Predisposing factors for serum sodium disturbance in patients with severe traumatic brain injury (SBI)
Disturbances in the plasma sodium level in patients with severe brain injury (SBI) is not a rare phenomenon and may cause adverse effects on prognosis and treatment outcomes. The knowledge of the prevalence of risk factors helps in early detection and good management of the serum sodium level disturbance. Materials and methods: This is a prospective clinical trial double blind study. The target population included patients with SBI who had disturbances in their plasma sodium level and were admitted at the ICU of Kashani Hospital, Isfahan, Iran, between January and October 2006. The patients with renal insufficiency, diuretic therapy, massive transfusion, brain death, and spinal cord injury were excluded. Gender, age, the prevalence of hypo- and hypernatremia, having tracheal tube or tracheostomy, requiring mechanical ventilation support, craniotomy, type of intracranial pathology, positive history of cardiopulmonary disease, the mean time after which the disturbance occurs, and the mean time needed for the recovery from the disturbance were studied. Results: The prevalence of hypo- and hypernatremia were 60% and 40%, respectively. Most of the patients were 21-50-year-old males with craniotomy. The mean time after which the disturbance occurs was 23 days after head trauma and the mean time needed for the recovery from sodium level disturbances was 11.5 days. Conclusion: Hypo- and hypernatremia are common complications of intracranial lesions. Early detection of serum sodium level disturbance is important in these patients and appropriate treatment may actually improve prognosis.
Predisposing factors for serum sodium disturbance in patients with severe traumatic brain injury (SBI)
Disturbances in the plasma sodium level in patients with severe brain injury (SBI) is not a rare phenomenon and may cause adverse effects on prognosis and treatment outcomes. The knowledge of the prevalence of risk factors helps in early detection and good management of the serum sodium level disturbance. Materials and methods: This is a prospective clinical trial double blind study. The target population included patients with SBI who had disturbances in their plasma sodium level and were admitted at the ICU of Kashani Hospital, Isfahan, Iran, between January and October 2006. The patients with renal insufficiency, diuretic therapy, massive transfusion, brain death, and spinal cord injury were excluded. Gender, age, the prevalence of hypo- and hypernatremia, having tracheal tube or tracheostomy, requiring mechanical ventilation support, craniotomy, type of intracranial pathology, positive history of cardiopulmonary disease, the mean time after which the disturbance occurs, and the mean time needed for the recovery from the disturbance were studied. Results: The prevalence of hypo- and hypernatremia were 60% and 40%, respectively. Most of the patients were 21-50-year-old males with craniotomy. The mean time after which the disturbance occurs was 23 days after head trauma and the mean time needed for the recovery from sodium level disturbances was 11.5 days. Conclusion: Hypo- and hypernatremia are common complications of intracranial lesions. Early detection of serum sodium level disturbance is important in these patients and appropriate treatment may actually improve prognosis.
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- Qureshi AI, Suri MF, Sung GY, Straw RN, Yahia AM, Saad M et al. Prognostic significance of hypernatremia and hyponatremia among patients with aneurysmal subarachnoid hemorrhage. Neurosurgery 2002; 50(4): 749-755.
- World Health Organization. International Classification of Impairments, Disabilities, and Handicaps. Geneva: WHO, 1980.
- Adrogue HJ, Madias NE. Hyponatremia. N Engl J Med 2000; 342(21): 1581-1589.
- Long CA, Marin P, Bayer AJ, Shetty HG, Pathy MS. Hypernatraemia in an adult in-patient population. Postgrad Med J 1991; 67(789): 643-645.
- 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): 387-393.
- Zhang W, Li S, Visocchi M, Wang X, Jiang J. Clinical Analysis of Hyponatremia in Acute Craniocerebral Injury. J Emerg Med 2008.
- Sterns RH. Hypernatremia in the intensive care unit: instant quality--just add water. Crit Care Med 1999; 27(6): 1041-1042.
- Katz MA. Hyperglycemia-induced hyponatremia: calculation of expected serum sodium depression. NEJM. 1973; 289: 843– 844.
- Kaufman HH, Timberlake G, Voelker J, Pait TG. Medical complications of head injury. Med Clin North Am 1993; 77(1): 43-60.
- Yano M, Yokota H, Otsuka T. [Fluid and nutritional management in severe head injuries]. No To Shinkei 1989; 41(1): 27-33.
- Aiyagari V, Deibert E, Diringer MN. Hypernatremia in the neurologic intensive care unit: how high is too high? J Crit Care 2006; 21(2): 163-172.
- Douglas JG, Fergusson RJ, Crompton GK, Grant IW. Artificial ventilation for neurological disease: retrospective analysis 1972- 81. Br Med J (Clin Res Ed) 1983; 286(6382): 1943-1946.