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Journal of Neurosurgical Sciences 2015 Oct 23


lingua: Inglese

Dysnatraemia is frequently a poor prognostic indicator in patients with acute subarachnoid hemorrhage having targeted sodium management

Spatenkova V. 1, Bradac O. 2, de Lacy P. 3, Skrabalek P. 4, Suchomel P. 5

1 Neurocenter, Neurointensive Care Unit, Regional Hospital, Liberec, Czech Republic;
2 Department of Neurosurgery, Central Military Hospital, Charles University, Prague, Czech Republic;
3 Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, United Kingdom;
4 Department of Clinical Biochemistry, Regional Hospital, Liberec, Czech Republic;
5 Neurocenter, Department of Neurosurgery, Regional Hospital, Liberec, Czech Republic


BACKGROUND: Dysnatraemias are common and carry a risk of poor prognosis in acute subarachnoid hemorrhage (SAH) patients. The aim of this study was to determine the frequency and outcome of dysnatraemias in 344 SAH patients treated by a targeted sodium management regimen.
METHODS: We performed a 10-year observational dysnatraemia study. Hyponatraemia was defined as serum sodium (SNa) below 135 mmol/l, hypernatraemia SNa above 150 mmol/l.
RESULTS: Dysnatraemia occurred in 35.8% patients (pts); this was more frequently hyponatraemia (19.8%) with a mean SNa 132.23±2.09 mmol/l, (16.0% mild, 3.2% moderate, 0.6% severe). Hypernatraemia occurred less commonly in 11.9%, p<0.001 with a mean SNa 154.21±3.72 mmol/l, (6.1% mild, 2.9% moderate, 2.9% severe). In 4.8% of pts there were episodes of both dysnatraemias. The incidence of hypo-osmolar hyponatraemia was 6.4%, Cerebral salt wasting (CSW) 3.5%, syndrome of inappropriate secretion of antidiuretic hormone (SIADH) 0.3% and Central diabetes insipidus 1.7%. The hypernatraemic pts had a higher inpatient mortality rate (p=0.001) and a worse overall outcome (p<0.001) than those hyponatraemic or normotraemic patients. Multivariate logistic regression showed that hypernatraemia was an independent risk factor for increased inpatient mortality and poor outcome in patients with SAH.
CONCLUSIONS: Our 10-year targeted sodium management regimen in acute SAH patients showed that dysnatraemias were frequent, predominantly hyponatraemia of which the more usual causes were CSW and not SIADH. Hypernatraemia was shown to be an independent risk factor for inpatient mortality and poor outcome.

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