Hyponatremia in Critically III Neurological Patients

Alejandro Rabinstein, Eelco F.M. Wijdicks

Research output: Contribution to journalReview article

125 Citations (Scopus)

Abstract

Background: Hyponatremia is the most common and important electrolyte disorder encountered in the neurologic intensive care unit (NICU). Advances in our knowledge of the pathophysiological mechanisms at play in patients with acute neurologic disease have improved our understanding of this derangement. Review Summary: Evaluation of hyponatremia requires a structured approach beginning with the measurement of serum and urine osmolalities. Most cases of hyponatremia in the NICU are associated with serum hypotonicity. latrogenic causes, most conspicuously inadequate tonicity of intravenous fluids, should be promptly identified and removed when possible. Two main mechanisms are responsible for most noniatrogenic cases of hyponatremia in patients with neurologic or neurosurgical disease: inappropriate secretion of antidiuretic hormone (SIADH) and cerebral salt wasting syndrome (CSW). Distinction between these two syndromes may be difficult and must be based on an accurate assessment of the patient's volume status. SIADH is associated with normal or slightly expanded volume status and should be treated with fluid restriction. Patients with CSW are hypovolemic and require adequate fluid and sodium replacement. Correction of hyponatremia should not exceed 8 to 10 mmol/L over any 24-hour period to avoid the risk of osmotic demyelination. Conclusions: Hyponatremia may complicate the clinical course of many acute neurologic and neurosurgical disorders. It is most often iatrogenic causes, CSW, or SIADH. Physicians working with critically ill neurologic patients should be familiar with management strategies addressing these underlying pathophysiological mechanisms.

Original languageEnglish (US)
Pages (from-to)290-300
Number of pages11
JournalNeurologist
Volume9
Issue number6
DOIs
StatePublished - Nov 1 2003

Fingerprint

Hyponatremia
Wasting Syndrome
Nervous System
Salts
Nervous System Diseases
Vasopressins
Intensive Care Units
Inappropriate ADH Syndrome
Hypovolemia
Demyelinating Diseases
Acute Disease
Serum
Critical Illness
Osmolar Concentration
Electrolytes
Sodium
Urine
Physicians

Keywords

  • Cerebral salt wasting
  • Hyponatremia
  • Natriuretic peptides
  • NICU
  • SIADH

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Hyponatremia in Critically III Neurological Patients. / Rabinstein, Alejandro; Wijdicks, Eelco F.M.

In: Neurologist, Vol. 9, No. 6, 01.11.2003, p. 290-300.

Research output: Contribution to journalReview article

Rabinstein, Alejandro ; Wijdicks, Eelco F.M. / Hyponatremia in Critically III Neurological Patients. In: Neurologist. 2003 ; Vol. 9, No. 6. pp. 290-300.
@article{6ff37f5fe47b489a8e5d80871fd5bb57,
title = "Hyponatremia in Critically III Neurological Patients",
abstract = "Background: Hyponatremia is the most common and important electrolyte disorder encountered in the neurologic intensive care unit (NICU). Advances in our knowledge of the pathophysiological mechanisms at play in patients with acute neurologic disease have improved our understanding of this derangement. Review Summary: Evaluation of hyponatremia requires a structured approach beginning with the measurement of serum and urine osmolalities. Most cases of hyponatremia in the NICU are associated with serum hypotonicity. latrogenic causes, most conspicuously inadequate tonicity of intravenous fluids, should be promptly identified and removed when possible. Two main mechanisms are responsible for most noniatrogenic cases of hyponatremia in patients with neurologic or neurosurgical disease: inappropriate secretion of antidiuretic hormone (SIADH) and cerebral salt wasting syndrome (CSW). Distinction between these two syndromes may be difficult and must be based on an accurate assessment of the patient's volume status. SIADH is associated with normal or slightly expanded volume status and should be treated with fluid restriction. Patients with CSW are hypovolemic and require adequate fluid and sodium replacement. Correction of hyponatremia should not exceed 8 to 10 mmol/L over any 24-hour period to avoid the risk of osmotic demyelination. Conclusions: Hyponatremia may complicate the clinical course of many acute neurologic and neurosurgical disorders. It is most often iatrogenic causes, CSW, or SIADH. Physicians working with critically ill neurologic patients should be familiar with management strategies addressing these underlying pathophysiological mechanisms.",
keywords = "Cerebral salt wasting, Hyponatremia, Natriuretic peptides, NICU, SIADH",
author = "Alejandro Rabinstein and Wijdicks, {Eelco F.M.}",
year = "2003",
month = "11",
day = "1",
doi = "10.1097/01.nrl.0000095258.07720.89",
language = "English (US)",
volume = "9",
pages = "290--300",
journal = "Neurologist",
issn = "1074-7931",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Hyponatremia in Critically III Neurological Patients

AU - Rabinstein, Alejandro

AU - Wijdicks, Eelco F.M.

PY - 2003/11/1

Y1 - 2003/11/1

N2 - Background: Hyponatremia is the most common and important electrolyte disorder encountered in the neurologic intensive care unit (NICU). Advances in our knowledge of the pathophysiological mechanisms at play in patients with acute neurologic disease have improved our understanding of this derangement. Review Summary: Evaluation of hyponatremia requires a structured approach beginning with the measurement of serum and urine osmolalities. Most cases of hyponatremia in the NICU are associated with serum hypotonicity. latrogenic causes, most conspicuously inadequate tonicity of intravenous fluids, should be promptly identified and removed when possible. Two main mechanisms are responsible for most noniatrogenic cases of hyponatremia in patients with neurologic or neurosurgical disease: inappropriate secretion of antidiuretic hormone (SIADH) and cerebral salt wasting syndrome (CSW). Distinction between these two syndromes may be difficult and must be based on an accurate assessment of the patient's volume status. SIADH is associated with normal or slightly expanded volume status and should be treated with fluid restriction. Patients with CSW are hypovolemic and require adequate fluid and sodium replacement. Correction of hyponatremia should not exceed 8 to 10 mmol/L over any 24-hour period to avoid the risk of osmotic demyelination. Conclusions: Hyponatremia may complicate the clinical course of many acute neurologic and neurosurgical disorders. It is most often iatrogenic causes, CSW, or SIADH. Physicians working with critically ill neurologic patients should be familiar with management strategies addressing these underlying pathophysiological mechanisms.

AB - Background: Hyponatremia is the most common and important electrolyte disorder encountered in the neurologic intensive care unit (NICU). Advances in our knowledge of the pathophysiological mechanisms at play in patients with acute neurologic disease have improved our understanding of this derangement. Review Summary: Evaluation of hyponatremia requires a structured approach beginning with the measurement of serum and urine osmolalities. Most cases of hyponatremia in the NICU are associated with serum hypotonicity. latrogenic causes, most conspicuously inadequate tonicity of intravenous fluids, should be promptly identified and removed when possible. Two main mechanisms are responsible for most noniatrogenic cases of hyponatremia in patients with neurologic or neurosurgical disease: inappropriate secretion of antidiuretic hormone (SIADH) and cerebral salt wasting syndrome (CSW). Distinction between these two syndromes may be difficult and must be based on an accurate assessment of the patient's volume status. SIADH is associated with normal or slightly expanded volume status and should be treated with fluid restriction. Patients with CSW are hypovolemic and require adequate fluid and sodium replacement. Correction of hyponatremia should not exceed 8 to 10 mmol/L over any 24-hour period to avoid the risk of osmotic demyelination. Conclusions: Hyponatremia may complicate the clinical course of many acute neurologic and neurosurgical disorders. It is most often iatrogenic causes, CSW, or SIADH. Physicians working with critically ill neurologic patients should be familiar with management strategies addressing these underlying pathophysiological mechanisms.

KW - Cerebral salt wasting

KW - Hyponatremia

KW - Natriuretic peptides

KW - NICU

KW - SIADH

UR - http://www.scopus.com/inward/record.url?scp=0344443379&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0344443379&partnerID=8YFLogxK

U2 - 10.1097/01.nrl.0000095258.07720.89

DO - 10.1097/01.nrl.0000095258.07720.89

M3 - Review article

C2 - 14629783

AN - SCOPUS:0344443379

VL - 9

SP - 290

EP - 300

JO - Neurologist

JF - Neurologist

SN - 1074-7931

IS - 6

ER -