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ISSN (Print): 1574-8871
ISSN (Online): 1876-1038

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Systematic Review Article

Hyponatremia Related to Neurocritical Care: Focus on Diagnosis and Therapy: A Systematic Review

Author(s): Gianluca Mezzini*, Stefano Marasco, Alessandro Bertuccio, Gabriele Savioli, Fabio Piccolella, Fabrizio Racca, Andrea Barbanera and Matteo Vitali

Volume 18, Issue 1, 2023

Published on: 06 January, 2023

Page: [19 - 27] Pages: 9

DOI: 10.2174/1574887118666221208161259

Price: $65

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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.

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[1]
Moro N, Katayama Y, Igarashi T, Mori T, Kawamata T, Kojima J. Hyponatremia in patients with traumatic brain injury: Incidence, mechanism, and response to sodium supplementation or retention therapy with hydrocortisone. Surg Neurol 2007; 68(4): 387-93.
[http://dx.doi.org/10.1016/j.surneu.2006.11.052] [PMID: 17905062]
[2]
Manzanares W, Aramendi I, Langlois PL, Biestro A. Hyponatremia in the neurocritical care patient: An approach based on current evidence. Med Intensiva 2015; 39(4): 234-43.
[3]
Castle-Kirszbaum M, Kyi M, Wright C, Goldschlager T, Danks RA, Parkin WG. Hyponatraemia and hypernatraemia: Disorders of water balance in neurosurgery. Neurosurg Rev 2021; 44(5): 2433-58.
[http://dx.doi.org/10.1007/s10143-020-01450-9] [PMID: 33389341]
[4]
Leonard J, Garrett RE, Salottolo K, et al. Cerebral salt wasting after traumatic brain injury: A review of the literature. Scand J Trauma Resusc Emerg Med 2015; 23(1): 98.
[http://dx.doi.org/10.1186/s13049-015-0180-5] [PMID: 26561391]
[5]
Paiva WS. Serum sodium disorders in patients with traumatic brain injury. Ther Clin Risk Manag 2011; 7: 345-9.
[http://dx.doi.org/10.2147/TCRM.S17692] [PMID: 21941440]
[6]
Lu DC, Binder DK, Chien B, Maisel A, Manley GT. Cerebral salt wasting and elevated brain natriuretic peptide levels after traumatic brain injury: 2 case reports. Surg Neurol 2008; 69(3): 226-9.
[http://dx.doi.org/10.1016/j.surneu.2007.02.051] [PMID: 18325424]
[7]
Shah K, Turgeon RD, Gooderham PA, Ensom MHH. Prevention and treatment of hyponatremia in patients with subarachnoid hemorrhage: A systematic review. World Neurosurg 2018; 109: 222-9.
[http://dx.doi.org/10.1016/j.wneu.2017.09.182] [PMID: 28987848]
[8]
Mistry AM, Mistry EA, Ganesh Kumar N, Froehler MT, Fusco MR, Chitale RV. Corticosteroids in the management of hyponatremia, hypovolemia, and vasospasm in subarachnoid hemorrhage: A meta-analysis. Cerebrovasc Dis 2016; 42(3-4): 263-71.
[http://dx.doi.org/10.1159/000446251] [PMID: 27173669]
[9]
Rabinstein AA, Bruder N. Management of hyponatremia and volume contraction. Neurocrit Care 2011; 15(2): 354-60.
[http://dx.doi.org/10.1007/s12028-011-9585-9] [PMID: 21748503]
[10]
Stelfox H, Ahmed SB, Khandwala F, Zygun D, Shahpori R, Laupland K. The epidemiology of intensive care unit-acquired hyponatraemia and hypernatraemia in medical-surgical intensive care units. Crit Care 2008; 12(6): R162.
[http://dx.doi.org/10.1186/cc7162] [PMID: 19094227]
[11]
Sterns RH, Hix JK, Silver SM. Management of hyponatremia in the ICU. Chest 2013; 144(2): 672-9.
[http://dx.doi.org/10.1378/chest.12-2600] [PMID: 23918113]
[12]
Hoorn EJ, Spasovski G. Recent developments in the management of acute and chronic hyponatremia. Curr Opin Nephrol Hypertens 2019; 28(5): 424-32.
[http://dx.doi.org/10.1097/MNH.0000000000000528] [PMID: 31232710]
[13]
Henry DA. Hyponatremia. Ann Intern Med 2015; 163(3): ITC1-ITC16.
[http://dx.doi.org/10.7326/AITC201508040] [PMID: 26237763]
[14]
Kylies D, Wenzel U. Hyponatremia-Diagnosis and therapy. Dtsch Med Wochenschr 2020; 145(21): 1573-9.
[http://dx.doi.org/10.1055/a-1020-7303] [PMID: 33080646]
[15]
Palmer BF. Hyponatremia in patients with central nervous system disease: SIADH versus CSW. Trends Endocrinol Metab 2003; 14(4): 182-7.
[http://dx.doi.org/10.1016/S1043-2760(03)00048-1] [PMID: 12714279]
[16]
Sterns RH, Silver SM. Cerebral salt wasting versus SIADH: What difference? J Am Soc Nephrol 2008; 19(2): 194-6.
[http://dx.doi.org/10.1681/ASN.2007101118] [PMID: 18216309]
[17]
Tenny S, Thorell W. Cerebral salt wasting syndrome. In: StatPearls. Treasure Island, (FL): StatPearls Publishing 2022.
[PMID: 30521276]
[18]
Donati-Genet PCM, Dubuis JM, Girardin E, Rimensberger PC. Acute symptomatic hyponatremia and cerebral salt wasting after head injury: An important clinical entity. J Pediatr Surg 2001; 36(7): 1094-7.
[http://dx.doi.org/10.1053/jpsu.2001.24770] [PMID: 11431791]
[19]
Askar A, Tarif N. Cerebral salt wasting in a patient with head trauma: Management with saline hydration and fludrocortisone. Saudi J Kidney Dis Transpl 2007; 18(1): 95-9.
[PMID: 17237900]
[20]
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021; 372: n71.
[http://dx.doi.org/10.1136/bmj.n71] [PMID: 33782057]
[21]
Wright WL. Sodium and fluid management in acute brain injury. Curr Neurol Neurosci Rep 2012; 12(4): 466-73.
[http://dx.doi.org/10.1007/s11910-012-0284-5] [PMID: 22622407]
[22]
Cui H, He G, Yang S, et al. Inappropriate antidiuretic hormone secretion and cerebral salt-wasting syndromes in neurological patients. Front Neurosci 2019; 13: 1170.
[http://dx.doi.org/10.3389/fnins.2019.01170] [PMID: 31780881]
[23]
Ridwan S, Zur B, Kurscheid J, et al. Hyponatremia after spontaneous aneurysmal subarachnoid hemorrhage-A prospective observational study. World Neurosurg 2019; 129: e538-44.
[http://dx.doi.org/10.1016/j.wneu.2019.05.210] [PMID: 31154098]
[24]
van Gijn J, Kerr RS, Rinkel GJE. Subarachnoid haemorrhage. Lancet 2007; 369(9558): 306-18.
[http://dx.doi.org/10.1016/S0140-6736(07)60153-6] [PMID: 17258671]
[25]
Kao CC, Winkler SS, Turner JH. Synovial cyst of spinal facet. J Neurosurg 1974; 41(3): 372-6.
[http://dx.doi.org/10.3171/jns.1974.41.3.0372] [PMID: 4416019]
[26]
Kieninger M, Kerscher C, Bründl E, et al. Acute hyponatremia after aneurysmal subarachnoid hemorrhage: Frequency, treatment, and outcome. J Clin Neurosci 2021; 88: 237-42.
[http://dx.doi.org/10.1016/j.jocn.2021.04.004] [PMID: 33992191]
[27]
Sherlock M, O’Sullivan E, Agha A, et al. The incidence and pathophysiology of hyponatraemia after subarachnoid haemorrhage. Clin Endocrinol 2006; 64(3): 250-4.
[http://dx.doi.org/10.1111/j.1365-2265.2006.02432.x] [PMID: 16487432]
[28]
Marupudi N, Mittal S. Diagnosis and management of hyponatremia in patients with aneurysmal subarachnoid hemorrhage. J Clin Med 2015; 4(4): 756-67.
[http://dx.doi.org/10.3390/jcm4040756] [PMID: 25937938]
[29]
Segatore M. Hyponatremia after aneurysmal subarachnoid hemorrhage. J Neurosci Nurs 1993; 25(2): 92-9.
[http://dx.doi.org/10.1097/01376517-199304000-00005] [PMID: 8478560]
[30]
Spatenkova V, Bradac O, de Lacy P, Skrabalek P, Suchomel P. Dysnatremia as a poor prognostic indicator in patients with acute subarachnoid hemorrhage. J Neurosurg Sci 2017; 61(4): 371-9.
[http://dx.doi.org/10.23736/S0390-5616.16.03411-1] [PMID: 26496416]
[31]
Solomon RA, Fink ME, Lennihan L. Early aneurysm surgery and prophylactic hypervolemic hypertensive therapy for the treatment of aneurysmal subarachnoid hemorrhage. Neurosurgery 1988; 23(6): 699-704.
[http://dx.doi.org/10.1227/00006123-198812000-00002] [PMID: 3216966]
[32]
Liamis G, Barkas F, Megapanou E, et al. Hyponatremia in acute stroke patients: Pathophysiology, clinical significance, and management options. Eur Neurol 2019; 82(1-3): 32-40.
[http://dx.doi.org/10.1159/000504475] [PMID: 31722353]
[33]
Shima S, Niimi Y, Moteki Y, et al. Prognostic significance of hyponatremia in acute stroke: A systematic review and meta-analysis. Cerebrovasc Dis 2020; 49(5): 531-9.
[http://dx.doi.org/10.1159/000510751] [PMID: 33017822]
[34]
Chen Z, Jia Q, Liu C. Association of hyponatremia and risk of short- and long-term mortality in patients with stroke: A systematic review and meta-analysis. J Stroke Cerebrovasc Dis 2019; 28(6): 1674-83.
[http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2019.02.021] [PMID: 30967305]
[35]
Kalita J, Singh RK, Misra UK. Cerebral salt wasting is the most common cause of hyponatremia in stroke. J Stroke Cerebrovasc Dis 2017; 26(5): 1026-32.
[http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2016.12.011] [PMID: 28110888]
[36]
Yousuf I, Gul A, Gupta S, Verma S, Saleem S. Hyponatremia in stroke. Ann Indian Acad Neurol 2014; 17(1): 55-7.
[http://dx.doi.org/10.4103/0972-2327.128554] [PMID: 24753660]
[37]
Huang WY, Weng WC, Peng TI, et al. Association of hyponatremia in acute stroke stage with three-year mortality in patients with first-ever ischemic stroke. Cerebrovasc Dis 2012; 34(1): 55-62.
[http://dx.doi.org/10.1159/000338906] [PMID: 22759703]
[38]
Rodrigues B, Staff I, Fortunato G, McCullough LD. Hyponatremia in the prognosis of acute ischemic stroke. J Stroke Cerebrovasc Dis 2014; 23(5): 850-4.
[http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2013.07.011] [PMID: 23954607]
[39]
Rajagopal R, Swaminathan G, Nair S, Joseph M. Hyponatremia in traumatic brain injury: A practical management protocol. World Neurosurg 2017; 108: 529-33.
[http://dx.doi.org/10.1016/j.wneu.2017.09.013] [PMID: 28899834]
[40]
Tudor RM, Thompson CJ. Posterior pituitary dysfunction following traumatic brain injury: Review. Pituitary 2019; 22(3): 296-304.
[http://dx.doi.org/10.1007/s11102-018-0917-z] [PMID: 30334138]
[41]
Léveillé E, Aljassar M, Beland B, Saeedi RJ, Marcoux J. Determinants of hyponatremia following a traumatic brain injury. Neurol Sci 2022; 43(6): 3775-82.
[http://dx.doi.org/10.1007/s10072-022-05894-3] [PMID: 35037099]
[42]
Auble BA, Bollepalli S, Makoroff K, et al. Hypopituitarism in pediatric survivors of inflicted traumatic brain injury. J Neurotrauma 2014; 31(4): 321-6.
[http://dx.doi.org/10.1089/neu.2013.2916] [PMID: 24028400]
[43]
Lohani S, Devkota UP. Hyponatremia in patients with traumatic brain injury: Etiology, incidence, and severity correlation. World Neurosurg 2011; 76(3-4): 355-60.
[http://dx.doi.org/10.1016/j.wneu.2011.03.042] [PMID: 21986437]
[44]
Lerner DP, Shepherd SA, Batra A. Hyponatremia in the neurologically ill patient: A review. Neurohospitalist 2020; 10(3): 208-16.
[http://dx.doi.org/10.1177/1941874419895124] [PMID: 32549945]
[45]
Jahangiri A, Wagner J, Tran MT, et al. Factors predicting postoperative hyponatremia and efficacy of hyponatremia management strategies after more than 1000 pituitary operations. J Neurosurg 2013; 119(6): 1478-83.
[http://dx.doi.org/10.3171/2013.7.JNS13273] [PMID: 23971964]
[46]
Janneck M, Burkhardt T, Rotermund R, Sauer N, Flitsch J, Aberle J. Hyponatremia after trans-sphenoidal surgery. Minerva Endocrinol 2014; 39(1): 27-31.
[PMID: 24513601]
[47]
Hussein Z, Tzoulis P, Marcus HJ, Grieve J, Dorward N, Bouloux PM. The management and outcome of hyponatraemia following transsphenoidal surgery: A retrospective observational study. Acta Neurochir 2022; 164(4): 1135-44.
[http://dx.doi.org/10.1007/s00701-022-05134-9]
[48]
Hussain NS, Piper M, Ludlam WG, Ludlam WH, Fuller CJ, Mayberg MR. Delayed postoperative hyponatremia after transsphenoidal surgery: Prevalence and associated factors. J Neurosurg 2013; 119(6): 1453-60.
[http://dx.doi.org/10.3171/2013.8.JNS13411] [PMID: 24053496]
[49]
Cuesta M, Hannon MJ, Thompson CJ. Diagnosis and treatment of hyponatraemia in neurosurgical patients. Endocrinol Nutr 2016; 63(5): 230-8.
[http://dx.doi.org/10.1016/j.endonu.2015.12.007] [PMID: 26965574]
[50]
Ausman JI. Hyponatremia in neurosurgical patients. Surg Neurol 2008; 69(3): 221-3.
[http://dx.doi.org/10.1016/j.surneu.2007.12.013] [PMID: 18325422]
[51]
Upadhyay UM, Gormley WB. Etiology and management of hyponatremia in neurosurgical patients. J Intensive Care Med 2012; 27(3): 139-44.
[http://dx.doi.org/10.1177/0885066610395489] [PMID: 21345881]
[52]
Hannon MJ, Thompson CJ. Hyponatremia in neurosurgical patients. Front Horm Res 2019; 52: 143-60.
[http://dx.doi.org/10.1159/000493244] [PMID: 32097924]
[53]
Sterns RH, Nigwekar SU, Hix JK. The treatment of hyponatremia. Semin Nephrol 2009; 29(3): 282-99.
[http://dx.doi.org/10.1016/j.semnephrol.2009.03.002] [PMID: 19523575]
[54]
Diringer MN, Zazulia AR. Hyponatremia in neurologic patients: Consequences and approaches to treatment. Neurologist 2006; 12(3): 117-26.
[http://dx.doi.org/10.1097/01.nrl.0000215741.01699.77] [PMID: 16688013]
[55]
Libert N, de Rudnicki S, Cirodde A, Mion G. Hypertonic salt serum, what’s up? Reanimation 2010; 19(2): 163-70.
[http://dx.doi.org/10.1016/j.reaurg.2010.01.004]
[56]
Thongrong C, Kong N, Govindarajan B, Allen D, Mendel E, Bergese SD. Current purpose and practice of hypertonic saline in neurosurgery: A review of the literature. World Neurosurg 2014; 82(6): 1307-18.
[http://dx.doi.org/10.1016/j.wneu.2013.02.027] [PMID: 23402866]
[57]
Spasovski G, Vanholder R, Allolio B, et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Eur J Endocrinol 2014; 170(3): G1-G47.
[http://dx.doi.org/10.1530/EJE-13-1020] [PMID: 24569125]
[58]
Braun MM, Barstow CH, Pyzocha NJ. Diagnosis and management of sodium disorders: Hyponatremia and hypernatremia. Am Fam Physician 2015; 91(5): 299-307.
[PMID: 25822386]
[59]
Feigin VL, Anderson N, Rinkel GJ, Algra A, van Gijn J, Bennett DA. Corticosteroids for aneurysmal subarachnoid haemorrhage and primary intracerebral haemorrhage. Cochrane Database Syst Rev 2005; 2005(3): CD004583.
[http://dx.doi.org/10.1002/14651858.CD004583.pub2]
[60]
Nakagawa I, Hironaka Y, Nishimura F, et al. Early inhibition of natriuresis suppresses symptomatic cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage. Cerebrovasc Dis 2013; 35(2): 131-7.
[http://dx.doi.org/10.1159/000346586] [PMID: 23406891]
[61]
Verbalis JG, Goldsmith SR, Greenberg A, Schrier RW, Sterns RH. Hyponatremia treatment guidelines 2007: Expert panel recommendations. Am J Med 2007; 120(11): S1-S21.
[http://dx.doi.org/10.1016/j.amjmed.2007.09.001] [PMID: 17981159]
[62]
Wright WL, Asbury WH, Gilmore JL, Samuels OB. Conivaptan for hyponatremia in the neurocritical care unit. Neurocrit Care 2009; 11(1): 6-13.
[http://dx.doi.org/10.1007/s12028-008-9152-1] [PMID: 19003543]
[63]
Friedman B, Cirulli J. Hyponatremia in critical care patients: Frequency, outcome, characteristics, and treatment with the vasopressin V2-receptor antagonist tolvaptan. J Crit Care 2013; 28(2): 219.e1-219.e12.
[http://dx.doi.org/10.1016/j.jcrc.2012.06.001] [PMID: 22884529]
[64]
Aditya S, Rattan A. Vaptans: A new option in the management of hyponatremia. Int J Appl Basic Med Res 2012; 2(2): 77-83.
[http://dx.doi.org/10.4103/2229-516X.106347] [PMID: 23776817]
[65]
Buckley MS, Patel SA, Hattrup AE, Kazem NH, Jacobs SC, Culver MA. Conivaptan for treatment of hyponatremia in neurologic and neurosurgical adults. Ann Pharmacother 2013; 47(9): 1194-200.
[http://dx.doi.org/10.1177/1060028013503126] [PMID: 24259735]
[66]
Walter KA, Bonk ME. Conivaptan: New treatment for hyponatremia. Am J Health Syst Pharm 2007; 64(13): 1385-95.
[http://dx.doi.org/10.2146/ajhp060383] [PMID: 17592003]
[67]
Corry JJ, Asaithambi G, Shaik AM, et al. Conivaptan for the reduction of cerebral edema in intracerebral hemorrhage: A safety and tolerability study. Clin Drug Investig 2020; 40(5): 503-9.
[http://dx.doi.org/10.1007/s40261-020-00911-9] [PMID: 32253717]
[68]
Berkenbosch JW, Lentz CW, Jimenez DF, Tobias JD. Cerebral salt wasting syndrome following brain injury in three pediatric patients: Suggestions for rapid diagnosis and therapy. Pediatr Neurosurg 2002; 36(2): 75-9.
[http://dx.doi.org/10.1159/000048356] [PMID: 11893888]
[69]
Steelman R, Corbitt B, Pate MFD. Early onset of cerebral salt wasting in a patient with head and facial injuries. J Oral Maxillofac Surg 2006; 64(4): 746-7.
[http://dx.doi.org/10.1016/j.joms.2005.12.025] [PMID: 16546664]
[70]
Simsek E, Dilli D. Yasıtlı U, Özlem N, Bostanci I, Dallar Y. Cerebral salt wasting in a child with cervicothoracic hematoma. J Pediatr Endocrinol Metab 2008; 21(7): 695-700.
[http://dx.doi.org/10.1515/JPEM.2008.21.7.695] [PMID: 18780605]
[71]
Kontogiorgi M, Opsimoulis P, Diamanti-Kandarakis E, Karabinis A. Cerebral salt wasting syndrome in traumatic brain injury following therapeutic barbiturate coma. Acta Neurochir (Wien) 2011; 153(8): 1719-20.
[http://dx.doi.org/10.1007/s00701-011-1042-1] [PMID: 21656119]
[72]
Zhang W, Li S, Visocchi M, Wang X, Jiang J. Clinical analysis of hyponatremia in acute craniocerebral injury. J Emerg Med 2010; 39(2): 151-7.
[http://dx.doi.org/10.1016/j.jemermed.2008.01.027] [PMID: 18722740]
[73]
Costa KN, Nakamura HM, Cruz LR, et al. Hyponatremia and brain injury: Absence of alterations of serum brain natriuretic peptide and vasopressin. Arq Neuropsiquiatr 2009; 67(4): 1037-44.
[http://dx.doi.org/10.1590/S0004-282X2009000600014] [PMID: 20069215]
[74]
Chaudhary N, Pathak S, Gupta MM, Agrawal N. Cerebral salt wasting syndrome following head injury in a child managed successfully with fludrocortisone. Case Rep Pediatr 2016; 2016: 1-4.
[http://dx.doi.org/10.1155/2016/6937465] [PMID: 27213068]
[75]
Ehtesham M, Mohmand M, Raj K, Hussain T, Kavita FNU, Kumar B. Clinical spectrum of hyponatremia in patients with stroke. Cureus 2019; 11(8): e5310.
[http://dx.doi.org/10.7759/cureus.5310] [PMID: 31592365]
[76]
Katayama Y, Haraoka J, Hirabayashi H, et al. A randomized controlled trial of hydrocortisone against hyponatremia in patients with aneurysmal subarachnoid hemorrhage. Stroke 2007; 38(8): 2373-5.
[http://dx.doi.org/10.1161/STROKEAHA.106.480038] [PMID: 17585086]

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