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Determinants of hyponatremia following a traumatic brain injury

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Abstract 

Background

Hyponatremia is common in patients with central nervous system disease. It may prolong hospitalization and increase morbidity and mortality. However, the incidence and risks factors remain largely unknown in traumatic brain injury (TBI). The objectives of this study are to characterize hyponatremia in TBI patients and find its main risk factors.

Methods

All patients admitted with a diagnosis of acute TBI over a 1-year period were included, except patients with known chronic hyponatremia, those who died within 72 h, and those receiving hyperosmolar therapy to treat their intracranial hypertension. Sodium levels throughout hospitalization were collected. Post-traumatic hyponatremia was defined as follows: borderline (1–2 points below normal and 1–2 days duration) and significant (more than 2 points below normal and/or more than 2 days duration). Demographic data, GCS, mechanism of injury, and CT findings were collected. These factors were correlated to the incidence of hyponatremia.

Results

Hyponatremia was found in 29% of the 283 included patients and was significant in 2/3 of the cases. Significant hyponatremia had a narrower peak, between 7 and 11 days, while borderline hyponatremia started earlier and was more distributed in time. Factors associated with hyponatremia were greater age (p = 0.004), worse ISS (p = 0.017), worse Marshall Grade on CT (p = 0.007), and a diffuse pattern of injury on CT (p < 0.001). Significant hyponatremia was associated with: a diffuse pattern of injury on CT (p = 0.032), the presence of intracerebral hemorrhage (p = 0.027), and multiple lesions on CT (p = 0.043).

Conclusions

Post-traumatic hyponatremia is common and can lead to serious consequences in TBI patients. Adequate monitoring and treatment are therefore important. Older patients and those with more significant injury on CT are more at risk.

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Authors and Affiliations

  1. Department of Neurology and Neurosurgery, McGill University Health Centre, 1650 Cedar Ave, Room L7-516, Montreal, QC, H3G 1A4, Canada

    Etienne Léveillé & Judith Marcoux

  2. Department of Neurosurgery and Neuroscience, Sabah Medical Region, Ibn Sina Hospital, Kuwait City, Kuwait

    Meshal Aljassar

  3. Foothills Medical Centre, University of Calgary, Calgary, AB, Canada

    Benjamin Beland

  4. King Abdulaziz University Hospital, Jeddah, Saudi Arabia

    Rothaina Jamal Saeedi

Authors
  1. Etienne Léveillé
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  2. Meshal Aljassar
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  3. Benjamin Beland
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  4. Rothaina Jamal Saeedi
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  5. Judith Marcoux
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Correspondence to Judith Marcoux.

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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.

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Léveillé, E., Aljassar, M., Beland, B. et al. Determinants of hyponatremia following a traumatic brain injury. Neurol Sci 43, 3775–3782 (2022). https://doi.org/10.1007/s10072-022-05894-3

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  • DOI: https://doi.org/10.1007/s10072-022-05894-3

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