Incidence of postoperative hyponatremia in neurosurgical patients in a hospital in Southern Colombia
Keywords:
Hyponatremia, Brain Injuries Traumatic, Subarachnoid Hemorrhage, Anesthesia, Neurosurgery
Abstract
Introduction:
Hyponatremia is the most frequently encountered electrolyte disorder in hospitalized patients, and its incidence is even greater when a neurological condition is present. A significant association has been found between hyponatremia and increases in mortality rates.
Objective:
To describe the incidence of hyponatremia in neurosurgical patients of a university hospital in southern Colombia.
Methods:
Descriptive, observational study that analyzed the medical records of adult patients admitted to the intensive care unit after having undergone a neurosurgical procedure in the period between 2014 and 2015. Perioperative characteristics and neurological outcomes were compared, central trend and scatter were calculated, and statistical confidence tests were applied.
Results:
A total of 79 patients were included in the study. The median age was 40 years and 73.4% were male. The most frequent diagnosis was head injury, followed by space-occupying lesion and non-traumatic subarachnoid hemorrhage. The incidence of hyponatremia was 25.3%; patients with a diagnosis of subarachnoid hemorrhage were 8 times more likely to have hyponatremia (odds ratio 8.0, 95% confidence interval: 1.777-36.018). Mortality for the group of patients presenting hyponatremia was 35%, and unfavorable neurological outcomes were present in 80%.
Conclusions:
Neurosurgical patients with a diagnosis of subarachnoid hemorrhage or space-occupying lesion associated with hyponatremia have a less favorable neurologic outcome, without circumstantially affecting mortality.
References
1. Gill G, Huda B, Boyd A, et al. Characteristics and mortality of severe hyponatraemia-a hospital-based study. Clin Endocrinol 2006;65: 246-249.
2. Wright WL. Sodium and fluid management in acute brain injury. Curr Neurol Neurosci Rep 2012;12:466-473.
3. Spasovski G, Vanholder R, Allolio B, et al. Clinical practice guide on the diagnosis and treatment of hyponatremia. Rev la Soc española Nefrol 2017;7:370-380.
4. Kuramatsu JB, Bobinger T, Volbers B, et al. Hyponatremia is an independent predictor of in-hospital mortality in spontaneous intracerebral hemorrhage. Stroke 2014;45:1285-1291.
5. Sherlock M, O’Sullivan E, Agha A, et al. The incidence and pathophysiology of hyponatraemia after subarachnoid haemorrhage. Clin Endocrinol 2006;64:250-254.
6. Vespa PM. Hormonal dysfunction in neurocritical patients. Curr Opin Crit Care 2013;19:107-112.
7. Rahman M, Friedman WA. Hyponatremia in neurosurgical patients: clinical guidelines development. Neurosurgery 2009;65: 925-935.
8. Fraser JF, Stieg PE. Hyponatremia in the neurosurgical patient: epidemiology, pathophysiology, diagnosis, and management. Neurosurgery 2006;59:222-228.
9. Dong KK, Kwon WJ. Hyponatremia in patients with neurologic disorders. Electrolyte Blood Press 2009;7:51-57.
10. Moro N, Katayama Y, Igarashi T, et al. Hyponatremia in patients with traumatic brain injury: incidence, mechanism, and response to sodium supplementation or retention therapy with hydrocortisone. Surg Neurol 2007;68:387-393.
11. Robertson GL. Regulation of arginine vasopressin in the syndrome of inappropriate antidiuresis. Am J Med 2006;119 (7 suppl 1):36-42.
12. Palmer BF. Hyponatremia in patients with central nervous system disease: SIADH versus CSW. Trends Endocrinol Metab 2003;14: 182-187.
13. Bhardwaj A. Neurological impact of vasopressin dysregulation and hyponatremia. Ann Neurol 2006;59:229-236.
14. Janus D, Wojcik M, Dolezal-Oltarzewska K, et al. Cerebral salt wasting in a postoperative period. Neuroendocrinol Lett 2014;35:252-256.
15. Rabinstein AA, Wijdicks EFM. Hyponatremia in critically ill neurological patients. Neurologist 2003;9:290-300.
16. Centers for Disease Control and Prevention (CDC). Report to Congress on Traumatic Brain Injury Epidemiology and Rehabilitation [Internet]. Atlanta: National Center for Injury Prevention and Control; Division of Unintentional Injury Prevention; 2015. [Cited 12 Ago 17]. Available at: https://www.cdc.gov/traumaticbraininjury/pdf/TBI_Report_to_Congress_Epi_and_Rehab-a.pdf.
17. Vaidya C, Ho W, Freda BJ. Management of hyponatremia: providing treatment and avoiding harm. Cleve Clin J Med 2010; 77:715-726.
18. Gray J, Morbitzer K, Liu-DeRyke X, et al. Hyponatremia in patients with spontaneous intracerebral hemorrhage. J Clin Med 2014;3:1322-1332.
19. Hannon MJ, Behan LA, O’Brien MMC, et al. Hyponatremia following mild/moderate subarachnoid hemorrhage is due to SIAD and glucocorticoid deficiency and not cerebral salt wasting. J Clin Endocrinol Metab 2014;99:291-298.
20. Jahangiri A, Wagner J, Tran MT, et al. Factors predicting postoperative hyponatremia and efficacy of hyponatremia management strategies after more than 1000 pituitary operations. J Neurosurg 2013;119:1478-1483.
21. Sherlock M, O’Sullivan E, Agha A, et al. Incidence and pathophysiology of severe hyponatraemia in neurosurgical patients. Postgrad Med J 2009;85:171-175.
22. Upadhyay UM, Gormley WB. Etiology and management of hyponatremia in neurosurgical patients. J Intensive Care Med 2012;27:139-144.
23. Agha A, Thornton E, O’Kelly P, et al. Posterior pituitary dysfunction after traumatic brain injury. Baseline 2004;89:5987-5992.
24. Moritz ML, Ayus JC. 100 cc 3% sodium chloride bolus: a novel treatment for hyponatremic encephalopathy. Metab Brain Dis 2010;25:91-96.
25. Ayus JC, Caputo D, Bazerque F, et al. Treatment of hyponatremic encephalopathy with a 3% sodium chloride protocol: a case series. Am J Kidney Dis 2015;65:435-442.
26. Spasovski G, Vanholder R, Allolio B, et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Nephrol Dial Transplant 2014;29 (suppl 2):1-39.
27. Verbalis JG, Goldsmith SR, Greenberg A, et al. Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med 2013;126 (10 suppl 1):S1-42.
28. Peri A. The use of vaptans in clinical endocrinology. J Clin Endocrinol Metab 2013;98:1321-1332.
29. Mohan S, Gu S, Parikh A, et al. Prevalence of hyponatremia and association with mortality: results from NHANES. Am J Med 2013;126:1127.e1-1137.e1.
30. Fukui S, Katoh H, Tsuzuki N, et al. Focal brain edema and natriuretic peptides in patients with subarachnoid hemorrhage. J Clin Neurosci 2004;11:507-511.
31. Sturdik I, Adamcova M, Kollerova J, et al. Hyponatraemia is an independent predictor of in-hospital mortality. Eur J Intern Med 2014;25:379-382.
32. Tzoulis P, Bagkeris E, Bouloux PM. A case-control study of hyponatraemia as an independent risk factor for inpatient mortality. Clin Endocrinol 2014;81:401-407.
33. Tisdall M, Crocker M, Watkiss J, et al. Disturbances of sodium in critically ill adult neurologic patients: a clinical review. J Neuro-surg Anesthesiol 2006;18:57-63.
2. Wright WL. Sodium and fluid management in acute brain injury. Curr Neurol Neurosci Rep 2012;12:466-473.
3. Spasovski G, Vanholder R, Allolio B, et al. Clinical practice guide on the diagnosis and treatment of hyponatremia. Rev la Soc española Nefrol 2017;7:370-380.
4. Kuramatsu JB, Bobinger T, Volbers B, et al. Hyponatremia is an independent predictor of in-hospital mortality in spontaneous intracerebral hemorrhage. Stroke 2014;45:1285-1291.
5. Sherlock M, O’Sullivan E, Agha A, et al. The incidence and pathophysiology of hyponatraemia after subarachnoid haemorrhage. Clin Endocrinol 2006;64:250-254.
6. Vespa PM. Hormonal dysfunction in neurocritical patients. Curr Opin Crit Care 2013;19:107-112.
7. Rahman M, Friedman WA. Hyponatremia in neurosurgical patients: clinical guidelines development. Neurosurgery 2009;65: 925-935.
8. Fraser JF, Stieg PE. Hyponatremia in the neurosurgical patient: epidemiology, pathophysiology, diagnosis, and management. Neurosurgery 2006;59:222-228.
9. Dong KK, Kwon WJ. Hyponatremia in patients with neurologic disorders. Electrolyte Blood Press 2009;7:51-57.
10. Moro N, Katayama Y, Igarashi T, et al. Hyponatremia in patients with traumatic brain injury: incidence, mechanism, and response to sodium supplementation or retention therapy with hydrocortisone. Surg Neurol 2007;68:387-393.
11. Robertson GL. Regulation of arginine vasopressin in the syndrome of inappropriate antidiuresis. Am J Med 2006;119 (7 suppl 1):36-42.
12. Palmer BF. Hyponatremia in patients with central nervous system disease: SIADH versus CSW. Trends Endocrinol Metab 2003;14: 182-187.
13. Bhardwaj A. Neurological impact of vasopressin dysregulation and hyponatremia. Ann Neurol 2006;59:229-236.
14. Janus D, Wojcik M, Dolezal-Oltarzewska K, et al. Cerebral salt wasting in a postoperative period. Neuroendocrinol Lett 2014;35:252-256.
15. Rabinstein AA, Wijdicks EFM. Hyponatremia in critically ill neurological patients. Neurologist 2003;9:290-300.
16. Centers for Disease Control and Prevention (CDC). Report to Congress on Traumatic Brain Injury Epidemiology and Rehabilitation [Internet]. Atlanta: National Center for Injury Prevention and Control; Division of Unintentional Injury Prevention; 2015. [Cited 12 Ago 17]. Available at: https://www.cdc.gov/traumaticbraininjury/pdf/TBI_Report_to_Congress_Epi_and_Rehab-a.pdf.
17. Vaidya C, Ho W, Freda BJ. Management of hyponatremia: providing treatment and avoiding harm. Cleve Clin J Med 2010; 77:715-726.
18. Gray J, Morbitzer K, Liu-DeRyke X, et al. Hyponatremia in patients with spontaneous intracerebral hemorrhage. J Clin Med 2014;3:1322-1332.
19. Hannon MJ, Behan LA, O’Brien MMC, et al. Hyponatremia following mild/moderate subarachnoid hemorrhage is due to SIAD and glucocorticoid deficiency and not cerebral salt wasting. J Clin Endocrinol Metab 2014;99:291-298.
20. Jahangiri A, Wagner J, Tran MT, et al. Factors predicting postoperative hyponatremia and efficacy of hyponatremia management strategies after more than 1000 pituitary operations. J Neurosurg 2013;119:1478-1483.
21. Sherlock M, O’Sullivan E, Agha A, et al. Incidence and pathophysiology of severe hyponatraemia in neurosurgical patients. Postgrad Med J 2009;85:171-175.
22. Upadhyay UM, Gormley WB. Etiology and management of hyponatremia in neurosurgical patients. J Intensive Care Med 2012;27:139-144.
23. Agha A, Thornton E, O’Kelly P, et al. Posterior pituitary dysfunction after traumatic brain injury. Baseline 2004;89:5987-5992.
24. Moritz ML, Ayus JC. 100 cc 3% sodium chloride bolus: a novel treatment for hyponatremic encephalopathy. Metab Brain Dis 2010;25:91-96.
25. Ayus JC, Caputo D, Bazerque F, et al. Treatment of hyponatremic encephalopathy with a 3% sodium chloride protocol: a case series. Am J Kidney Dis 2015;65:435-442.
26. Spasovski G, Vanholder R, Allolio B, et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Nephrol Dial Transplant 2014;29 (suppl 2):1-39.
27. Verbalis JG, Goldsmith SR, Greenberg A, et al. Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med 2013;126 (10 suppl 1):S1-42.
28. Peri A. The use of vaptans in clinical endocrinology. J Clin Endocrinol Metab 2013;98:1321-1332.
29. Mohan S, Gu S, Parikh A, et al. Prevalence of hyponatremia and association with mortality: results from NHANES. Am J Med 2013;126:1127.e1-1137.e1.
30. Fukui S, Katoh H, Tsuzuki N, et al. Focal brain edema and natriuretic peptides in patients with subarachnoid hemorrhage. J Clin Neurosci 2004;11:507-511.
31. Sturdik I, Adamcova M, Kollerova J, et al. Hyponatraemia is an independent predictor of in-hospital mortality. Eur J Intern Med 2014;25:379-382.
32. Tzoulis P, Bagkeris E, Bouloux PM. A case-control study of hyponatraemia as an independent risk factor for inpatient mortality. Clin Endocrinol 2014;81:401-407.
33. Tisdall M, Crocker M, Watkiss J, et al. Disturbances of sodium in critically ill adult neurologic patients: a clinical review. J Neuro-surg Anesthesiol 2006;18:57-63.
How to Cite
1.
Rocha-Rivera HF, Javela-Rugeles JD, Barrios-Torres JC, Montalvo-Arce C, Tovar-Cardozo JH, Tejada-Perdomo JH. Incidence of postoperative hyponatremia in neurosurgical patients in a hospital in Southern Colombia. Colomb. J. Anesthesiol. [Internet]. 2018 Apr. 1 [cited 2024 Apr. 24];46(2):103-11. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/186
Downloads
Download data is not yet available.
Published
2018-04-01
How to Cite
1.
Rocha-Rivera HF, Javela-Rugeles JD, Barrios-Torres JC, Montalvo-Arce C, Tovar-Cardozo JH, Tejada-Perdomo JH. Incidence of postoperative hyponatremia in neurosurgical patients in a hospital in Southern Colombia. Colomb. J. Anesthesiol. [Internet]. 2018 Apr. 1 [cited 2024 Apr. 24];46(2):103-11. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/186
Issue
Section
Original
Altmetric
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
