Frequency and Types of Hyponatremia in Stroke Patients Admitted in a Referral Neuroscience Institute of Dhaka

Maliha Hakim

doi:10.11648/j.cnn.20190302.14

Abstract

Background: Hyponatremia is a common electrolyte abnormality in acute stroke patients and may be related to variable etiology. Objective: To observe the frequency and types of hyponatremia in hospitalized acute stroke patients. Materials and methods: This cross-sectional study, carried out in a referral neuroscience institute of Dhaka during February to November 2017, included 209 patients admitted with acute stroke (65 ischemic, age 61.5±13.3 years, M/F: 45/20; 144 hemorrhagic, age 59.2±13.1 years, M/F: 80/64). The clinical and laboratory values on admission were recorded. Those having hyponatremia (serum sodium <135 mmol/L) on admission were evaluated by clinical features (history of vomiting or diarrhoea, volume status, urine output) and laboratory parameters (urine osmolality, urine sodium, plasma osmolality, blood urea, hematocrit) to determine the types of hyponatremia. Results: Four patients died before the serum could be sent for electrolytes. Among the rest, 36 (17.6%) had hyponatremia on admission. Serum sodium level was <125 mmol/L in 7 (19.4%) and 125-134 mmol/L in rest of the patients having hyponatremia (29; 80.6%). The frequency of hyponatremia was similar in ischemic and hemorrhagic stroke (17.2% vs. 17.7%, p=0.925). Syndrome of inappropriate antidiuresis (SIAD) was most frequent cause of hyponatremia (50.0%), followed by cerebral salt wasting (CSW; 30.6%). The rest had either hyponatremia related to gastrointestinal (GI) fluid loss (2.8%) or died before a cause of hyponatremia could be ascertained (11.1%). There was no significant difference of age, gender, NIHSS score and GCS score on admission as well as in hospital stay and in-hospital mortality between patients with or without hyponatremia (p=ns for all). Frequency of CSW was relatively higher in hemorrhagic stroke (hemorrhagic vs. ischemic: 32.0% vs. 27.3%) and SIAD in ischemic stroke (hemorrhagic vs. ischemic: 40.0% vs. 72.7%) but did not reach level of statistical significance. Conclusion: Frequency of hyponatremia seems remarkable in hospitalized acute stroke patients, SIAD and CSW being the most frequent cause.

Highlights

Hyponatremia is a common finding in critically ill patients; acute stroke is no exception [1]
Neurological insult itself leads to either syndrome of inappropriate anti-diuresis (SIAD) or cerebral salt wasting (CSW) in patients with stroke, but other common causes like gastrointestinal fluid loss or drug related causes may be present in such condition
The clinical and laboratory values on admission as well as length of hospital stay and in-hospital mortality were recorded. Those having hyponatremia on admission were evaluated by clinical evaluation and laboratory parameters to determine the type of hyponatremia according to the current recommendations (Figure 1) [4, 5]

Summary

Introduction

Hyponatremia is a common finding in critically ill patients; acute stroke is no exception [1]. Neurological insult itself leads to either syndrome of inappropriate anti-diuresis (SIAD) or cerebral salt wasting (CSW) in patients with stroke, but other common causes like gastrointestinal fluid loss or drug related causes may be present in such condition. Differentiation of these conditions is important as the modalities and mood of correcting hyponatremia is different [2]. To Clinical Neurology and Neuroscience 2019; 3(2): 46-49 assess the frequency as well as the types of hyponatremia in acute stroke patients the current study was carried out in a referral neuroscience hospital of Dhaka, Bangladesh. Conclusion: Frequency of hyponatremia seems remarkable in hospitalized acute stroke patients, SIAD and CSW being the most frequent cause

Objectives

Methods

Results