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Management of Hyponatremia and Volume Contraction

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Abstract

Hyponatremia is the most common electrolyte imbalance seen in patients with aneurysmal subarachnoid hemorrhage, occurring in one-third to one-half of patients. Hyponatremia may be caused by cerebral salt wasting and by the syndrome of inappropriate secretion of antidiuretic hormone or a combination of both. Limited data are available describing hyponatremia treatment in subarachnoid hemorrhage patients. A Medline search was performed for English-language manuscripts describing original research in the treatment for hyponatremia in patients with aneurysmal subarachnoid hemorrhage. Seven appropriate articles were identified as followed: three testing fludrocortisone, two hydrocortisone, and one each for hypertonic saline and 5% albumin. Data quality for treatment efficacy and safety were moderate for corticosteroid studies and low or very low for hypertonic saline and 5% albumin. Available data, although limited, support early treatment with corticosteroids to limit hyponatremia, with fludrocortisone causing fewer side effects.

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Correspondence to Alejandro A. Rabinstein.

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Participants: Michael N. Diringer, Thomas P. Bleck, Nicolas Bruder, E. Sander Connolly, Jr., Giuseppe Citerio, Daryl Gress, Daniel Hanggi, J. Claude Hemphill, III, MAS, Brian Hoh, Giuseppe Lanzino, Peter Le Roux, David Menon, Alejandro Rabinstein, Erich Schmutzhard, Lori Shutter, Nino Stocchetti, Jose Suarez, Miriam Treggiari, MY Tseng, Mervyn Vergouwen, Paul Vespa, Stephan Wolf, Gregory J. Zipfel.

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Rabinstein, A.A., Bruder, N. Management of Hyponatremia and Volume Contraction. Neurocrit Care 15, 354–360 (2011). https://doi.org/10.1007/s12028-011-9585-9

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