“Hyponatremia in Stroke: Cerebral Salt Wasting Versus Syndrome of Inappropriate Anti-Diuresis”

Natarajan, Kumar; Prasad, Maya

doi:10.9790/0853-150780122

Cited by 5 publications

(7 citation statements)

References 21 publications

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“…The incidence of hyponatremia in our study group was 19.1%. This nding is consistent with Natarajan et al study which reported incidence of hyponatremia as 20% (13).However there were studies which showed higher hyponatremia incidence as high as 45.3% (15). In our study there was higher incidence of CSWS (51%).…”

Section: Discussionsupporting

confidence: 92%

Incidence and Predictors of Cerebral Salt Wasting Syndrome in Stroke Patients – Results of a Prospective Observational Study

Ranasinghe

Bowatte

Antonypillai³

et al. 2022

Preprint

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BackgroundCerebral salt wasting syndrome (CSWS) and Syndrome of Inappropriate Anti Diuretic Hormone secretion (SIADH) are the most common aetiological factors for developing hyponatremia following stroke. The differentiation of these two entities is crucial as the treatment options are completely different. Hence the knowledge on predictors of CSWS is important to make a more accurate diagnosis of CSWS. MethodsTwo hundred and fourty six patients with confirmed stroke were prospectively observed throughout the hospital stay in a tertiary referral center in Sri Lanka to identify the possible predictors of CSWS. Hyponatremia was defined as serum Na+ level less than 131mmo/l. Serum osmolality, urine osmolality, urinary Na+, serum cortisol and thyroid function tests were performed on all the hyponatremic patients. Differentiation of the CSWS and SIADH was based on physical examination findings and laboratory parameters. ResultsThe incidence of hyponatremia in our study population was 19.1% (95% Confidence Interval 14.39-24.58). The majority of patients (24, 51%) were attributed to CSWS. SIADH group comprised of 17 (36.2%) patients and 6 (12.7%) patients had other undetermined causes. There was a significant statistical difference between the aetiologies of hyponatremia and laboratory investigations like urinary Na+, urinary osmolality and serum osmolality. Demographic characteristics, comorbidities, imaging findings and clinical parameters like systolic blood pressure, diastolic blood pressure, on admission GCS were considered in the multivariable logistic regression model and the overall model was not significant. Conclusion The incidence of CSWS is higher than the incidence of SIADH. The demographic characteristics, comorbidities, imaging and clinical parameters like blood pressure, on admission GCS could not predict the occurrence of CSWS

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Section: Discussionsupporting

confidence: 92%

Incidence and Predictors of Cerebral Salt Wasting Syndrome in Stroke Patients – Results of a Prospective Observational Study

Ranasinghe

Bowatte

Antonypillai³

et al. 2022

Preprint

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“…Mean age of male was 61.93±9.17 and of female was 63.40±6.15. Maximum male 17% (17) were between 56-60 years and female 12% (12) were between 61-65 years. There were 64 cases of ischemic stroke (ISCHS) and 36 cases of intracerebral haemorrhage (ICH).…”

Section: Resultsmentioning

confidence: 97%

“…16 A study by Natarajan K et al reported in 20% cases. 17 Bondopadhyay et al and Siddiqui et al showed that hyponatraemia was common in their series of ICH. 12,13 Mean baseline serum potassium level in our study was 3.65±0.48 meq/L in ICH and 3.83±0.40 in ISCHS.…”

Section: Discussionmentioning

confidence: 96%

Clinical profiles, electrolytes status in acute strokes and their outcome

2018

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Background: Intracerebral hemorrhage (ICH) and Ischemic strokes (ISCHS) can occurs along with many metabolic abnormalities in acute stage. Electrolyte disturbances can occurs in acute stage of strokes due to many causes. The aim of the present study is to observe the clinical profiles, electrolytes status in acute stage of strokes and their outcome.Methods: One hundred stroke patients diagnosed clinically and confirmed by CT or MRI within 24 hours of onset were consecutively selected for the study after fulfillment of inclusion criteria in the indoor department of medicine, VSSIMSAR, Burla, Odisha (India), from Nov 2015 to Nov 2017. Baseline Glasgow Coma Scale (GCS), serum electrolytes were estimated along with other biochemical tests as needed. Glasgow Outcome Scale (GOS) was determined after 5th day of strokes. Data were collected and analyzed. Results: Hyponatraemia present in 13 (36.11%) of ICH and 6 (2.38%) ISCHS. Hypokalaemia was present in 7 (9.44%) of ICH and 11(17.19%) ISCHS. Hypocalcaemia was present in 3 (8.33%) of ICH and 18(28.12%) ISCHS. (P 0.0001). Hypomagnesaemia in 2(5.56%) ICH and 21 (32.81%) ISCHS. (P 0.0001). Minor GCS in 38 (62.29%), moderate 15 (24.59%) and severe 8(13.12%) patients with dyselectrolytemia versus 31 (79.48%), 5 (12.82%) and 3 (7.7%) with normal electrolytes respectively. GOS was good in 30 (49.18%), poor 18 (29.51%) and GOS 1 (Deaths) 13 (21.31%) versus 32(82.05%), 5(12.82%) and 1(1.3%) in patients with normal electrolytes status. (P 0.03).Conclusions: E Hyponatraemia and hypoklaemia was very often present in ICH and hypocalcaemia and hypomagnesaemia in ISCHS, Higher rates of morbidity and mortalities was associated with dyselectrolytemia.

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“…The results of these findings were corroborated by various studies. [11][12][13][14][15][16][17][18][19][20] It may therefore be considered that there may be a true association between the degree of hyponatremia in patients mortality in acute ischemic stroke patients.…”

Section: Discussionmentioning

confidence: 99%

Impact of hyponatremia on outcome of acute ischemic stroke in a tertiary care hospital.

Kidwai

Ara

Rasheed

et al. 2019

TPMJ

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Objectives: To determine the frequency and impact of hyponatermia on outcome in patients of acute ischemic stroke admitted to a Tertiary Care Hospital, Karachi. Study Design: Prospective, cross-sectional, observational study. Setting: Department of Medicine, Abbasi Shaheed Hospital, Karachi. Period: January 2015 to May 2018. Material and Methods: A total of 110 patients of both gender presented with acute ischemic stroke and hyponatermia (2 consecutive serum sodium levels (< 135 mEq/L). Diagnosis of syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and cerebral salt wasting (CSW) was based on predefined criteria. Mortality was considered in terms of modified Rankin Scale with score of 6 within four weeks of admission. Data was analyzed by using SPSS Version 20. Result: Out of 110 acute ischemic stroke patients, 66 (60%) were male and 44 (40%) were female. The mean age was 61.45 ± 11.8 years. Mean serum sodium level was 128.4 ± 6.07. Older ages are associated with high mortality rate of 20%. Moderate (29%) and severe (11%) hyponatremia was associated with 21% and 33% mortality respectively. Overall mortality in patients with hyponatremia was 14.5%. Conclusion: Mortality rates are higher in acute ischemic stroke patients presented with moderate to severe hyponatremia.

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“Hyponatremia in Stroke: Cerebral Salt Wasting Versus Syndrome of Inappropriate Anti-Diuresis”

Cited by 5 publications

References 21 publications

Incidence and Predictors of Cerebral Salt Wasting Syndrome in Stroke Patients – Results of a Prospective Observational Study

Incidence and Predictors of Cerebral Salt Wasting Syndrome in Stroke Patients – Results of a Prospective Observational Study

Clinical profiles, electrolytes status in acute strokes and their outcome

Impact of hyponatremia on outcome of acute ischemic stroke in a tertiary care hospital.

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