11) cerebral durante os primeiros cinco dias do pós-operatório. os pacientes foram submetidos a dosagens diárias de só-dio sérico e urinário até o 5º dia pós-operatório, com controle de volume urinário neste período e dosagem de arginina-vasopressina (AVP) plasmática no 1º, 3º e 5º dias pós-operatórios. Resultados: A sPs foi encontrada em 27/30 pacientes (90%), em 14/27 (46,7%) associada à diminuição dos níveis de AVP plasmá-tica (síndrome mista). A sIADH foi encontrada em 3/30 pacientes (10%). Não houve diferença entre os dois grupos de pacientes. Conclusão: A sPs foi a síndrome mais freqüente, em metade de casos associada ao DI. A sIADH foi a menos freqüente.PAlAVrAs-cHAVe: síndrome perdedora de sal, síndrome de secreção inapropriada de hormônio antidiurético, diabetes insipidus, síndrome mista, neurocirurgia.

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Section: Discussionsupporting

confidence: 93%

“…this suggests that csWs is the principal cause of natriuresis in these patients 2,10,30 . the present study also shows that most of the patients who developed hyponatremia and natriuresis presented no increase in plasma AVP levels, suggesting that the probable cause of natriuresis in these patients is csWs.…”

Section: Discussionmentioning

confidence: 78%

Syndromes related to sodium and arginine vasopressin alterations in post-operative neurosurgery

Cardoso

Dragosavac

Araújo

et al. 2007

Arq. Neuro-Psiquiatr.

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“…6,11,15,19 The etiology of hypernatremia may not be strictly defined in patients with TBI, and this condition may be due to hyperosmolar therapy; hypovolemia; insensible free water losses; or high sodium load in intravenous fluids, feeds, or medications. 20 Additionally, hypothalamic dysfunction not resulting in overt diabetes insipidus may contribute to hypernatremia after TBI. 15 In the present study, even mild and moderate hypernatremia was independently associated with increased mortality, and this relationship was maintained in patients who did not receive mannitol to treat cerebral edema.…”

Section: Fig 1 Kaplan-meier Curve Showing Survival Rates By Severitmentioning

confidence: 99%

Morbidity and mortality associated with hypernatremia in patients with severe traumatic brain injury

Vedantam

Robertson

Gopinath

2017

Neurosurgical Focus

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OBJECTIVEHypernatremia is independently associated with increased mortality in critically ill patients. Few studies have evaluated the impact of hypernatremia on early mortality in patients with severe traumatic brain injury (TBI) treated in a neurocritical care unit.METHODSA retrospective review of patients with severe TBI (admission Glasgow Coma Scale score ≤ 8) treated in a single neurocritical care unit between 1986 and 2012 was performed. Patients with at least 3 serum sodium values were selected for the study. Patients with diabetes insipidus and those with hypernatremia on admission were excluded. The highest serum sodium level during the hospital stay was recorded, and hypernatremia was classified as none (≤ 150 mEq/L), mild (151–155 mEq/L), moderate (156–160 mEq/L), and severe (> 160 mEq/L). Multivariate Cox regression analysis was performed to determine independent predictors of early mortality.RESULTSA total of 588 patients with severe TBI were studied. The median number of serum sodium measurements for patients in this study was 17 (range 3–190). No hypernatremia was seen in 371 patients (63.1%), mild hypernatremia in 77 patients (13.1%), moderate hypernatremia in 50 patients (8.5%), and severe hypernatremia in 90 patients (15.3%). Hypernatremia was detected within the 1st week of admission in 79.3% of patients (n = 172), with the majority of patients (46%) being diagnosed within 72 hours after admission. Acute kidney injury, defined as a rise in creatinine of ≥ 0.3 mg/dl, was observed in 162 patients (27.6%) and was significantly associated with the degree of hypernatremia (p < 0.001). At discharge, 148 patients (25.2%) had died. Hypernatremia was a significant independent predictor of mortality (hazard ratios for mild: 3.4, moderate: 4.4, and severe: 8.4; p < 0.001). Survival analysis showed significantly lower survival rates for patients with greater degrees of hypernatremia (log-rank test, p < 0.001).CONCLUSIONSHypernatremia after admission in patients with severe TBI was independently associated with greater risk of early mortality. In addition to severe hypernatremia, mild and moderate hypernatremia were significantly associated with increased early mortality in patients with severe TBI.

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“…Patients with polytrauma and traumatic brain injury are the most critically ill patients, and hyponatremia is frequently seen in these patients [2][3][4]. Hyponatremia is one of the common causes of secondary brain injury [5].…”

Section: Introductionmentioning

confidence: 99%

Effect of Early Correction of Hyponatremia on Neurological Outcome in Traumatic Brain Injury Patients

Ahmad¹,

Alrais²,

Elkholy³

et al. 2017

Intensive & Crit Care

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Disturbances of Sodium in Critically Ill Adult Neurologic Patients

Cited by 140 publications

References 59 publications

Syndromes related to sodium and arginine vasopressin alterations in post-operative neurosurgery

Syndromes related to sodium and arginine vasopressin alterations in post-operative neurosurgery

Morbidity and mortality associated with hypernatremia in patients with severe traumatic brain injury

Effect of Early Correction of Hyponatremia on Neurological Outcome in Traumatic Brain Injury Patients

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