Advertisement

Neurocritical Care

, Volume 26, Issue 2, pp 182–190 | Cite as

Risk of Hyponatremia in Patients with Aneurysmal Subarachnoid Hemorrhage Treated with Exogenous Vasopressin Infusion

  • Nancy Marr
  • Jessica Yu
  • Demetrios J. Kutsogiannis
  • Sherif Hanafy Mahmoud
Original Article

Abstract

Background

Vasopressin is one of the vasopressors used to augment blood pressure in subarachnoid hemorrhage (SAH) patients with clinically significant vasospasm. The purpose of the present study was to determine whether the administration of vasopressin to a population of SAH patients was an independent predictor of developing hyponatremia.

Methods

A retrospective review on the health records of 106 patients admitted to the University of Alberta Hospital Neurosciences ICU, Edmonton AB, Canada, with SAH from June 2013 to December 2015 was conducted. Serum sodium changes in patients receiving vasoactive drugs were compared. In addition, independent predictors for hyponatremia (Na < 135 mmol/L) were determined using a multivariate logistic regression model.

Results

Patients treated with vasopressin in addition to other vasoactive drugs had significantly higher sodium changes compared to those treated with other vasoactive drugs (−4.7 ± 6 vs −0.1 ± 2.4 mmol/L, respectively, p value 0.001). Hyponatremia occurred in 14 patients (70 %) treated with vasopressin, 10 patients (44 %) treated with vasoactive drugs other than vasopressin (p value 0.081), and 24 patients (38 %) who did not receive any vasoactive drug (p value 0.013). In multivariate logistic regression analysis, when adjusting for disease severity, age, sex, aneurysm location, and treatment, vasopressin was associated with hyponatremia (OR 3.58, 95 % CI, 1.02–12.5, p value 0.046).

Conclusions

The results of the present study suggest that hyponatremia may be more common in SAH patients treated with exogenous vasopressin compared to those who did not receive it. Serum sodium should be monitored closely when vasopressin is being used in the SAH population. Further studies are needed to confirm the effect of exogenous vasopressin on serum sodium levels in SAH populations.

Keywords

Subarachnoid hemorrhage Vasopressin Hyponatremia Hypertonic saline Vasopressors 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

References

  1. 1.
    Connolly ES Jr, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American heart association/American stroke association. Stroke. 2012;43:1711–37.CrossRefPubMedGoogle Scholar
  2. 2.
    Diringer MN, Bleck TP, Claude Hemphill J 3rd, et al. Critical care management of patients following aneurysmal subarachnoid hemorrhage: recommendations from the neurocritical care society’s multidisciplinary consensus conference. Neurocrit Care. 2011;15:211–40.CrossRefPubMedGoogle Scholar
  3. 3.
    Suarez JI, Tarr RW, Selman WR. Aneurysmal subarachnoid hemorrhage. N Engl J Med. 2006;354:387–96.CrossRefPubMedGoogle Scholar
  4. 4.
    Muehlschlegel S, Dunser MW, Gabrielli A, Wenzel V, Layon AJ. Arginine vasopressin as a supplementary vasopressor in refractory hypertensive, hypervolemic, hemodilutional therapy in subarachnoid hemorrhage. Neurocrit Care. 2007;6:3–10.CrossRefPubMedGoogle Scholar
  5. 5.
    Rang HP, Ritter JM, Flower RJ, Henderson G. The pituitary and the adrenal cortex. In: Rang and Dale's pharmacology. 8th ed. Edinburgh; New York: Elsevier/Churchill Livingstone; 2015. p. 402–417.Google Scholar
  6. 6.
    Russell JA, Walley KR, Singer J, et al. Vasopressin versus norepinephrine infusion in patients with septic shock. N Engl J Med. 2008;358:877–87.CrossRefPubMedGoogle Scholar
  7. 7.
    Salazar M, Hu BB, Vazquez J, Wintz RL, Varon J. Exogenous vasopressin-induced hyponatremia in patients with vasodilatory shock: two case reports and literature review. J Intensive Care Med. 2015;30:253–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Mapa B, Taylor BE, Appelboom G, Bruce EM, Claassen J, Connolly ES. Impact of hyponatremia on morbidity, mortality, and complications after aneurysmal subarachnoid hemorrhage: a systematic review. World Neurosurg. 2016;85:305–14.CrossRefPubMedGoogle Scholar
  9. 9.
    Wijdicks EFM, Vermeulen M, Hijdra A, Van Gijn J. Hyponatremia and cerebral infarction in patients with ruptured intracranial aneurysms: is fluid restriction harmful? Ann Neurol. 1985;17:137–40.CrossRefPubMedGoogle Scholar
  10. 10.
    Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–81.CrossRefPubMedGoogle Scholar
  11. 11.
    Obeid JS, McGraw CA, Minor BL, et al. Procurement of shared data instruments for research electronic data capture (REDCap). J Biomed Inform. 2013;46:259–65.CrossRefPubMedGoogle Scholar
  12. 12.
    Obritsch MD, Jung R, Fish DN, MacLaren R. Effects of continuous vasopressin infusion in patients with septic shock. Ann Pharmacother. 2004;38:1117–22.CrossRefPubMedGoogle Scholar
  13. 13.
    Grinevich V, Knepper MA, Verbalis J, Reyes I, Aguilera G. Acute endotoxemia in rats induces down-regulation of V2 vasopressin receptors and aquaporin-2 content in the kidney medulla. Kidney Int. 2004;65:54–62.CrossRefPubMedGoogle Scholar
  14. 14.
    Sharshar T, Blanchard A, Paillard M, Raphael JC, Gajdos P, Annane D. Circulating vasopressin levels in septic shock. Crit Care Med. 2003;31:1752–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Mather HM, Ang V, Jenkins JS. Vasopressin in plasma and CSF of patients with subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry. 1981;44:216–9.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Liu ZW, Gu H, Zhang BF, et al. Rapidly increased vasopressin promotes acute platelet aggregation and early brain injury after experimental subarachnoid hemorrhage in a rat model. Brain Res. 2016;1639:108–19.CrossRefPubMedGoogle Scholar
  17. 17.
    Diringer MN, Wu KC, Verbalis JG, Hanley DF. Hypervolemic therapy prevents volume contraction but not hyponatremia following subarachnoid hemorrhage. Ann Neurol. 1992;31:543–50.CrossRefPubMedGoogle Scholar
  18. 18.
    Hannon MJ, Behan LA, O’Brien MM, et al. Hyponatremia following mild/moderate subarachnoid hemorrhage is due to SIAD and glucocorticoid deficiency and not cerebral salt wasting. J Clin Endocrinol Metab. 2014;99:291–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Wijdicks EF, Vermeulen M, ten Haaf JA, Hijdra A, Bakker WH, van Gijn J. Volume depletion and natriuresis in patients with a ruptured intracranial aneurysm. Ann Neurol. 1985;18:211–6.CrossRefPubMedGoogle Scholar
  20. 20.
    Sayama T, Inamura T, Matsushima T, Inoha S, Inoue T, Fukui M. High incidence of hyponatremia in patients with ruptured anterior communicating artery aneurysms. Neurol Res. 2000;22:151–5.CrossRefPubMedGoogle Scholar
  21. 21.
    Saramma P, Menon RG, Srivastava A, Sarma PS. Hyponatremia after aneurysmal subarachnoid hemorrhage: implications and outcomes. J Neurosci Rural Pract. 2013;4:24–8.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Nancy Marr
    • 1
  • Jessica Yu
    • 1
  • Demetrios J. Kutsogiannis
    • 2
  • Sherif Hanafy Mahmoud
    • 1
  1. 1.Faculty of Pharmacy and Pharmaceutical SciencesUniversity of AlbertaEdmontonCanada
  2. 2.Division of Critical Care Medicine, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada

Personalised recommendations