Neurocritical Care

, Volume 6, Issue 3, pp 195–199 | Cite as

Inadvertent hyponatremia leading to acute cerebral edema and early evidence of herniation

  • Jessica Carpenter
  • Steve Weinstein
  • John Myseros
  • Gilbert Vezina
  • Michael J. Bell
Practical Pearl



For years, the maintenance of normal or supranormal serum sodium (Na) concentrations has been believed to be beneficial in brain injuries. Recently published guidelines for cerebral trauma recommend the use of hypertonic saline to achieve hypernatremia for the management of increased intracranial pressure and these standards are generally practiced across most diseases in neurocritical care including stroke, hemorrhage and tumors. Severe hyponatremia has long been known to be detrimental, but objective evidence for the harm of mild hyponatremia as a secondary injury has been scarce.

Description of Case

In this case report, we describe a child with aneurysmal subarachnoid hemorrhage who had a sudden, inadvertent decrease in serum Na (128 meq/l) that was associated with a deterioration of her neurological examination and evidence of early transtentorial herniation on emergent brain CT scan. These findings were quickly reversed after the serum Na was corrected.


This report emphasizes that close monitoring of serum Na and osmolarity in acute head injured children is important, and provides evidence that alterations of these parameters is a substantial risk for cerebral edema in children with evolving brain injuries and briefly reviews the literature regarding the risks of hyponatremia in children.


Cerebral edema Hyponatremia Child Hypertonic saline Hyponatremic encephalopathy 


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Copyright information

© Humana Press Inc. 2007

Authors and Affiliations

  • Jessica Carpenter
    • 1
  • Steve Weinstein
    • 1
  • John Myseros
    • 2
  • Gilbert Vezina
    • 3
  • Michael J. Bell
    • 4
    • 5
  1. 1.Department of Neurology, Children’s Research InstituteChildren’s National Medical CenterWashingtonUSA
  2. 2.Department of NeurosurgeryChildren’s Research Institute, Children’s National Medical CenterWashingtonUSA
  3. 3.Department of NeuroradiologyChildren’s Research Institute, Children’s National Medical CenterWashingtonUSA
  4. 4.Department of Critical Care MedicineChildren’s Research Institute, Children’s National Medical CenterWashingtonUSA
  5. 5.Neurocritical Care, Children’s National Medical CenterCenter for Neuroscience Research, Children’s Research InstituteWashingtonUSA

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