Abstract
Hyponatremia is the most frequently encountered electrolyte abnormality in critically ill patients. Hyponatremia on admission has been identified as an independent predictor of in-hospital mortality in patients with spontaneous intracerebral hemorrhage (sICH). However, the incidence and etiology of hyponatremia (HN) during hospitalization in a neurointensive care unit following spontaneous intracerebral hemorrhage (sICH) remains unknown. This was a retrospective analysis of consecutive patients admitted to Detroit Receiving Hospital for sICH between January 2006 and July 2009. All serum Na levels were recorded for patients during the ICU stay. HN was defined as Na <135 mmol/L. A total of 99 patients were analyzed with HN developing in 24% of sICH patients. Patients with HN had an average sodium nadir of 130 ± 3 mmol/L and an average time from admission to sodium <135 mmol/L of 3.9 ± 5.7 days. The most common cause of hyponatremia was syndrome of inappropriate antidiuretic hormone (90% of HN patients). Patients with HN were more likely to have fever (50% vs. 23%; p = 0.01), infection (58% vs. 28%; p = 0.007) as well as a longer hospital length of stay (14 (8–25) vs. 6 (3–9) days; p < 0.001). Of the patients who developed HN, fifteen (62.5%) patients developed HN in the first week following sICH. This shows HN has a fairly high incidence following sICH. The presence of HN is associated with longer hospital length of stays and higher rates of patient complications, which may result in worse patient outcomes. Further study is necessary to characterize the clinical relevance and treatment of HN in this population.
Highlights
Hyponatremia is the most frequent electrolyte abnormality in hospitalized patients, especially those with neurologic injury, and is associated with increased morbidity and mortality [1,2]
While hyponatremia has been widely described after traumatic brain injury, subarachnoid hemorrhage, and neurosurgical intervention, there is limited information describing the incidence and etiology of hyponatremia in patients with spontaneous intracerebral hemorrhage
Previous studies assessing the pathogenesis of hyponatremia following subarachnoid hemorrhage [4,5,6,7] or traumatic brain injury [9] have implicated the syndrome of inappropriate antidiuretic hormone (SIADH) or cerebral salt wasting syndrome (CSWS)
Summary
Hyponatremia is the most frequent electrolyte abnormality in hospitalized patients, especially those with neurologic injury, and is associated with increased morbidity and mortality [1,2]. Hyponatremia in patients with neurological injury may exacerbate cerebral edema through fluid shifts causing intracranial hypertension and potentially leading to worsening of neurological outcomes. The in-hospital mortality in brain-injured patients with severe hyponatremia (serum sodium
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