BES2005 Poster Presentations Endocrine tumours and neoplasia (46 abstracts)
Implications of severe hyponatraemia in neurosurgical patients
M Sherlock 1 , E O'Sullivan 1 , A Agha 1 , LA Behan 1 , F Finucane 1 , D Owens 1 , D Rawluk 2 & CJ Thompson 1
1Academic Department of Endocrinology, Beaumont Hospital, Dublin, Ireland; 2deapartment of Neurosurgery, Beaumont Hospital, Dublin, Ireland.
Hyponatraemia is a well-recognised neurosurgical complication, but the incidence and complications are unknown.
Objective : We aimed to define the incidence, pathophysiology and effects of significant hyponatraemia following neurosurgical admissions.
Methods: All neurosurgical patients with significant hyponatraemia (plasma sodium <130 millimol per litre) between January 2002 and September 2003 were identified from computerised laboratory records. Data were collected by retrospective casenote analysis. Pathophysiology of hyponatraemia was defined by the criteria of Smith et al 1999.
Results: Hyponatraemia developed in 187/3561 (5.3%) of all neurosurgical admissions. Hyponatraemia was commoner following traumatic brain injury (TBI, 44/457, 9.6%, p<0.001), intracerebral tumours (56/355,15.8%, p<0.001), pituitary tumours (5/81, 6.25% p=0.004) and subarachnoid haemorrhage (62/316, 9.6% p<0.001) than in spinal disease (4/489, 0.81%). Pathophysiology was SIADH in 116 (62%, 31 drug induced; carbamazepine 7, desmopressin 10, SSRI 14) , hypovolaemic hyponatraemia 50 (26.7%), cerebral salt wasting (CSW) 9 (4.8%), intravenous fluids 7 (3.7%) and mixed SIADH/CSW 5 (2.7%). Hyponatraemic patients with symptoms of cerebral irritation had lower plasma sodium concentrations (Mean(SD) 124.8(0.34) millimol per litre) than asympomatic patients (126.6+0.29 millimol per litre p < 0.0001). Hyponatraemic patients had a longer hospital stay than normonatraemic patients (median 19 vs. 11 days). Hyponatraemia did not increase mortality.
Conclusions: Hyponatraemia is common in intracerebral disorders and is associated with longer hospital stay. Cerebral irritation is associated with more severe hyponatraemia. SIADH is the commonest cause of hyponatraemia and is frequently drug-induced. Our data do not support published data which suggest that CSW is the commonest cause of neurosurgical hyponatraemia.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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