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2014 ; 3
(4
): 1084-104
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Neurosurgical Hyponatremia
#MMPMID26237593
Hannon MJ
; Thompson CJ
J Clin Med
2014[Oct]; 3
(4
): 1084-104
PMID26237593
show ga
Hyponatremia is a frequent electrolyte imbalance in hospital inpatients. Acute
onset hyponatremia is particularly common in patients who have undergone any type
of brain insult, including traumatic brain injury, subarachnoid hemorrhage and
brain tumors, and is a frequent complication of intracranial procedures. Acute
hyponatremia is more clinically dangerous than chronic hyponatremia, as it
creates an osmotic gradient between the brain and the plasma, which promotes the
movement of water from the plasma into brain cells, causing cerebral edema and
neurological compromise. Unless acute hyponatremia is corrected promptly and
effectively, cerebral edema may manifest through impaired consciousness level,
seizures, elevated intracranial pressure, and, potentially, death due to cerebral
herniation. The pathophysiology of hyponatremia in neurotrauma is multifactorial,
but most cases appear to be due to the syndrome of inappropriate antidiuretic
hormone secretion (SIADH). Classical treatment of SIADH with fluid restriction is
frequently ineffective, and in some circumstances, such as following subarachnoid
hemorrhage, contraindicated. However, the recently developed vasopressin receptor
antagonist class of drugs provides a very useful tool in the management of
neurosurgical SIADH. In this review, we summarize the existing literature on the
clinical features, causes, and management of hyponatremia in the neurosurgical
patient.