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J. Clin. Med. 2014, 3(4), 1084-1104; doi:10.3390/jcm3041084

Neurosurgical Hyponatremia

1
Department of Endocrinology, St. Bartholomew's Hospital, London, EC1A 7BE, UK
2
Academic Department of Endocrinology, Beaumont Hospital/RCSI Medical School, Dublin, Ireland
*
Author to whom correspondence should be addressed.
Received: 3 August 2014 / Revised: 11 September 2014 / Accepted: 22 September 2014 / Published: 14 October 2014
(This article belongs to the Special Issue Hyponatremia: Advances in Diagnosis and Management)
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Abstract

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. View Full-Text
Keywords: hyponatremia; neurosurgery; SIADH; SAH; TBI hyponatremia; neurosurgery; SIADH; SAH; TBI
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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Hannon, M.J.; Thompson, C.J. Neurosurgical Hyponatremia. J. Clin. Med. 2014, 3, 1084-1104.

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