Target Serum Sodium Levels During Intensive Care Unit Management of Aneurysmal Subarachnoid Hemorrhage

Abstract

In patients with SAH, both hyponatremia and hypernatremia during ICU management were significantly associated with unfavorable neurologic outcomes.

Aneurysmal subarachnoid hemorrhage: intensive care for improving neurological outcome

“…Referring to this summary, the optimal threshold seemed to be 145 mmol/L, as suggested in a previous study [ 60 ], and hypernatremia was associated with poor outcomes. The preventive effect of a specific drug or protocol on hypernatremia has not been tested to date.…”

“…However, there are few studies describing the characteristics of sodium alteration in ICU. A single-center retrospective observational study showed that serum sodium concentrations increased for the first few days and decreased to the nadir level at 6–12 days [ 60 ]. A similar trend was observed in another retrospective study [ 61 ].…”

“…Although a systematic review showed that hyponatremia was associated with longer hospitalization and cerebral infarction, whether hyponatremia affects neurological outcomes remains controversial [ 62 ]. The threshold of hyponatremia associated with poor neurological outcomes was addressed in a retrospective observational study involving 131 patients [ 60 ]. In this study, multiple regression analysis showed that minimum sodium levels in the ICU were associated with unfavorable neurological outcomes at hospital discharge, and receiver operating characteristics curve analysis derived a cutoff value of 132 mmol/L.…”

“…Hypernatremia is commonly defined as serum sodium levels > 145 mmol/L and develops less frequently than hyponatremia [ 60 ]. SAH-related hypothalamic dysfunction induces central diabetes insipidus followed by hypernatremia [ 66 , 67 ].…”

Корекція Порушень Обміну Натрію В Пацієнтів Відділень Інтенсивної Терапії: Старі Методи І Сучасні Підходи

“…Починають із внутрішньовенного введення 1-2 літрів збалансованих сольових розчинів, а потім застосовують колоїди. При субарахноїдальних крововиливах рівень натрію сироватки плазми вищий 145 ммоль/л чи нижчий 132 ммоль/л веде до небажаних неврологічних наслідків у 88,2 % пацієнтів відділень інтенсивної терапії [21]. Рекомендують також раннє призначення флудрокортизону, особливо хворим із травматичним субрахноїдальним крововиливом [19].…”