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Hyponatremia in Patients with Spontaneous Intracerebral Hemorrhage

Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
Department of Pharmacy, Detroit Receiving Hospital, Detroit, MI 48201, USA
Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA
Department of Pharmacy, New Hanover Regional Medical Center, Wilmington, NC 28401, USA
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
J. Clin. Med. 2014, 3(4), 1322-1332;
Received: 29 August 2014 / Revised: 28 October 2014 / Accepted: 31 October 2014 / Published: 20 November 2014
(This article belongs to the Special Issue Hyponatremia: Advances in Diagnosis and Management)
PDF [144 KB, uploaded 20 November 2014]


Hyponatremia is the most frequently encountered electrolyte abnormality in critically ill patients. Hyponatremia on admission has been identified as an independent predictor of in-hospital mortality in patients with spontaneous intracerebral hemorrhage (sICH). However, the incidence and etiology of hyponatremia (HN) during hospitalization in a neurointensive care unit following spontaneous intracerebral hemorrhage (sICH) remains unknown. This was a retrospective analysis of consecutive patients admitted to Detroit Receiving Hospital for sICH between January 2006 and July 2009. All serum Na levels were recorded for patients during the ICU stay. HN was defined as Na <135 mmol/L. A total of 99 patients were analyzed with HN developing in 24% of sICH patients. Patients with HN had an average sodium nadir of 130 ± 3 mmol/L and an average time from admission to sodium <135 mmol/L of 3.9 ± 5.7 days. The most common cause of hyponatremia was syndrome of inappropriate antidiuretic hormone (90% of HN patients). Patients with HN were more likely to have fever (50% vs. 23%; p = 0.01), infection (58% vs. 28%; p = 0.007) as well as a longer hospital length of stay (14 (8–25) vs. 6 (3–9) days; p < 0.001). Of the patients who developed HN, fifteen (62.5%) patients developed HN in the first week following sICH. This shows HN has a fairly high incidence following sICH. The presence of HN is associated with longer hospital length of stays and higher rates of patient complications, which may result in worse patient outcomes. Further study is necessary to characterize the clinical relevance and treatment of HN in this population. View Full-Text
Keywords: hyponatremia; intracerebral hemorrhage; syndrome of inappropriate antidiuretic hormone; cerebral salt wasting syndrome hyponatremia; intracerebral hemorrhage; syndrome of inappropriate antidiuretic hormone; cerebral salt wasting syndrome

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Gray, J.R.; Morbitzer, K.A.; Liu-DeRyke, X.; Parker, D., Jr.; Zimmerman, L.H.; Rhoney, D.H. Hyponatremia in Patients with Spontaneous Intracerebral Hemorrhage. J. Clin. Med. 2014, 3, 1322-1332.

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