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Hyponatremia and Brain Injury: Historical and Contemporary Perspectives

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Abstract

Hyponatremia is common in neurocritical care patients and is associated with significant morbidity and mortality. Despite decades of research into the syndrome of inappropriate antidiuretic hormone (SIADH) and cerebral salt wasting (CSW), their underlying pathophysiological mechanisms are still not fully understood. This paper reviews the history behind our understanding of hyponatremia in patients with neurologic injury, including the first reports of CSW and SIADH, and current and future challenges to diagnosis and management in this setting. Such challenges include distinguishing CSW, SIADH, and hypovolemic hyponatremia due to a normal pressure natriuresis from the administration of large volumes of fluids, and hyponatremia due to certain medications used in the neurocritical care population. Potential treatments for hyponatremia include mineralocorticoids and vasopressin 2 receptor antagonists, but further work is required to validate their usage. Ultimately, a greater understanding of the pathophysiological mechanisms underlining hyponatremia in neurocritical care patients remains our biggest obstacle to optimizing patient outcomes in this challenging population.

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Authors and Affiliations

  1. Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK

    Matthew A. Kirkman & Ahmed Ibrahim

  2. Neurointensive Care Unit, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Salford, UK

    Angelique F. Albert

  3. Intensive Care Unit, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK

    Doris Doberenz

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  1. Matthew A. Kirkman
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Kirkman, M.A., Albert, A.F., Ibrahim, A. et al. Hyponatremia and Brain Injury: Historical and Contemporary Perspectives. Neurocrit Care 18, 406–416 (2013). https://doi.org/10.1007/s12028-012-9805-y

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