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Is "cerebral hyponatraemia" iatrogenic?

W F Bouzarth, H A Shenkin

Lancet (London, England)

|May 8, 1982

Summary

Hyponatraemia in patients with central nervous system (CNS) disease is often due to excessive fluid intake, not inappropriate antidiuretic hormone secretion. Limiting intravenous fluids is recommended during acute stress.

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Area of Science:

Neurology
Endocrinology
Nephrology

Background:

Hyponatraemia and hypoosmolality are commonly observed in patients with central nervous system (CNS) disease or trauma.
These electrolyte imbalances are frequently attributed to the inappropriate secretion of antidiuretic hormone (ADH), a condition termed the syndrome of inappropriate antidiuretic hormone secretion (SIADH).
A "cerebral" aetiology for these changes has been previously postulated.

Purpose of the Study:

To re-evaluate the aetiology of hyponatraemia in patients with CNS disease or trauma.
To determine if the observed increase in antidiuretic activity is truly inappropriate or a physiological response.
To provide recommendations for fluid management in this patient population.

Main Methods:

Review of published reports on hyponatraemia in CNS disease.
Analysis of data from the present study concerning antidiuretic activity and fluid balance.
Correlation of clinical findings with laboratory parameters.

Main Results:

The increase in antidiuretic activity observed in patients with CNS disease or trauma is generally appropriate and expected.
Hyponatraemia in these patients is suggested to be primarily caused by excessive administration of intravenous fluids.
The data challenges the prevailing notion of widespread inappropriate ADH secretion as the sole cause.

Conclusions:

The hyponatraemia observed in CNS disease or trauma is likely a result of iatrogenic fluid overload rather than inappropriate ADH secretion.
Intravenous fluid administration in patients with CNS disease or brain injury should be strictly limited during acute stress.
A fluid intake of approximately 1 litre per day (e.g., 2.5% glucose in 0.45% saline for a 70 kg adult) is suggested.

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