Surumi Makkat Mukkil Sheikh1, Neetha Thattaparambil Chandran2, Asish Karthik3, Irfana Hameed4, Sunanda Chulliparambil5
BACKGROUND
Hyponatremia is the most frequently encountered electrolyte abnormality in
hospitalized patients, especially those with neurological injury. Acute onset
hyponatremia is common in patients with any type of cerebral insult including
traumatic brain injury (TBI), subarachnoid haemorrhage (SAH) and brain tumours.
Also seen as a complication of intracranial procedures, contributing to increased
morbidity and mortality. Early diagnosis and effective management can reduce
mortality associated with this condition. This study was done to estimate the
prevalence of hyponatremia in neurosurgical patients in our institution.
METHODS
This is an observational study that analysed the adult patients admitted to the
neuro intensive care unit (ICU) after having undergone the neurosurgical
procedure from January 2019 to July 2019. A structured questionnaire was used
for data collection. The prevalence of hyponatremia was calculated with preoperative
serum sodium levels in the study population.
RESULTS
In this study with 61 patients undergoing neurosurgical procedures, the
prevalence of hyponatremia was 34.4 %. The majority of patients for surgery
comes between 41 to 50 years. 57.4 % cases were with traumatic brain injury,
11.5 % cases were with sub arachnoid haemorrhage and 31.1 % were with
intracranial tumour. 26 % of hyponatremia patients belonged to mild grade while
8 % to moderate grade. 62.5 % of patients above 70 years, 44.4 % of patients
between 51 to 60 years and 40 % of patients between 61 and 70 years presented
with mild hyponatremia. 37.5 % of patients above 70 years and 10 % of patients
between 61 and 70 years presented with moderate hyponatremia.
CONCLUSIONS
Our study showed an increased prevalence of hyponatremia in neurosurgical
patients which demand effective approaches for an accurate and timely diagnosis
of this electrolyte disorder. Hyponatremia frequently occurs in patients with TBI,
SAH and intracranial tumours. It is also essential to differentiate between
syndrome of inappropriate antidiuretic hormone (SIADH) and cerebral salt wasting
syndrome (CSW) as the treatment modalities are entirely different for these two
entities. Early detection, close monitoring, etiological evaluation and prompt
treatment based on aetiology can reduce the complications and improve patient’s
outcomes.
