Volume supplementation with iso-sodium solution prevents hypernatremia after head injury

Area of Science:

• Neurology
• Nephrology
• Critical Care Medicine

Background:

• Head injury can lead to electrolyte imbalances, including hypernatremia.
• Maintaining fluid balance is crucial in managing patients with traumatic brain injury.
• Pre-existing dehydration and impaired renal function can complicate fluid management.

Purpose of the Study:

• To assess the efficacy of a novel volume supplement protocol in preventing hypernatremia in patients with head injuries.
• To identify factors influencing the success of the protocol.

Main Methods:

• A protocol involving iso-sodium solution infusion was implemented in 20 head-injured patients with hypotonic urine.
• The protocol aimed to achieve a positive 8-hour water balance.
• Patient outcomes, including serum sodium levels, water balance, creatinine clearance, and mean arterial pressure, were monitored.

Main Results:

• The protocol normalized serum sodium in 6 patients and temporarily increased it in 12.
• Negative cumulative water balance and reduced creatinine clearance were observed in 7 of the 12 patients with temporary increases in sodium.
• Two non-surviving patients had creatinine clearance below 40 mL/min/m2 prior to supplementation, indicating severe renal impairment.

Conclusions:

• The developed volume supplement protocol is effective in preventing hypernatremia in head-injured patients with preserved renal function.
• Pre-existing dehydration and reduced arterial pressure can impair urinary sodium excretion, potentially aggravating hypernatremia.
• Creatinine clearance is a critical indicator for the successful application of this fluid management strategy.