Hyponatremia in the neurocritical care patient: An approach based on current evidence.

Abstract

In the neurocritical care setting, hyponatremia is the commonest electrolyte disorder, which is associated with significant morbimortality. Cerebral salt wasting and syndrome of inappropriate antidiuretic hormone have been classically described as the 2 most frequent entities responsible of hyponatremia in neurocritical care patients. Nevertheless, to distinguish between both syndromes is usually difficult and useless as volume status is difficult to be determined, underlying pathophysiological mechanisms are still not fully understood, fluid restriction is usually contraindicated in these patients, and the first option in the therapeutic strategy is always the same: 3% hypertonic saline solution. Therefore, we definitively agree with the current concept of "cerebral salt wasting", which means that whatever is the etiology of hyponatremia, initially in neurocritical care patients the treatment will be the same: hypertonic saline solution.

• Authors: W Manzanares, I Aramendi, P L Langlois, A Biestro
• Journal: Medicina intensiva (Med Intensiva) Vol. 39 Issue 4 Pg. 234-43 (May 2015) ISSN: 1578-6749 [Electronic] Spain
• PMID: 25593019 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

Chemical References

• Antidiuretic Hormone Receptor Antagonists
• Saline Solution, Hypertonic
• Fludrocortisone
• fludrocortisone acetate

Topics

• Antidiuretic Hormone Receptor Antagonists (therapeutic use)
• Brain Diseases (complications, physiopathology)
• Brain Injuries, Traumatic (complications, physiopathology)
• Brain Ischemia (complications, physiopathology)
• Cerebrovascular Circulation
• Combined Modality Therapy
• Critical Illness
• Early Diagnosis
• Fludrocortisone (analogs & derivatives, therapeutic use)
• Humans
• Hyponatremia (epidemiology, etiology, physiopathology, therapy)
• Inappropriate ADH Syndrome (complications)
• Myelinolysis, Central Pontine (etiology, prevention & control)
• Natriuresis
• Neurosurgical Procedures
• Postoperative Complications (etiology, physiopathology)
• Saline Solution, Hypertonic (therapeutic use)
• Subarachnoid Hemorrhage (complications, physiopathology, therapy)
• Vasoconstriction