Subscribe to RSS
DOI: 10.1055/s-0036-1592186
A Prospective Study on Hyponatremia in Traumatic Brain Injury
Publication History
20 July 2016
09 August 2016
Publication Date:
29 August 2016 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00029202/201602/lookinside/thumbnails/10-1055-s-0036-1592186_1600023oa-1.jpg)
Abstract
Background Hyponatremia is the commonest electrolyte imbalance in traumatic brain injury (TBI) with a reported incidence of 15 to 20%.
Methodology A prospective observational analytical study was conducted from January 2015 to December 2015. Mild and moderate TBI patients aged between 13 and 65 years, with no comorbid conditions were included in the study. Patients were monitored for hyponatremia, and etiology was found out using standard investigation protocol.
Results A total of 153 patients were included in the study. Incidence of hyponatremia was 21.6% (33/153). Cerebral salt wasting syndrome was more common than syndrome of inappropriate secretion of antidiuretic hormone. Incidence was higher in patients with low Glasgow coma scale score (p = 0.001) and in patients with parenchymal contusions (p = 0.008). Incidence correlated well with Marshal computed tomography (CT) score (p = 0.013). No significant difference of incidence was noted in relation to age or gender. Patients with hyponatremia had significantly prolonged intensive care unit (p < 0.001) and hospital stay (p < 0.001). Outcome at discharge was worse in patients with hyponatremia (p = 0.002), whereas both groups had similar outcome at 3-month follow-up (p = 0.087).
Conclusions Hyponatremia is a very common electrolyte imbalance in patients of TBI. Marshal CT grading and initial Glasgow coma scale score correlate well with the incidence of hyponatremia. More aggressive sodium monitoring may be required in parenchymal contusions in view of increased chance of development of hyponatremia. Hyponatremia adversely affect the immediate outcome in TBI, while long term outcome is usually unaffected.
-
References
- 1 Adrogué HJ, Madias NE. Hyponatremia. N Engl J Med 2000; 342 (21) 1581-1589
- 2 Spasovski G, Vanholder R, Allolio B , et al; Hyponatraemia Guideline Development Group. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Nephrol Dial Transplant 2014; 29 (Suppl. 02) i1-i39
- 3 Meng X, Shi B. Traumatic Brain Injury Patients With a Glasgow Coma Scale Score of ≤8, Cerebral Edema, and/or a Basal Skull Fracture are More Susceptible to Developing Hyponatremia. J Neurosurg Anesthesiol 2016; 28 (1) 21-26
- 4 Lohani S, Devkota UP. Hyponatremia in patients with traumatic brain injury: etiology, incidence, and severity correlation. World Neurosurg 2011; 76 (3–4) 355-360
- 5 Leonard J, Garrett RE, Salottolo K , et al. Cerebral salt wasting after traumatic brain injury: a review of the literature. Scand J Trauma Resusc Emerg Med 2015; 23: 98
- 6 Yumoto T, Sato K, Ugawa T, Ichiba S, Ujike Y. Prevalence, risk factors, and short-term consequences of traumatic brain injury-associated hyponatremia. Acta Med Okayama 2015; 69 (4) 213-218
- 7 Laureno R. Central pontine myelinolysis following rapid correction of hyponatremia. Ann Neurol 1983; 13 (3) 232-242
- 8 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
- 9 Bayan P, Bhawalkar JS, Jadhav SL, Banerjee A. Profile of non-fatal injuries due to road traffic accidents from a industrial town in India. Int J Crit Illn Inj Sci 2013; 3 (1) 8-11
- 10 Ganveer GB, Tiwari RR. Injury pattern among non-fatal road traffic accident cases: a cross-sectional study in Central India. Indian J Med Sci 2005; 59 (1) 9-12
- 11 Dóczi T, Tarjányi J, Huszka E, Kiss J. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) after head injury. Neurosurgery 1982; 10 (6 Pt 1): 685-688
- 12 Paiva WS, Bezerra DAF, Amorim RLO , et al. Serum sodium disorders in patients with traumatic brain injury. Ther Clin Risk Manag 2011; 7: 345-349
- 13 Sorkhi H, Salehi Omran MR, Barari Savadkoohi R, Baghdadi F, Nakhjavani N, Bijani A. CSWS Versus SIADH as the Probable Causes of Hyponatremia in Children With Acute CNS Disorders. Iran J Child Neurol 2013; 7 (3) 34-39
- 14 Betjes MG, Koopmans RP. [Hyponatremia in acute intracranial disorders: cerebral salt wasting]. Ned Tijdschr Geneeskd 2000; 144 (12) 553-556
- 15 Betjes MGH. Hyponatremia in acute brain disease: the cerebral salt wasting syndrome. Eur J Intern Med 2002; 13 (1) 9-14
- 16 Sherlock M, O'Sullivan E, Agha A , et al. The incidence and pathophysiology of hyponatraemia after subarachnoid haemorrhage. Clin Endocrinol (Oxf) 2006; 64 (3) 250-254
- 17 Singh S, Bohn D, Carlotti APCP, Cusimano M, Rutka JT, Halperin ML. Cerebral salt wasting: truths, fallacies, theories, and challenges. Crit Care Med 2002; 30 (11) 2575-2579
- 18 Bussmann C, Bast T, Rating D. Hyponatraemia in children with acute CNS disease: SIADH or cerebral salt wasting?. Childs Nerv Syst 2001; 17 (1–2) 58-62 , discussion 63
- 19 Momi J, Tang CM, Abcar AC, Kujubu DA, Sim JJ. Hyponatremia-what is cerebral salt wasting?. Perm J 2010; 14 (2) 62-65
- 20 Arieff AI, Ayus JC, Fraser CL. Hyponatraemia and death or permanent brain damage in healthy children. BMJ 1992; 304 (6836) 1218-1222
- 21 Alimohamadi M, Saghafinia M, Alikhani F, Danial Z, Shirani M, Amirjamshidi A. Impact of electrolyte imbalances on the outcome of aneurysmal subarachnoid hemorrhage: A prospective study. Asian J Neurosurg 2016; 11 (1) 29-33