Hyponatraemia Research Paper
HYPONATRAEMIA IN THE NEUROSURGICAL PATIENT
INTRODUCTION
Sodium the most abundant electrolyte in the human body, and therefore the osmolality of body fluids is strongly dependent on its concentration. Osmolality in turn is important in maintaining homeostasis within the brain. Ironically, dysfunction of the brain can cause changes in sodium homeostasis. To avoid neurological deterioration, morbidity or mortality the sodium level must be corrected promptly. The two most common causes of hyponatraemia in neurosurgical patients are Syndrome of Inappropriate Antidiuretic Hormone (SIADH) and Cerebral Salt Wasting (CSW). Distinguishing between both causes is important for correct treatment.
INDEX CASE
A 50 year old male presented to the accident and emergency department after being assaulted and chopped to the head multiple times. Witnesses reported that he had no seizures, but lost consciousness at the scene …show more content…
Hyponatraemia is very common in neurosurgical patients. Sherlock et al looked at the incidence of hyponatraemia in neurosurgical patients with various disorders(2). With severe hyponatraemia defined in their study as less than 130mmol/l, hyponatraemia was more common in patients with pituitary disorders 6.25%, traumatic brain injury 9.6%, intracranial neoplasm 15.8% and subarachnoid haemorrhage 19.6%. Other studies shows a higher incidence in trauma with Moro et al finding a prevalence of 16.8%(2). Hyponatraemia 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 hyponatraemia is corrected promptly and effectively, cerebral edema may manifest through impaired consciousness level, seizures, elevated intracranial pressure, and, potentially, death due to cerebral
INTRODUCTION
Sodium the most abundant electrolyte in the human body, and therefore the osmolality of body fluids is strongly dependent on its concentration. Osmolality in turn is important in maintaining homeostasis within the brain. Ironically, dysfunction of the brain can cause changes in sodium homeostasis. To avoid neurological deterioration, morbidity or mortality the sodium level must be corrected promptly. The two most common causes of hyponatraemia in neurosurgical patients are Syndrome of Inappropriate Antidiuretic Hormone (SIADH) and Cerebral Salt Wasting (CSW). Distinguishing between both causes is important for correct treatment.
INDEX CASE
A 50 year old male presented to the accident and emergency department after being assaulted and chopped to the head multiple times. Witnesses reported that he had no seizures, but lost consciousness at the scene …show more content…
Hyponatraemia is very common in neurosurgical patients. Sherlock et al looked at the incidence of hyponatraemia in neurosurgical patients with various disorders(2). With severe hyponatraemia defined in their study as less than 130mmol/l, hyponatraemia was more common in patients with pituitary disorders 6.25%, traumatic brain injury 9.6%, intracranial neoplasm 15.8% and subarachnoid haemorrhage 19.6%. Other studies shows a higher incidence in trauma with Moro et al finding a prevalence of 16.8%(2). Hyponatraemia 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 hyponatraemia is corrected promptly and effectively, cerebral edema may manifest through impaired consciousness level, seizures, elevated intracranial pressure, and, potentially, death due to cerebral