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Hyponatremia in critically ill neurological patients
Alejandro A Rabinstein1, Eelco F M Wijdicks
1Neurological Neurosurgical Intensive Care Unit, Saint Mary's Hospital, Rochester, MN 55905, USA.
The Neurologist
|November 25, 2003
Summary
Hyponatremia is a common disorder in neurologic intensive care units. Correctly identifying iatrogenic causes, SIADH, or CSW and managing volume status is key to treatment and avoiding complications.
Area of Science:
- Neurology
- Nephrology
- Intensive Care Medicine
Background:
- Hyponatremia is the most frequent and significant electrolyte disturbance in the neurologic intensive care unit (NICU).
- Understanding pathophysiological mechanisms in acute neurologic disease has improved knowledge of hyponatremia.
Purpose of the Study:
- To outline the evaluation and management of hyponatremia in the NICU.
- To differentiate between causes of hyponatremia, including iatrogenic, SIADH, and CSW.
- To emphasize safe correction rates to prevent osmotic demyelination.
Main Methods:
- Structured evaluation starting with serum and urine osmolalities.
- Assessment of patient volume status to differentiate between SIADH and CSW.
- Monitoring correction rates to prevent osmotic demyelination syndrome.
Main Results:
- Most NICU hyponatremia cases involve serum hypotonicity.
- Iatrogenic causes, SIADH, and CSW are primary contributors.
- SIADH requires fluid restriction; CSW needs fluid and sodium replacement.
Conclusions:
- Hyponatremia frequently complicates acute neurologic and neurosurgical conditions.
- Common causes include iatrogenic factors, CSW, and SIADH.
- Clinicians must be adept at managing these conditions in critically ill neurologic patients.