Abstract
Hyponatremia is often seen after transsphenoidal surgery and is a source of considerable economic burden and patient-related morbidity and mortality. We performed a retrospective review of 344 patients who underwent transsphenoidal surgery at our institution between 2006 and 2012. Postoperative hyponatremia was seen in 18.0% of patients at a mean of 3.9 days postoperatively. Hyponatremia was most commonly mild (51.6%) and clinically asymptomatic (93.8%). SIADH was the primary cause of hyponatremia in the majority of cases (n = 44, 71.0%), followed by cerebral salt wasting (n = 15, 24.2%) and desmopressin over-administration (n = 3, 4.8%). The incidence of postoperative hyponatremia was significantly higher in patients with cardiac, renal and/or thyroid disease (p = 0.0034, Objective Risk (OR) = 2.60) and in female patients (p = 0.011, OR = 2.18) or patients undergoing post-operative cerebrospinal fluid drainage (p = 0.0006). Treatment with hypertonic saline (OR = −2.4, p = 0.10) and sodium chloride tablets (OR = −1.57, p = 0.45) was associated with a non-significant trend toward faster resolution of hyponatremia. The use of fluid restriction and diuretics should be de-emphasized in the treatment of post-transsphenoidal hyponatremia, as they have not been shown to significantly alter the time-course to the restoration of sodium balance.
Highlights
Hyponatremia is a common finding in both the neurosurgical patient population and the inpatient population in general [1,2]
Post-transsphenoidal hyponatremia is often attributed to syndrome of inappropriate antidiuretic hormone (SIADH), early evidence indicates that a variety of other etiologies may be implicated [19,24], though the precise etiology of hyponatremia in any given case is often difficult to assess accurately
The findings of this study and others indicate that hyponatremia is a relatively common finding after transsphenoidal surgery, and one with a complex pathophysiology
Summary
Hyponatremia is a common finding in both the neurosurgical patient population and the inpatient population in general [1,2]. Hypernatremia related to diabetes insipidus (DI) is perhaps the most anticipated electrolyte abnormality to occur after transsphenoidal surgery, but hyponatremia has been shown to occur with greater frequency and result in a greater degree of patient morbidity in some series [17,18,19,20,21]. Diagnostic criteria based on accurately quantifiable factors (e.g., plasma urea, atrial natriuretic peptide, antidiuretic hormone and other serum markers) have not been demonstrated to be accurate predictors of hyponatremia etiology in all cases, and their use in the evaluation of hyponatremia is not supported by the literature (Class III evidence) [24]. Further complicating matters is that the differential diagnosis of hyponatremia, even after transsphenoidal surgery, includes a number of possibilities (e.g., including secondary adrenal insufficiency, over-administration of desmopressin acetate and renal, cardiac or thyroid dysfunction, among others)
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