Incidence and pathophysiology of severe hyponatraemia in neurosurgical patients
Background:Hyponatraemia is a well-recognised complication of neurosurgical conditions, but the incidence and implications have not been well documented.Objective:To define the incidence, pathophysiology and clinical implications of significant hyponatraemia in several neurosurgical conditions.Metho...
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| Veröffentlicht in: | Postgraduate medical journal 2009-04, Vol.85 (1002), p.171-175 |
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| creator | Sherlock, M O’Sullivan, E Agha, A Behan, L A Owens, D Finucane, F Rawluk, D Tormey, W Thompson, C J |
| description | Background:Hyponatraemia is a well-recognised complication of neurosurgical conditions, but the incidence and implications have not been well documented.Objective:To define the incidence, pathophysiology and clinical implications of significant hyponatraemia in several neurosurgical conditions.Methods: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 |
| doi_str_mv | 10.1136/pgmj.2008.072819 |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_67209402</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>67209402</sourcerecordid><originalsourceid>FETCH-LOGICAL-b495t-d1fcf236a815d6e19711e3e1405539e9b6a387117a505c0ab06ec6cfb953c8a53</originalsourceid><addsrcrecordid>eNqFkE1r3DAQhkVpaLZp7z0VQ2kvxVuNZUnWMWw_khASCGl6FLI83vXWll3JLt1_XxkvKfSSk2D0vMM7DyFvgK4BmPg0bLv9OqO0WFOZFaCekRXkQqVUcvGcrChlWcpzyU7JyxD2lAKTObwgp6BykCDYitxeOttU6CwmxlXJYMZdP-wOoenbfntI-joJ-Bs9JrvD0DszeoNdY5LGJQ4n34fJbxtr2jnYoBvDK3JSmzbg6-N7Rr5__XK_uUivb79dbs6v0zJXfEwrqG2dMWEK4JVAUBIAGUJOOWcKVSkMK-JMGk65paakAq2wdak4s4Xh7Ix8WPYOvv81YRh11wSLbWsc9lPQQmZU5TSL4Lv_wH0_eRe7aZAFiJwVTESKLpSNNwWPtR580xl_0ED1rFrPqvWsWi-qY-TtcfFUdlj9CxzdRuD9ETAhKqq9iarDI5dBDqpQM5cuXBNG_PP4b_zPeAWTXN88bPQNPFzd3X--0z8i_3Hhy9joyZp_ARQ1pCE</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1781643836</pqid></control><display><type>article</type><title>Incidence and pathophysiology of severe hyponatraemia in neurosurgical patients</title><source>Oxford University Press Journals All Titles (1996-Current)</source><source>MEDLINE</source><source>BMJ Journals - NESLi2</source><creator>Sherlock, M ; O’Sullivan, E ; Agha, A ; Behan, L A ; Owens, D ; Finucane, F ; Rawluk, D ; Tormey, W ; Thompson, C J</creator><creatorcontrib>Sherlock, M ; O’Sullivan, E ; Agha, A ; Behan, L A ; Owens, D ; Finucane, F ; Rawluk, D ; Tormey, W ; Thompson, C J</creatorcontrib><description><![CDATA[Background:Hyponatraemia is a well-recognised complication of neurosurgical conditions, but the incidence and implications have not been well documented.Objective:To define the incidence, pathophysiology and clinical implications of significant hyponatraemia in several neurosurgical conditions.Methods: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.Results: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).Conclusions: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.]]></description><identifier>ISSN: 0032-5473</identifier><identifier>EISSN: 1469-0756</identifier><identifier>DOI: 10.1136/pgmj.2008.072819</identifier><identifier>PMID: 19417163</identifier><language>eng</language><publisher>London: The Fellowship of Postgraduate Medicine</publisher><subject>Adult ; Aged ; Biological and medical sciences ; Central Nervous System Diseases - surgery ; cerebral salt-wasting syndrome ; Electrolytes ; Epidemiology ; Female ; Fluids ; General aspects ; Humans ; Hypertension ; hyponatraemia ; Hyponatremia - etiology ; Inappropriate ADH Syndrome - etiology ; Laboratories ; Male ; Medical diagnosis ; Medical sciences ; Middle Aged ; Mortality ; Neurosciences ; neurosurgical ; Neurosurgical Procedures - adverse effects ; Plasma ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Sodium ; syndrome of inappropriate antidiuretic hormone secretion ; Traumatic brain injury ; Tumors ; Urine</subject><ispartof>Postgraduate medical journal, 2009-04, Vol.85 (1002), p.171-175</ispartof><rights>2009 The Fellowship of Postgraduate Medicine</rights><rights>2009 INIST-CNRS</rights><rights>Copyright: 2009 2009 The Fellowship of Postgraduate Medicine</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b495t-d1fcf236a815d6e19711e3e1405539e9b6a387117a505c0ab06ec6cfb953c8a53</citedby><cites>FETCH-LOGICAL-b495t-d1fcf236a815d6e19711e3e1405539e9b6a387117a505c0ab06ec6cfb953c8a53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://pmj.bmj.com/content/85/1002/171.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttps://pmj.bmj.com/content/85/1002/171.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,314,776,780,3183,23550,27901,27902,77342,77373</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21419893$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19417163$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sherlock, M</creatorcontrib><creatorcontrib>O’Sullivan, E</creatorcontrib><creatorcontrib>Agha, A</creatorcontrib><creatorcontrib>Behan, L A</creatorcontrib><creatorcontrib>Owens, D</creatorcontrib><creatorcontrib>Finucane, F</creatorcontrib><creatorcontrib>Rawluk, D</creatorcontrib><creatorcontrib>Tormey, W</creatorcontrib><creatorcontrib>Thompson, C J</creatorcontrib><title>Incidence and pathophysiology of severe hyponatraemia in neurosurgical patients</title><title>Postgraduate medical journal</title><addtitle>Postgrad Med J</addtitle><description><![CDATA[Background:Hyponatraemia is a well-recognised complication of neurosurgical conditions, but the incidence and implications have not been well documented.Objective:To define the incidence, pathophysiology and clinical implications of significant hyponatraemia in several neurosurgical conditions.Methods: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.Results: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).Conclusions: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.]]></description><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Central Nervous System Diseases - surgery</subject><subject>cerebral salt-wasting syndrome</subject><subject>Electrolytes</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Fluids</subject><subject>General aspects</subject><subject>Humans</subject><subject>Hypertension</subject><subject>hyponatraemia</subject><subject>Hyponatremia - etiology</subject><subject>Inappropriate ADH Syndrome - etiology</subject><subject>Laboratories</subject><subject>Male</subject><subject>Medical diagnosis</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Neurosciences</subject><subject>neurosurgical</subject><subject>Neurosurgical Procedures - adverse effects</subject><subject>Plasma</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Sodium</subject><subject>syndrome of inappropriate antidiuretic hormone secretion</subject><subject>Traumatic brain injury</subject><subject>Tumors</subject><subject>Urine</subject><issn>0032-5473</issn><issn>1469-0756</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqFkE1r3DAQhkVpaLZp7z0VQ2kvxVuNZUnWMWw_khASCGl6FLI83vXWll3JLt1_XxkvKfSSk2D0vMM7DyFvgK4BmPg0bLv9OqO0WFOZFaCekRXkQqVUcvGcrChlWcpzyU7JyxD2lAKTObwgp6BykCDYitxeOttU6CwmxlXJYMZdP-wOoenbfntI-joJ-Bs9JrvD0DszeoNdY5LGJQ4n34fJbxtr2jnYoBvDK3JSmzbg6-N7Rr5__XK_uUivb79dbs6v0zJXfEwrqG2dMWEK4JVAUBIAGUJOOWcKVSkMK-JMGk65paakAq2wdak4s4Xh7Ix8WPYOvv81YRh11wSLbWsc9lPQQmZU5TSL4Lv_wH0_eRe7aZAFiJwVTESKLpSNNwWPtR580xl_0ED1rFrPqvWsWi-qY-TtcfFUdlj9CxzdRuD9ETAhKqq9iarDI5dBDqpQM5cuXBNG_PP4b_zPeAWTXN88bPQNPFzd3X--0z8i_3Hhy9joyZp_ARQ1pCE</recordid><startdate>20090401</startdate><enddate>20090401</enddate><creator>Sherlock, M</creator><creator>O’Sullivan, E</creator><creator>Agha, A</creator><creator>Behan, L A</creator><creator>Owens, D</creator><creator>Finucane, F</creator><creator>Rawluk, D</creator><creator>Tormey, W</creator><creator>Thompson, C J</creator><general>The Fellowship of Postgraduate Medicine</general><general>BMJ Publishing Group</general><general>Oxford University Press</general><scope>BSCLL</scope><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>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20090401</creationdate><title>Incidence and pathophysiology of severe hyponatraemia in neurosurgical patients</title><author>Sherlock, M ; O’Sullivan, E ; Agha, A ; Behan, L A ; Owens, D ; Finucane, F ; Rawluk, D ; Tormey, W ; Thompson, C J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b495t-d1fcf236a815d6e19711e3e1405539e9b6a387117a505c0ab06ec6cfb953c8a53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Central Nervous System Diseases - surgery</topic><topic>cerebral salt-wasting syndrome</topic><topic>Electrolytes</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Fluids</topic><topic>General aspects</topic><topic>Humans</topic><topic>Hypertension</topic><topic>hyponatraemia</topic><topic>Hyponatremia - etiology</topic><topic>Inappropriate ADH Syndrome - etiology</topic><topic>Laboratories</topic><topic>Male</topic><topic>Medical diagnosis</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Neurosciences</topic><topic>neurosurgical</topic><topic>Neurosurgical Procedures - adverse effects</topic><topic>Plasma</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>Sodium</topic><topic>syndrome of inappropriate antidiuretic hormone secretion</topic><topic>Traumatic brain injury</topic><topic>Tumors</topic><topic>Urine</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sherlock, M</creatorcontrib><creatorcontrib>O’Sullivan, E</creatorcontrib><creatorcontrib>Agha, A</creatorcontrib><creatorcontrib>Behan, L A</creatorcontrib><creatorcontrib>Owens, D</creatorcontrib><creatorcontrib>Finucane, F</creatorcontrib><creatorcontrib>Rawluk, D</creatorcontrib><creatorcontrib>Tormey, W</creatorcontrib><creatorcontrib>Thompson, C J</creatorcontrib><collection>Istex</collection><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>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Postgraduate medical journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sherlock, M</au><au>O’Sullivan, E</au><au>Agha, A</au><au>Behan, L A</au><au>Owens, D</au><au>Finucane, F</au><au>Rawluk, D</au><au>Tormey, W</au><au>Thompson, C J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Incidence and pathophysiology of severe hyponatraemia in neurosurgical patients</atitle><jtitle>Postgraduate medical journal</jtitle><addtitle>Postgrad Med J</addtitle><date>2009-04-01</date><risdate>2009</risdate><volume>85</volume><issue>1002</issue><spage>171</spage><epage>175</epage><pages>171-175</pages><issn>0032-5473</issn><eissn>1469-0756</eissn><abstract><![CDATA[Background:Hyponatraemia is a well-recognised complication of neurosurgical conditions, but the incidence and implications have not been well documented.Objective:To define the incidence, pathophysiology and clinical implications of significant hyponatraemia in several neurosurgical conditions.Methods: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.Results: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).Conclusions: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.]]></abstract><cop>London</cop><pub>The Fellowship of Postgraduate Medicine</pub><pmid>19417163</pmid><doi>10.1136/pgmj.2008.072819</doi><tpages>5</tpages></addata></record> |
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| ispartof | Postgraduate medical journal, 2009-04, Vol.85 (1002), p.171-175 |
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| subjects | Adult Aged Biological and medical sciences Central Nervous System Diseases - surgery cerebral salt-wasting syndrome Electrolytes Epidemiology Female Fluids General aspects Humans Hypertension hyponatraemia Hyponatremia - etiology Inappropriate ADH Syndrome - etiology Laboratories Male Medical diagnosis Medical sciences Middle Aged Mortality Neurosciences neurosurgical Neurosurgical Procedures - adverse effects Plasma Public health. Hygiene Public health. Hygiene-occupational medicine Sodium syndrome of inappropriate antidiuretic hormone secretion Traumatic brain injury Tumors Urine |
| title | Incidence and pathophysiology of severe hyponatraemia in neurosurgical patients |
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