Related Experiment Video

Updated: May 17, 2026

A Pediatric Concussion Model in Mice: Closed Head Injury with Long-Term Disorders (CHILD)
07:01

A Pediatric Concussion Model in Mice: Closed Head Injury with Long-Term Disorders (CHILD)

Published on: February 7, 2025

Hypernatremia is associated with increased risk of mortality in pediatric severe traumatic brain injury

Ibrahim M Alharfi1, Tanya Charyk Stewart, Shawn H Kelly

  • 1Department of Paediatrics, Western University, London, Ontario, Canada.

Journal of Neurotrauma
|October 13, 2012
PubMed

Insights

Acquired hypernatremia in children with severe traumatic brain injury (sTBI) is linked to worse outcomes. This condition independently predicts higher mortality and increased need for intensive care among survivors.

Area of Science:

  • Pediatric Critical Care Medicine
  • Neurotrauma Research
  • Electrolyte Balance Disorders

Background:

  • Acquired hypernatremia is a known complication in hospitalized patients, often correlating with adverse outcomes.
  • The specific impact of acquired hypernatremia on outcomes in pediatric severe traumatic brain injury (sTBI) requires further elucidation.

Purpose of the Study:

  • To investigate the association between acquired hypernatremia and clinical outcomes in pediatric patients with sTBI.
  • To identify risk factors and independent predictors of mortality and morbidity in this patient population.

Main Methods:

  • A retrospective cohort study was conducted on pediatric patients (2000-2009) with sTBI (Glasgow Coma Scale ≤8, Maximum Abbreviated Injury Scale ≥4).
  • Patients were categorized based on serum sodium levels: normonatremia (135-150 mmol/L), hypernatremia (151-160 mmol/L), and severe hypernatremia (>160 mmol/L).
  • Statistical analyses, including logistic regression, were used to evaluate the relationship between hypernatremia and outcomes, adjusting for potential confounders.

Main Results:

  • Hypernatremia was observed in 24% of the 165 sTBI patients, with severe hypernatremia in 6%.
  • Hypernatremia was independently associated with poorer neurological status (lower GCS), fixed pupils on admission, and development of central diabetes insipidus.
  • Mortality rates were significantly higher in hypernatremic groups (4-fold for hypernatremia, 6-fold for severe hypernatremia; p<0.001).
  • Hypernatremic survivors experienced longer Pediatric Critical Care Unit and hospital stays and were less likely to be discharged home.

Conclusions:

  • Acquired hypernatremia in pediatric sTBI is a significant indicator of increased mortality risk.
  • Hypernatremia is independently associated with specific neurological deficits and complications, including central diabetes insipidus.
  • Management of electrolyte balance, particularly sodium levels, is crucial for improving outcomes in pediatric sTBI patients.

Related Concept Videos

Regulation of Water Intake01:25

Regulation of Water Intake

Osmolality refers to the number of solute particles per kilogram of solvent in a solution. Plasma osmolality specifically indicates the total number of solute particles per kilogram of water in blood plasma. This value reflects the body's hydration status and is tightly regulated through mechanisms controlling water intake and output. While water consumption is a conscious decision, the body has intrinsic regulatory systems to maintain fluid balance. Dehydration, a state of water deficit...
Disorder of Water Balance01:29

Disorder of Water Balance

Water balance disorders are medical conditions that occur when there is a deviation from the body's water volume or osmolarity, disrupting normal homeostasis and leading todehydration, hypotonic hydration, hyperhydration, edema, or water intoxication.
Dehydration
Dehydration occurs when the body loses fluids (particularly water).
Causes:
The major causes of dehydration include excessive sweating, fever, vomiting, diarrhea, and diuresis.
Signs and Symptoms:
Symptoms primarily include intense...
Bacterial Meningitis I: Introduction01:22

Bacterial Meningitis I: Introduction

Bacterial meningitis is a severe, life-threatening inflammation of the meninges, particularly the pia mater and arachnoid mater, affecting the subarachnoid space, ventricles, and cerebrospinal fluid (CSF). If untreated, it can lead to significant neurological complications or death.Causative AgentsCommon pathogens vary with age and immune status. In adults, major organisms include Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. Streptococcus agalactiae (group B...
Cerebral Edema ll: Pathophysiology01:22

Cerebral Edema ll: Pathophysiology

Vasogenic edema is a major form of cerebral edema characterized by abnormal accumulation of fluid in the brain’s extracellular space due to disruption of the blood–brain barrier (BBB). The BBB is a specialized structure composed of endothelial cells connected by tight junctions, supported by astrocytic endfeet and a basement membrane. Under normal conditions, it tightly regulates the movement of ions, proteins, and solutes between the bloodstream and brain parenchyma. When this barrier loses...
Nephrotic Syndrome I : Introduction01:24

Nephrotic Syndrome I : Introduction

Nephrotic Syndrome is a chronic kidney disorder defined by clinical findings such as severe proteinuria, hypoalbuminemia, hyperlipidemia, and edema. These symptoms result from damage to the glomeruli, the kidney’s filtering units, increasing their permeability to proteins.Definition and Meaning:Proteinuria, defined as the loss of more than 3.5 grams of protein per day in adults, is a crucial feature of nephrotic syndrome. This condition is often accompanied by edema, the accumulation of fluid...
Cytotoxic Edema: Pathophysiology01:21

Cytotoxic Edema: Pathophysiology

Cytotoxic edema is a form of cerebral edema characterized by intracellular swelling of neurons, astrocytes, and other glial cells. It develops when the mechanisms responsible for maintaining ionic gradients across the cell membrane become impaired. Under normal physiological conditions, the sodium–potassium ATPase actively transports sodium ions out of the cell and potassium ions into the cell, preserving osmotic balance and enabling electrical signaling. This pump requires a continuous supply...