Abstract
Sodium disturbances are frequent and serious complications in neurocritically ill patients. Hyponatremia is more common than hypernatremia, which is, however, prognostically worse. The aim of this study was to analyse outcome and frequency of sodium disturbances in relation to measured serum osmolality in neurologic-neurosurgical critically ill patients. A 5-year retrospective collection of patients (pts) and laboratory data were made from the Laboratory Information System database in the Clinical Biochemistry Department. The criteria for patients’ inclusion was acute brain disease and serum sodium (SNa+) <135 mmol/l (hyponatremia) or SNa+ >150 mmol/l (hypernatremia). Hypoosmolality was defined as measured serum osmolality (SOsm) <275 mmol/kg, hyperosmolality as SOsm >295 mmol/kg. We performed analysis of differences between hyponatremia and hypernatremia and subanalysis of differences between hypoosmolal hyponatremia and hypernatremia. From 1,440 pts with acute brain diseases there were 251 (17 %) pts with hyponatremia (mean SNa+ 131.78 ± 2.89 mmol/l, SOsm 279.46 ± 11.84 mmol/kg) and 75 (5 %) pts with hypernatremia (mean SNa+ 154.38 ± 3.76 mmol/l, SOsm 326.07 ± 15.93 mmol/kg). Hypoosmolal hyponatremia occurred in 50 (20 % of hyponatremic patients) pts (mean SNa+ 129.62 ± 4.15 mmol/l; mean SOsm 267.35 ± 6.28 mmol/kg). Multiple logistic regression analysis showed that hypernatremia is a significant predictor of mortality during neurologic-neurosurgical intensive care unit (NNICU) stay (OR 5.3, p = 0.002) but not a predictor of bad outcome upon discharge from NNICU, defined as Glasgow Coma Scale 1–3. These results showed that hypernatremia occurred less frequently than all hyponatremias, but more often than hypoosmolal hyponatremia. Hypernatremia was shown to be a significant predictor of NNICU mortality compared to hyponatremia.
Similar content being viewed by others
References
Tisdall M, Crocker M, Watkiss J et al (2006) Disturbances of sodium in critically ill adult neurologic patients: a clinical review. J Neurosurg Anesthesiol 18:57–63
Aiyagari V, Deibert E, Diringer M (2006) Hypernatremia in the neurologic intensive care unit: how high is too high? J Crit Care 21:163–172
Diringer MN, Zazulia AR (2006) Hyponatremia in neurologic patients: consequences and approaches to treatment. Neurologist 12:117–126
Fisher LA, Ko N, Miss J et al (2006) Hypernatremia predicts adverse cardiovascular and neurological outcomes after SAH. Neurocrit Care 5:180–185
Fraser JF, Stieg PE (2006) Hyponatremia in the neurosurgical patient: epidemiology, pathophysiology, diagnosis, and management. Neurosurgery 59:222–229
Rabinstein AA, Wijdicks EF (2003) Hyponatremia in critically ill neurological patients. Neurologist 9:290–300
Qureshi AI, Suri MF, Sung GY et al (2002) Prognostic significance of hypernatremia and hyponatremia among patients with aneurysmal subarachnoid hemorrhage. Neurosurgery 50:749–756
Takaku A, Shindo K, Tanaka S et al (1979) Fluid and electrolyte disturbances in patients with intracranial aneurysms. Surg Neurol 11:349–356
Disney L, Weir B, Grace M et al (1989) Trends in blood pressure, osmolality and electrolytes after subarachnoid hemorrhage from aneurysms. Can J Neurol Sci 16:299–304
Diringer MN (1992) Management of sodium abnormalities in patients with CNS disease. Clin Neuropharmacol 15:427–447
Nathan BR (2007) Cerebral correlates of hyponatremia. Neurocrit Care 6:72–78
Dvir D, Beigel R, Hoffmann C et al (2009) Hyponatremic brain edema: correlation with serial computed tomography scans. Isr Med Assoc J 11:442–443
Schrier RW, Bansal S (2008) Diagnosis and management of hyponatremia in acute illness. Curr Opin Crit Care 14:627–634
Miulli D (2008) Fluid management. In: Siddiqi J (ed) Neurosurgical intensive care. Thieme, New York, pp 290–312
Vaidya C, Ho W, Freda BJ (2010) Management of hyponatremia: providing treatment and avoiding harm. Cleve Clin J Med 77:715–726
Funk GC, Lindner G, Druml W et al (2010) Incidence and prognosis of dysnatremias present on ICU admission. Intensive Care Med 36:304–311
Polderman KH, Schreuder WO, Strack van Schijndel RJ et al (1999) Hypernatremia in the intensive care unit: an indicator of quality of care? Crit Care Med 27:1105–1108
Shoker AS (1994) Application of the clearance concept to hyponatremic and hypernatremic disorders: a phenomenological analysis. Clin Chem 40:1220–1227
Lolin Y, Jackowski A (1992) Hyponatraemia in neurosurgical patients: diagnosis using derived parameters of sodium and water homeostasis. Br J Neurosurg 6:457–466
Sam R, Feizi I (2012) Understanding hypernatremia. Am J Nephrol 36:97–104
Hoorn EJ, Betjes MG, Weigel J et al (2008) Hypernatraemia in critically ill patients: too little water and too much salt. Nephrol Dial Transpl 23:1562–1568
Lindner G, Funk GC, Schwarz C et al (2007) Hypernatremia in the critically ill is an independent risk factor for mortality. Am J Kidney Dis 50:952–957
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Spatenkova, V., Bradac, O. & Skrabalek, P. Outcome and frequency of sodium disturbances in neurocritically ill patients. Acta Neurol Belg 113, 139–145 (2013). https://doi.org/10.1007/s13760-012-0137-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13760-012-0137-7