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Approach to the Management of Sodium Disorders in the Neuro Critical Care Unit

  • Critical Care Neurology (H Hinson, Section Editor)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Abstract

Purpose of Review

To present an overview of the current diagnostic and therapeutic approaches for patients with hyponatremia and hypernatremia in the neurocritical care unit (NCCU).

Recent Findings

Dysnatremias are associated with poor neurological outcomes and mortality in neurocritically ill patients. Volume status determination, although challenging, is critical in differentiating between the two most common etiologies of hyponatremia in the NCCU: SIADH and salt wasting. Central diabetes insipidus (CDI) is common in post trans-sphenoidal surgery patients and in severe brain injuries where it portends a poor prognosis.

Summary

Treatment of dysnatremia should take into account severity of symptoms, rapidity of onset, and presence and extent of underlying brain injury. Severe acute hyponatremia is an emergency that should be treated with intravenous hypertonic saline. Controlled speed of correction is crucial in preventing osmotic demyelination syndrome in the most vulnerable patients in patients with chronic hyponatremia. SIADH is the most common cause of hyponatremia in the NCCU and is usually treated with fluid restriction, vaptans, oral salt, urea, and occasionally saline and loop diuretics. Salt wasting is a common cause of hypovolemic hyponatremia in severe brain injuries and should be managed with fluid and salt repletion ± fludrocortisone. Hypernatremia is treated with hypotonic solutions after correcting volume status as needed with isotonic solution, with the addition of desmopressin or vasopressin in cases of CDI.

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Authors and Affiliations

  1. Department of Neurology, Division of Neurocritical Care, Henry Ford Health System, 2799 W Grand Blvd, CFP 466, Detroit, MI, 48202, USA

    Murad Baba MD MBA, Stacey Williamson MD & Ahmad Riad Ramadan MD

  2. Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA

    Diana Alsbrook MD

  3. Division of Nephrology and Hypertension, Henry Ford Health System, Detroit, MI, USA

    Sandeep Soman MD

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  1. Murad Baba MD MBA
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  2. Diana Alsbrook MD
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  5. Ahmad Riad Ramadan MD
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Baba, M., Alsbrook, D., Williamson, S. et al. Approach to the Management of Sodium Disorders in the Neuro Critical Care Unit. Curr Treat Options Neurol 24, 327–346 (2022). https://doi.org/10.1007/s11940-022-00723-6

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