Bernard Toney Jr., DMSc, PA-C
The most common electrolyte disorder in hospitalized patients is hyponatremia, which is the most common complication in neurosurgical patients after intracranial insults. Its incidence is 38% to 50% in neurosurgical patients.1 Hyponatremia can lead to cerebral irritation and cerebral edema, which results in severe complications and adverse outcomes, including permanent disability and death. Brain insults experienced by neurosurgical patients, including traumatic brain injury, subarachnoid hemorrhage, and brain tumors, may acutely develop hyponatremia. Hyponatremia in neurosurgical patients is from one of two entities: syndrome of inappropriate antidiuretic hormone (SIADH) or cerebral salt wasting (CSW). Regulation of osmolarity between the brain and the kidney is directly related to these syndromes because of the alteration in these mechanisms. The correct diagnosis is crucial. The distinction between SIADH and CSW is challenging to establish but essential for patient treatment. A systematic approach to recognizing, diagnosing, and treating hyponatremia in neurosurgical patients can minimize complications.
Riekers W. Hyponatremia in Neurosurgical Patients: Etiology and Management. Lynchburg Journal of Medical Science. 2022; 4(3).
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