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Prevention and Correction of Dysnatremia After Aneurysmal Subarachnoid Hemorrhage

  • Practice Guidance for Critical Care Management of SAH
  • Published:
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Abstract

Background

Dysnatremia occurs commonly in patients with aneurysmal subarachnoid hemorrhage (aSAH). The mechanisms for development of sodium dyshomeostasis are complex, including the cerebral salt-wasting syndrome, the syndrome of inappropriate secretion of antidiuretic hormone, diabetes insipidus. Iatrogenic occurrence of altered sodium levels plays a role, as sodium homeostasis is tightly linked to fluid and volume management.

Methods

Narrative review of the literature.

Results

Many studies have aimed to identify factors predictive of the development of dysnatremia, but data on associations between dysnatremia and demographic and clinical variables are variable. Furthermore, although a clear relationship between serum sodium serum concentrations and outcomes has not been established—poor outcomes have been associated with both hyponatremia and hypernatremia in the immediate period following aSAH and set the basis for seeking interventions to correct dysnatremia. While sodium supplementation and mineralocorticoids are frequently administered to prevent or counter natriuresis and hyponatremia, evidence to date is insufficient to gauge the effect of such treatment on outcomes.

Conclusions

In this article, we reviewed available data and provide a practical interpretation of these data as a complement to the newly issued guidelines for management of aSAH. Gaps in knowledge and future directions are discussed.

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Acknowledgements

We would like to acknowledge and thank Melody Eckert for creating Fig. 1.

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Authors and Affiliations

  1. Departments of Neurology and Neurosurgery, College of Medicine, University of Florida, Gainesville, FL, USA

    Katharina M. Busl

  2. Department of Neurology, Mayo Clinic Rochester, Rochester, MN, USA

    Alejandro A. Rabinstein

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KMB conceptualized the article, acquired the data, and drafted the article. AAR acquired data, analyzed and interpreted the data, and critically revised the article. Both authors approved the final version of the manuscript as submitted.

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Correspondence to Katharina M. Busl.

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KMB does not report any conflict of interest for this publication. She is a member of the editorial board of the journal Neurocritical Care, is associate editor for Critical Care Medicine, is on the Board of Directors for Art-in-Medicine, and has received honoraria for course directorship and speaking from the American Academy of Neurology. AAR reports no conflicts of interest for this publication. He is a Clinical Events Committee member for trials sponsored by Boston Scientific and is on the advisory board for Astra Zeneca, Brainomix, Shionogi, and Chiesi.

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Busl, K.M., Rabinstein, A.A. Prevention and Correction of Dysnatremia After Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care 39, 70–80 (2023). https://doi.org/10.1007/s12028-023-01735-z

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