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    Incidence and pathophysiology of severe hyponatraemia in neurosurgical patients.

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    Authors
    Sherlock, M
    O'Sullivan, E
    Agha, A
    Behan, L A
    Owens, D
    Finucane, F
    Rawluk, D
    Tormey, W
    Thompson, C J
    Affiliation
    Department of Academic Endocrinology, Beaumont Hospital, Dublin, Ireland.
    Issue Date
    2009-04
    MeSH
    Adult
    Aged
    Central Nervous System Diseases
    Female
    Humans
    Hyponatremia
    Inappropriate ADH Syndrome
    Male
    Middle Aged
    Neurosurgical Procedures
    
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    Citation
    Incidence and pathophysiology of severe hyponatraemia in neurosurgical patients. 2009, 85 (1002):171-5 Postgrad Med J
    Journal
    Postgraduate medical journal
    URI
    http://hdl.handle.net/10147/127605
    DOI
    10.1136/pgmj.2008.072819
    PubMed ID
    19417163
    Abstract
    Hyponatraemia is a well-recognised complication of neurosurgical conditions, but the incidence and implications have not been well documented.
    To define the incidence, pathophysiology and clinical implications of significant hyponatraemia in several neurosurgical conditions.
    All patients admitted to the Irish National Neurosciences Centre at Beaumont Hospital, Dublin with traumatic brain injury, subarachnoid haemorrhage, intracranial neoplasm, pituitary disorders and spinal disorders who developed significant hyponatraemia (plasma sodium <130 mmol/l) from January 2002 to September 2003 were identified from computerised laboratory records. Data were collected by retrospective case note analysis.
    Hyponatraemia was more common in patients with pituitary disorders (5/81, 6.25%; p = 0.004), traumatic brain injury (44/457, 9.6%; p<0.001), intracranial neoplasm (56/355, 15.8%; p<0.001) and subarachnoid haemorrhage (62/316, 19.6%; p<0.001) than in those with spinal disorders (4/489, 0.81%). The pathophysiology of hyponatraemia was: syndrome of inappropriate antidiuretic hormone secretion (SIADH) in 116 cases (62%) (31 (16.6%) drug-associated), hypovolaemic hyponatraemia in 50 cases (26.7%) (which included patients with insufficient data to assign to the cerebral salt-wasting group (CSWS)), CSWS in nine cases (4.8%), intravenous fluids in seven cases (3.7%) and mixed SIADH/CSWS in five cases (2.7%). Hyponatraemic patients with cerebral irritation had significantly lower plasma sodium concentrations (mean (SD) 124.8 (0.34) mmol/l) than asymptomatic patients (126.6 (0.29) mmol/l) (p<0.0001). Hyponatraemic patients had a significantly longer hospital stay (median 19 days (interquartile range (IQR) 12-28)) than normonatraemic patients (median 12 days (IQR 10.5-15)) (p<0.001).
    Hyponatraemia is common in intracerebral disorders and is associated with a longer hospital stay. Cerebral irritation is associated with more severe hyponatraemia. SIADH is the most common cause of hyponatraemia and is often drug-associated.
    Item Type
    Article
    Language
    en
    ISSN
    1469-0756
    ae974a485f413a2113503eed53cd6c53
    10.1136/pgmj.2008.072819
    Scopus Count
    Collections
    Beaumont Hospital

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