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J Clin Med. 2014 Nov 20;3(4):1322-32. doi: 10.3390/jcm3041322.

Hyponatremia in Patients with Spontaneous Intracerebral Hemorrhage.

Author information

1
Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA. jaimeleigh03@gmail.com.
2
Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. kmorbitzer@unc.edu.
3
Department of Pharmacy, Detroit Receiving Hospital, Detroit, MI 48201, USA. xiliu@yahoo.com.
4
Department of Pharmacy, Detroit Receiving Hospital, Detroit, MI 48201, USA. jaimeleigh03@gmail.com.
5
Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA. jaimeleigh03@gmail.com.
6
Department of Pharmacy, New Hanover Regional Medical Center, Wilmington, NC 28401, USA. lisahallzimmerman@gmail.com.
7
Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. drhoney@unc.edu.

Abstract

Hyponatremia is the most frequently encountered electrolyte abnormality in critically ill patients. Hyponatremia on admission has been identified as an independent predictor of in-hospital mortality in patients with spontaneous intracerebral hemorrhage (sICH). However, the incidence and etiology of hyponatremia (HN) during hospitalization in a neurointensive care unit following spontaneous intracerebral hemorrhage (sICH) remains unknown. This was a retrospective analysis of consecutive patients admitted to Detroit Receiving Hospital for sICH between January 2006 and July 2009. All serum Na levels were recorded for patients during the ICU stay. HN was defined as Na <135 mmol/L. A total of 99 patients were analyzed with HN developing in 24% of sICH patients. Patients with HN had an average sodium nadir of 130 ± 3 mmol/L and an average time from admission to sodium <135 mmol/L of 3.9 ± 5.7 days. The most common cause of hyponatremia was syndrome of inappropriate antidiuretic hormone (90% of HN patients). Patients with HN were more likely to have fever (50% vs. 23%; p = 0.01), infection (58% vs. 28%; p = 0.007) as well as a longer hospital length of stay (14 (8-25) vs. 6 (3-9) days; p < 0.001). Of the patients who developed HN, fifteen (62.5%) patients developed HN in the first week following sICH. This shows HN has a fairly high incidence following sICH. The presence of HN is associated with longer hospital length of stays and higher rates of patient complications, which may result in worse patient outcomes. Further study is necessary to characterize the clinical relevance and treatment of HN in this population.

KEYWORDS:

cerebral salt wasting syndrome; hyponatremia; intracerebral hemorrhage; syndrome of inappropriate antidiuretic hormone

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