Title:Hyponatremia Related to Neurocritical Care: Focus on Diagnosis and
Therapy: A Systematic Review
Volume: 18
Issue: 1
Author(s): Gianluca Mezzini*, Stefano Marasco, Alessandro Bertuccio, Gabriele Savioli, Fabio Piccolella, Fabrizio Racca, Andrea Barbanera and Matteo Vitali
Affiliation:
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Department of Neurosurgery, St. Antonio and Biagio and Cesare Arrigo Hospital, Neurosurgery Unit,
Alessandria 15121, Italy
Keywords:
Hyponatremia, neurocritical-care, traumatic brain injury, head trauma, stroke, SAH, neurosurgery.
Abstract:
Introduction: Hyponatremia is the most frequently occurring electrolyte disorder in
neurocritical care and traumatic brain injury, aneurysmal subarachnoid hemorrhage (SAH),
neurosurgery, and ischemic stroke are the clinical conditions more often associated with this
condition. SIADH and CSWS are the main causes of hyponatremia in neurologically ill patients.
Since hyponatremia is a negative prognostic factor for neurocritical patients, early diagnosis and
consequent targeted therapy are of fundamental importance. The present review was carried out
to provide a brief recap on the main causes and management of hyponatremia in the neurocritical
patient.
Methods: A methodical search of the medical literature using the online database MEDLINE was
carried out and studies comprising case reports, prospective and retrospective observational
studies, or randomized controlled clinical trials in which there is a diagnosis of hyponatremia in
neurocritical patients were included.
Results: 18 articles were analyzed, consisting of 8 case reports, 4 case series, 3 prospective trials,
1 retrospective study, and 1 multicenter trial. A total of 1371 patients from 18 studies were
included. Patients’ average age was 29.28 ± 20.9, respectively. TBI was the main cause of
hyponatremia in the literature reviewed; 12 studies were about the relationship between TBI and
hyponatremia, 2 studies about stroke, 2 studies about SAH and 1 about hyponatremia postneurosurgical
procedure.
Discussion: Hyponatremia is the most common electrolyte disorder in hospitalized patients and
the main scenarios of hyponatremic neurocritical patients are subarachnoid hemorrhage, ischemic
stroke, traumatic brain injury and iatrogenic hyponatremia due to neurosurgical cases.
Conclusion: Hyponatremia is a frequent finding in neurocritical care and is also a recognized
negative prognostic factor leading to increased mortality and ICU length hospitalization. Its
diagnosis and therapy are essential for correct neurocritical management. The most common
cause of serum sodium abnormality is SIADH, and an early diagnosis for target treatment is
paramount to prevent delayed symptoms and complications.
