Hyponatremia Following Mild/Moderate Subarachnoid Hemorrhage Is Due To SIAD and Glucocorticoid Deficiency and not Cerebral Salt Wasting
Context: Hyponatremia is common after acute subarachnoid hemorrhage (SAH) but the etiology is unclear and there is a paucity of prospective data in the field. The cause of hyponatremia is variously attributed to the syndrome of inappropriate antidiuresis (SIAD), acute glucocorticoid insufficiency, a...
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| creator | Hannon, M. J Behan, L. A O'Brien, M. M. C Tormey, W Ball, S. G Javadpur, M Sherlock, M Thompson, C. J |
| description | Context:
Hyponatremia is common after acute subarachnoid hemorrhage (SAH) but the etiology is unclear and there is a paucity of prospective data in the field. The cause of hyponatremia is variously attributed to the syndrome of inappropriate antidiuresis (SIAD), acute glucocorticoid insufficiency, and the cerebral salt wasting syndrome (CSWS).
Objective:
The objective was to prospectively determine the etiology of hyponatremia after SAH using sequential clinical examination and biochemical measurement of plasma cortisol, arginine vasopressin (AVP), and brain natriuretic peptide (BNP).
Design:
This was a prospective cohort study.
Setting:
The setting was the National Neurosurgery Centre in a tertiary referral centre in Dublin, Ireland.
Patients:
One hundred patients with acute nontraumatic aneurysmal SAH were recruited on presentation.
Interventions:
Clinical examination and basic biochemical evaluation were performed daily. Plasma cortisol at 0900 hours, AVP, and BNP concentrations were measured on days 1, 2, 3, 4, 6, 8, 10, and 12 following SAH. Those with 0900 hours plasma cortisol |
| doi_str_mv | 10.1210/jc.2013-3032 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1490756713</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1490756713</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4489-46ade02472df11f2d219151f891972d8f1aecf8d7273389b582cc8c91807ed863</originalsourceid><addsrcrecordid>eNptkE2PEyEYgCdG49bVm2fDxcSDswsMM8Bx07rbJrvx0DV6IxTe2VIpVJhJ01_g35baqhdJCHnD8349VfWW4CtCCb7emCuKSVM3uKHPqgmRrK05kfx5NcGYklpy-u2iepXzBmPCWNu8rC4oo0wQQSfVz_lhF4MeEmydRrfR-7h34Qk9OG-vH6KFpAdAy3GlkzbrEJ1Fc9jGlNb6CdAio9kI6DGi5eJmhnSw6M6PJpqYBmeO8Ax6ZxwEc_j9G-KAppBglbRHS-0H9FXnoTR8Xb3otc_w5vxeVl9uPz1O5_X957vF9Oa-NowJWbNOW8CUcWp7QnpqKZGkJb2QZWNqRU80mF5YTnnTCLlqBTVGGEkE5mBF11xWH051dyn-GCEPauuyAe91gDhmRZjEvO04aQr68YSaFHNO0KtdcludDopgdVSvNkYd1auj-oK_O1ceV1uwf-E_rgvw_gzobLTvkw7G5X-cIB3lHS4cO3H76AdI-bsf95DUGoqutcLlsI6LunRmmJSoLreRJa05pUGw0SQXYJcgZ7WJYwpF6f-n_gVFp6xH</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1490756713</pqid></control><display><type>article</type><title>Hyponatremia Following Mild/Moderate Subarachnoid Hemorrhage Is Due To SIAD and Glucocorticoid Deficiency and not Cerebral Salt Wasting</title><source>Oxford University Press Journals All Titles (1996-Current)</source><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><source>Journals@Ovid Complete</source><creator>Hannon, M. J ; Behan, L. A ; O'Brien, M. M. C ; Tormey, W ; Ball, S. G ; Javadpur, M ; Sherlock, M ; Thompson, C. J</creator><creatorcontrib>Hannon, M. J ; Behan, L. A ; O'Brien, M. M. C ; Tormey, W ; Ball, S. G ; Javadpur, M ; Sherlock, M ; Thompson, C. J</creatorcontrib><description>Context:
Hyponatremia is common after acute subarachnoid hemorrhage (SAH) but the etiology is unclear and there is a paucity of prospective data in the field. The cause of hyponatremia is variously attributed to the syndrome of inappropriate antidiuresis (SIAD), acute glucocorticoid insufficiency, and the cerebral salt wasting syndrome (CSWS).
Objective:
The objective was to prospectively determine the etiology of hyponatremia after SAH using sequential clinical examination and biochemical measurement of plasma cortisol, arginine vasopressin (AVP), and brain natriuretic peptide (BNP).
Design:
This was a prospective cohort study.
Setting:
The setting was the National Neurosurgery Centre in a tertiary referral centre in Dublin, Ireland.
Patients:
One hundred patients with acute nontraumatic aneurysmal SAH were recruited on presentation.
Interventions:
Clinical examination and basic biochemical evaluation were performed daily. Plasma cortisol at 0900 hours, AVP, and BNP concentrations were measured on days 1, 2, 3, 4, 6, 8, 10, and 12 following SAH. Those with 0900 hours plasma cortisol <300 nmol/L were empirically treated with iv hydrocortisone.
Main Outcome Measures:
Plasma sodium concentration was recorded daily along with a variety of clinical and biochemical criteria. The cause of hyponatremia was determined clinically. Later measurement of plasma AVP and BNP concentrations enabled a firm biochemical diagnosis of the cause of hyponatremia to be made.
Results:
Forty-nine of 100 developed hyponatremia <135 mmol/L, including 14/100 <130 mmol/L. The cause of hyponatremia, and determined by both clinical examination and biochemical hormone measurement, was SIAD in 36/49 (71.4%), acute glucocorticoid insufficiency in 4/49 (8.2%), incorrect iv fluids in 5/49 (10.2%), and hypovolemia in 5/49 (10.2%). There were no cases of CSWS.
Conclusions:
The most common cause of hyponatremia after acute nontraumatic aneurysmal SAH is SIAD. Acute glucocorticoid insufficiency accounts for a small but significant number of cases. We found no cases of CSWS.</description><identifier>ISSN: 0021-972X</identifier><identifier>EISSN: 1945-7197</identifier><identifier>DOI: 10.1210/jc.2013-3032</identifier><identifier>PMID: 24248182</identifier><identifier>CODEN: JCEMAZ</identifier><language>eng</language><publisher>Bethesda, MD: Endocrine Society</publisher><subject>Adolescent ; Adrenal Insufficiency - blood ; Adrenal Insufficiency - complications ; Adrenal Insufficiency - epidemiology ; Adrenocorticotropic Hormone - blood ; Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Brain Diseases, Metabolic - blood ; Brain Diseases, Metabolic - complications ; Brain Diseases, Metabolic - epidemiology ; Cohort Studies ; Endocrinopathies ; Feeding. Feeding behavior ; Female ; Fundamental and applied biological sciences. Psychology ; Glucocorticoids - deficiency ; Humans ; Hydrocortisone - blood ; Hyponatremia - blood ; Hyponatremia - epidemiology ; Hyponatremia - etiology ; Inappropriate ADH Syndrome - blood ; Inappropriate ADH Syndrome - complications ; Inappropriate ADH Syndrome - epidemiology ; Male ; Medical sciences ; Middle Aged ; Neurosurgical Procedures - adverse effects ; Neurosurgical Procedures - statistics & numerical data ; Severity of Illness Index ; Sodium - metabolism ; Subarachnoid Hemorrhage - blood ; Subarachnoid Hemorrhage - complications ; Subarachnoid Hemorrhage - epidemiology ; Subarachnoid Hemorrhage - surgery ; Vertebrates: anatomy and physiology, studies on body, several organs or systems ; Vertebrates: endocrinology ; Young Adult</subject><ispartof>The journal of clinical endocrinology and metabolism, 2014-01, Vol.99 (1), p.291-298</ispartof><rights>Copyright © 2014 by The Endocrine Society</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4489-46ade02472df11f2d219151f891972d8f1aecf8d7273389b582cc8c91807ed863</citedby><cites>FETCH-LOGICAL-c4489-46ade02472df11f2d219151f891972d8f1aecf8d7273389b582cc8c91807ed863</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,4010,27900,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28162760$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24248182$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hannon, M. J</creatorcontrib><creatorcontrib>Behan, L. A</creatorcontrib><creatorcontrib>O'Brien, M. M. C</creatorcontrib><creatorcontrib>Tormey, W</creatorcontrib><creatorcontrib>Ball, S. G</creatorcontrib><creatorcontrib>Javadpur, M</creatorcontrib><creatorcontrib>Sherlock, M</creatorcontrib><creatorcontrib>Thompson, C. J</creatorcontrib><title>Hyponatremia Following Mild/Moderate Subarachnoid Hemorrhage Is Due To SIAD and Glucocorticoid Deficiency and not Cerebral Salt Wasting</title><title>The journal of clinical endocrinology and metabolism</title><addtitle>J Clin Endocrinol Metab</addtitle><description>Context:
Hyponatremia is common after acute subarachnoid hemorrhage (SAH) but the etiology is unclear and there is a paucity of prospective data in the field. The cause of hyponatremia is variously attributed to the syndrome of inappropriate antidiuresis (SIAD), acute glucocorticoid insufficiency, and the cerebral salt wasting syndrome (CSWS).
Objective:
The objective was to prospectively determine the etiology of hyponatremia after SAH using sequential clinical examination and biochemical measurement of plasma cortisol, arginine vasopressin (AVP), and brain natriuretic peptide (BNP).
Design:
This was a prospective cohort study.
Setting:
The setting was the National Neurosurgery Centre in a tertiary referral centre in Dublin, Ireland.
Patients:
One hundred patients with acute nontraumatic aneurysmal SAH were recruited on presentation.
Interventions:
Clinical examination and basic biochemical evaluation were performed daily. Plasma cortisol at 0900 hours, AVP, and BNP concentrations were measured on days 1, 2, 3, 4, 6, 8, 10, and 12 following SAH. Those with 0900 hours plasma cortisol <300 nmol/L were empirically treated with iv hydrocortisone.
Main Outcome Measures:
Plasma sodium concentration was recorded daily along with a variety of clinical and biochemical criteria. The cause of hyponatremia was determined clinically. Later measurement of plasma AVP and BNP concentrations enabled a firm biochemical diagnosis of the cause of hyponatremia to be made.
Results:
Forty-nine of 100 developed hyponatremia <135 mmol/L, including 14/100 <130 mmol/L. The cause of hyponatremia, and determined by both clinical examination and biochemical hormone measurement, was SIAD in 36/49 (71.4%), acute glucocorticoid insufficiency in 4/49 (8.2%), incorrect iv fluids in 5/49 (10.2%), and hypovolemia in 5/49 (10.2%). There were no cases of CSWS.
Conclusions:
The most common cause of hyponatremia after acute nontraumatic aneurysmal SAH is SIAD. Acute glucocorticoid insufficiency accounts for a small but significant number of cases. We found no cases of CSWS.</description><subject>Adolescent</subject><subject>Adrenal Insufficiency - blood</subject><subject>Adrenal Insufficiency - complications</subject><subject>Adrenal Insufficiency - epidemiology</subject><subject>Adrenocorticotropic Hormone - blood</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Brain Diseases, Metabolic - blood</subject><subject>Brain Diseases, Metabolic - complications</subject><subject>Brain Diseases, Metabolic - epidemiology</subject><subject>Cohort Studies</subject><subject>Endocrinopathies</subject><subject>Feeding. Feeding behavior</subject><subject>Female</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Glucocorticoids - deficiency</subject><subject>Humans</subject><subject>Hydrocortisone - blood</subject><subject>Hyponatremia - blood</subject><subject>Hyponatremia - epidemiology</subject><subject>Hyponatremia - etiology</subject><subject>Inappropriate ADH Syndrome - blood</subject><subject>Inappropriate ADH Syndrome - complications</subject><subject>Inappropriate ADH Syndrome - epidemiology</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Neurosurgical Procedures - adverse effects</subject><subject>Neurosurgical Procedures - statistics & numerical data</subject><subject>Severity of Illness Index</subject><subject>Sodium - metabolism</subject><subject>Subarachnoid Hemorrhage - blood</subject><subject>Subarachnoid Hemorrhage - complications</subject><subject>Subarachnoid Hemorrhage - epidemiology</subject><subject>Subarachnoid Hemorrhage - surgery</subject><subject>Vertebrates: anatomy and physiology, studies on body, several organs or systems</subject><subject>Vertebrates: endocrinology</subject><subject>Young Adult</subject><issn>0021-972X</issn><issn>1945-7197</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNptkE2PEyEYgCdG49bVm2fDxcSDswsMM8Bx07rbJrvx0DV6IxTe2VIpVJhJ01_g35baqhdJCHnD8349VfWW4CtCCb7emCuKSVM3uKHPqgmRrK05kfx5NcGYklpy-u2iepXzBmPCWNu8rC4oo0wQQSfVz_lhF4MeEmydRrfR-7h34Qk9OG-vH6KFpAdAy3GlkzbrEJ1Fc9jGlNb6CdAio9kI6DGi5eJmhnSw6M6PJpqYBmeO8Ax6ZxwEc_j9G-KAppBglbRHS-0H9FXnoTR8Xb3otc_w5vxeVl9uPz1O5_X957vF9Oa-NowJWbNOW8CUcWp7QnpqKZGkJb2QZWNqRU80mF5YTnnTCLlqBTVGGEkE5mBF11xWH051dyn-GCEPauuyAe91gDhmRZjEvO04aQr68YSaFHNO0KtdcludDopgdVSvNkYd1auj-oK_O1ceV1uwf-E_rgvw_gzobLTvkw7G5X-cIB3lHS4cO3H76AdI-bsf95DUGoqutcLlsI6LunRmmJSoLreRJa05pUGw0SQXYJcgZ7WJYwpF6f-n_gVFp6xH</recordid><startdate>201401</startdate><enddate>201401</enddate><creator>Hannon, M. J</creator><creator>Behan, L. A</creator><creator>O'Brien, M. M. C</creator><creator>Tormey, W</creator><creator>Ball, S. G</creator><creator>Javadpur, M</creator><creator>Sherlock, M</creator><creator>Thompson, C. J</creator><general>Endocrine Society</general><general>Copyright by The Endocrine Society</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201401</creationdate><title>Hyponatremia Following Mild/Moderate Subarachnoid Hemorrhage Is Due To SIAD and Glucocorticoid Deficiency and not Cerebral Salt Wasting</title><author>Hannon, M. J ; Behan, L. A ; O'Brien, M. M. C ; Tormey, W ; Ball, S. G ; Javadpur, M ; Sherlock, M ; Thompson, C. J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4489-46ade02472df11f2d219151f891972d8f1aecf8d7273389b582cc8c91807ed863</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adolescent</topic><topic>Adrenal Insufficiency - blood</topic><topic>Adrenal Insufficiency - complications</topic><topic>Adrenal Insufficiency - epidemiology</topic><topic>Adrenocorticotropic Hormone - blood</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Brain Diseases, Metabolic - blood</topic><topic>Brain Diseases, Metabolic - complications</topic><topic>Brain Diseases, Metabolic - epidemiology</topic><topic>Cohort Studies</topic><topic>Endocrinopathies</topic><topic>Feeding. Feeding behavior</topic><topic>Female</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Glucocorticoids - deficiency</topic><topic>Humans</topic><topic>Hydrocortisone - blood</topic><topic>Hyponatremia - blood</topic><topic>Hyponatremia - epidemiology</topic><topic>Hyponatremia - etiology</topic><topic>Inappropriate ADH Syndrome - blood</topic><topic>Inappropriate ADH Syndrome - complications</topic><topic>Inappropriate ADH Syndrome - epidemiology</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Neurosurgical Procedures - adverse effects</topic><topic>Neurosurgical Procedures - statistics & numerical data</topic><topic>Severity of Illness Index</topic><topic>Sodium - metabolism</topic><topic>Subarachnoid Hemorrhage - blood</topic><topic>Subarachnoid Hemorrhage - complications</topic><topic>Subarachnoid Hemorrhage - epidemiology</topic><topic>Subarachnoid Hemorrhage - surgery</topic><topic>Vertebrates: anatomy and physiology, studies on body, several organs or systems</topic><topic>Vertebrates: endocrinology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hannon, M. J</creatorcontrib><creatorcontrib>Behan, L. A</creatorcontrib><creatorcontrib>O'Brien, M. M. C</creatorcontrib><creatorcontrib>Tormey, W</creatorcontrib><creatorcontrib>Ball, S. G</creatorcontrib><creatorcontrib>Javadpur, M</creatorcontrib><creatorcontrib>Sherlock, M</creatorcontrib><creatorcontrib>Thompson, C. J</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The journal of clinical endocrinology and metabolism</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hannon, M. J</au><au>Behan, L. A</au><au>O'Brien, M. M. C</au><au>Tormey, W</au><au>Ball, S. G</au><au>Javadpur, M</au><au>Sherlock, M</au><au>Thompson, C. J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hyponatremia Following Mild/Moderate Subarachnoid Hemorrhage Is Due To SIAD and Glucocorticoid Deficiency and not Cerebral Salt Wasting</atitle><jtitle>The journal of clinical endocrinology and metabolism</jtitle><addtitle>J Clin Endocrinol Metab</addtitle><date>2014-01</date><risdate>2014</risdate><volume>99</volume><issue>1</issue><spage>291</spage><epage>298</epage><pages>291-298</pages><issn>0021-972X</issn><eissn>1945-7197</eissn><coden>JCEMAZ</coden><abstract>Context:
Hyponatremia is common after acute subarachnoid hemorrhage (SAH) but the etiology is unclear and there is a paucity of prospective data in the field. The cause of hyponatremia is variously attributed to the syndrome of inappropriate antidiuresis (SIAD), acute glucocorticoid insufficiency, and the cerebral salt wasting syndrome (CSWS).
Objective:
The objective was to prospectively determine the etiology of hyponatremia after SAH using sequential clinical examination and biochemical measurement of plasma cortisol, arginine vasopressin (AVP), and brain natriuretic peptide (BNP).
Design:
This was a prospective cohort study.
Setting:
The setting was the National Neurosurgery Centre in a tertiary referral centre in Dublin, Ireland.
Patients:
One hundred patients with acute nontraumatic aneurysmal SAH were recruited on presentation.
Interventions:
Clinical examination and basic biochemical evaluation were performed daily. Plasma cortisol at 0900 hours, AVP, and BNP concentrations were measured on days 1, 2, 3, 4, 6, 8, 10, and 12 following SAH. Those with 0900 hours plasma cortisol <300 nmol/L were empirically treated with iv hydrocortisone.
Main Outcome Measures:
Plasma sodium concentration was recorded daily along with a variety of clinical and biochemical criteria. The cause of hyponatremia was determined clinically. Later measurement of plasma AVP and BNP concentrations enabled a firm biochemical diagnosis of the cause of hyponatremia to be made.
Results:
Forty-nine of 100 developed hyponatremia <135 mmol/L, including 14/100 <130 mmol/L. The cause of hyponatremia, and determined by both clinical examination and biochemical hormone measurement, was SIAD in 36/49 (71.4%), acute glucocorticoid insufficiency in 4/49 (8.2%), incorrect iv fluids in 5/49 (10.2%), and hypovolemia in 5/49 (10.2%). There were no cases of CSWS.
Conclusions:
The most common cause of hyponatremia after acute nontraumatic aneurysmal SAH is SIAD. Acute glucocorticoid insufficiency accounts for a small but significant number of cases. We found no cases of CSWS.</abstract><cop>Bethesda, MD</cop><pub>Endocrine Society</pub><pmid>24248182</pmid><doi>10.1210/jc.2013-3032</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0021-972X |
| ispartof | The journal of clinical endocrinology and metabolism, 2014-01, Vol.99 (1), p.291-298 |
| issn | 0021-972X 1945-7197 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1490756713 |
| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection; Journals@Ovid Complete |
| subjects | Adolescent Adrenal Insufficiency - blood Adrenal Insufficiency - complications Adrenal Insufficiency - epidemiology Adrenocorticotropic Hormone - blood Adult Aged Aged, 80 and over Biological and medical sciences Brain Diseases, Metabolic - blood Brain Diseases, Metabolic - complications Brain Diseases, Metabolic - epidemiology Cohort Studies Endocrinopathies Feeding. Feeding behavior Female Fundamental and applied biological sciences. Psychology Glucocorticoids - deficiency Humans Hydrocortisone - blood Hyponatremia - blood Hyponatremia - epidemiology Hyponatremia - etiology Inappropriate ADH Syndrome - blood Inappropriate ADH Syndrome - complications Inappropriate ADH Syndrome - epidemiology Male Medical sciences Middle Aged Neurosurgical Procedures - adverse effects Neurosurgical Procedures - statistics & numerical data Severity of Illness Index Sodium - metabolism Subarachnoid Hemorrhage - blood Subarachnoid Hemorrhage - complications Subarachnoid Hemorrhage - epidemiology Subarachnoid Hemorrhage - surgery Vertebrates: anatomy and physiology, studies on body, several organs or systems Vertebrates: endocrinology Young Adult |
| title | Hyponatremia Following Mild/Moderate Subarachnoid Hemorrhage Is Due To SIAD and Glucocorticoid Deficiency and not Cerebral Salt Wasting |
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