Hyponatremia in neurological patients: cerebral salt wasting versus inappropriate antidiuretic hormone secretion

Brimioulle, Serge; Orellana-Jimenez, Carlos; Aminian, Adel; Vincent, Jean‐Louis

doi:10.1007/s00134-007-0905-7

Cited by 67 publications

(44 citation statements)

References 21 publications

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“…Second, we cannot be certain that the patients we included did not have a RSWS rather than a SIADH. The existence of the RSWS is controversial as suggested recently by Brimioulle et al [25] who demonstrated no difference in red blood cell, plasma and blood volumes between hypo- and normonatremic ICU patients. Even if the existence of this entity remains under debate due to conflicting conclusions from different studies, treatments are theoretically opposite with infusion of fluids and Na in the salt-wasting syndrome and fluid restriction for SIADH.…”

Section: Discussionmentioning

confidence: 99%

Treatment of the Syndrome of Inappropriate Secretion of Antidiuretic Hormone with Urea in Critically Ill Patients

et al. 2012

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Background: Hyponatremia occurring as a result of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a common and potentially lethal complication in critically ill patients. Urea, by inducing renal water excretion and promoting sodium (Na) retention, has been well described as a treatment for chronic SIADH. However, there are limited data on its use for the treatment of SIADH as encountered in patients admitted to the intensive care unit (ICU). We assessed the effects of urea administration for treatment of SIADH in ICU patients. Methods: Data from ICU patients treated with urea for SIADH between January 2000 and August 2010 were reviewed. The time courses of Na and urea concentrations were analyzed by variance analysis (ANOVA). Results: Records from 24 patients were analyzed. The most common etiology of SIADH was neurological (18 patients). Before urea administration, the mean serum Na concentration was 124.8 ± 5.9 mEq/l. There was a significant increase in serum Na from the second day of treatment (131.4 ± 3.5 mEq/l, p < 0.001) and a normalization of mean serum Na by the fourth day (136.2 ± 4.1 mEq/l, p < 0.001). The mean serum urea concentration also increased (from 29.8 ± 11.1 mg/dl before urea to 57.6 ± 24.0 mg/dl on the first day of treatment, p < 0.001). Conclusions: Urea administration appears useful for the treatment of SIADH-associated hyponatremia in critically ill patients. Prospective randomized controlled studies are needed to confirm these results.

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Section: Discussionmentioning

confidence: 99%

Treatment of the Syndrome of Inappropriate Secretion of Antidiuretic Hormone with Urea in Critically Ill Patients

et al. 2012

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“…1,3,4 A postulated mechanism of hyponatremia influencing outcome also in neurointensive care could be its relation to an increased nonosmotic release of AVP caused by the overstimulation of the neurohumoral axis or by baroreceptor failure in elderly patients leading to cerebral hypoperfusion. 11,28 After severe neurotrauma such as ICH, increased intracranial pressures and cerebral hypoperfusion may even aggravate secondary brain injury. Assuming that these mechanisms play a role in patients with ICH, increased AVP levels themselves could contribute to a reduced tolerance to cerebral hypoxia.…”

Section: May 2014mentioning

confidence: 99%

Hyponatremia Is an Independent Predictor of In-Hospital Mortality in Spontaneous Intracerebral Hemorrhage

Kuramatsu

Bobinger

Volbers

et al. 2014

Stroke

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Background and Purpose-Hyponatremia is the most frequent electrolyte disturbance in critical care. Across various disciplines, hyponatremia is associated with increased mortality and longer hospital stay, yet in intracerebral hemorrhage (ICH) no data are available. This the first study that investigated the prevalence and clinical associations of hyponatremia in patients with ICH. Methods-This observational study included all consecutive spontaneous ICH patients (n=464) admitted during a 5-year period to the Department of Neurology. Patient characteristics, in-hospital measures, mortality, and functional outcome (90 days and 1 year) were analyzed to determine the effects of hyponatremia (Na <135 mEq/L). Multivariable regression analyses were calculated for factors associated with hyponatremia and predictors of in-hospital mortality. Results-The prevalence of hyponatremia on hospital admission was 15.6% (n=66). Normonatremia was achieved and maintained in almost all hyponatremia patients <48 hours. In-hospital mortality was roughly doubled in hyponatremia compared with nonhyponatremia patients (40.9%; n=27 versus 21.1%; n=75), translating into a 2.5-fold increased odds ratio (P<0.001). Multivariable analyses identified hyponatremia as an independent predictor of in-hospital mortality (odds ratio, 2.2; 95% confidence interval, 1.05-4.62; P=0.037). Within 90 days after ICH, hyponatremia patients surviving hospital stay were also at greater risk of death (odds ratio, 4.8; 95% confidence interval, 2.1-10.6; P<0.001); thereafter, mortality rates were similar. Conclusions-Hyponatremia was identified as an independent predictor of in-hospital mortality with a fairly high prevalence in spontaneous ICH patients. The presence of hyponatremia at hospital admission is related to an increased short-term mortality in patients surviving acute care, possibly reflecting a preexisting condition that is linked to worse outcome due to greater comorbidity. Correction of hyponatremia does not seem to compensate its influence on mortality, which strongly warrants future research. (Stroke. 2014;45:1285-1291.)

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“…To shed some light on this controversy, Brimioulle et al prospectively investigated whether hypotonic hyponatremia is associated with SIADH or CSWS in patients with acute neurological disorders with normal renal function and clinically normal fluid status. These authors concluded that adequate blood volumes in hyponatremic patients confirm the diagnosis of SIADH and do not support the concept of CSWS [10]. The distinction is furthermore not important in children with TBM as hyponatremia complicating intracranial disease should always be treated with hypertonic saline (regardless of volume status) [6].…”

Section: Tb Meningitis and Hyponatremiamentioning

confidence: 95%

MR imaging of the posterior hypophysis in children with tuberculous meningitis

2009

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The syndrome of inappropriate antidiuretic hormone secretion (SIADH) contributes to the morbidity and mortality in children with tuberculous meningitis (TBM). MRI assists in the early diagnosis of TBM and absence of the normal posterior pituitary bright spot (PPS) on T1-weighted MRI in TBM may indicate the functional integrity of the posterior hypophysis. The objective of this retrospective descriptive study of 22 children with TBM was to determine the prevalence of an absent PPS on T1-weighted MRI in children with TBM and its correlation with serum sodium levels (hyponatremia), severity of disease at presentation, and developmental outcome after 6 months. The prevalence of absent PPS in children with TBM was 55%. No significant correlation was found between the PPS and serum sodium status (p = 0.41) or severity of disease at presentation (p = 0.104). There was however a correlation between absent PPS and poorer developmental outcome at 6-month follow-up (p = 0.027).

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Hyponatremia in neurological patients: cerebral salt wasting versus inappropriate antidiuretic hormone secretion

Abstract: The adequate blood volumes in hyponatremic patients confirm the diagnosis of SIADH and do not support the concept of CSWS.

Cited by 67 publications

References 21 publications

Treatment of the Syndrome of Inappropriate Secretion of Antidiuretic Hormone with Urea in Critically Ill Patients

Treatment of the Syndrome of Inappropriate Secretion of Antidiuretic Hormone with Urea in Critically Ill Patients

Hyponatremia Is an Independent Predictor of In-Hospital Mortality in Spontaneous Intracerebral Hemorrhage

MR imaging of the posterior hypophysis in children with tuberculous meningitis

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