Treatment of Hyponatremia in Patients with Acute Neurological Injury

Theresa Human, Aaron M. Cook, Brian Anger, Kathleen Bledsoe, Amber Castle, David Deen, Haley Gibbs, Christine Lesch, Norah Liang, Karen McAllen, Christopher Morrison, Dennis Parker, Anthony Rowe, Denise Rhoney, Kiranpal Sangha, Elena Santayana, Scott Taylor, Eljim Tesoro, Gretchen Brophy

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Little data exist regarding the practice of sodium management in acute neurologically injured patients. This study describes the practice variations, thresholds for treatment, and effectiveness of treatment in this population. Methods: This retrospective, multicenter, observational study identified 400 ICU patients, from 17 centers, admitted for ≥48 h with subarachnoid hemorrhage (SAH), traumatic brain injury (TBI), intraparenchymal hemorrhage, or intracranial tumors between January 1, 2011 and July 31, 2012. Data collection included demographics, APACHE II, Glascow Coma Score (GCS), serum sodium (Na+), fluid rate and tonicity, use of sodium-altering therapies, intensive care unit (ICU) and hospital length of stay, and modified Rankin score upon discharge. Data were collected for the first 21 days of ICU admission or ICU discharge, whichever came first. Sodium trigger for treatment defined as the Na+ value prior to treatment with response defined as an increase of ≥4 mEq/L at 24 h. Results: Sodium-altering therapy was initiated in 34 % (137/400) of patients with 23 % (32/137) having Na+ >135 mEq/L at time of treatment initiation. The most common indications for treatment were declining serum Na+ (68/116, 59 %) and cerebral edema with mental status changes (21/116, 18 %). Median Na+ treatment trigger was 133 mEq/L (IQR 129–139) with no difference between diagnoses. Incidence and treatment of hyponatremia was more common in SAH and TBI [SAH (49/106, 46 %), TBI (39/97, 40 %), ICH (27/102, 26 %), tumor (22/95, 23 %); p = 0.001]. The most common initial treatment was hypertonic saline (85/137, 62 %), followed by oral sodium chloride tablets (42/137, 31 %) and fluid restriction (15/137, 11 %). Among treated patients, 60 % had a response at 24 h. Treated patients had lower admission GCS (12 vs. 14, p = 0.02) and higher APACHE II scores (12 vs. 10, p = 0.001). There was no statistically significant difference in outcome when comparing treated and untreated patients. Conclusion: Sodium-altering therapy is commonly employed among neurologically injured patients. Hypertonic saline infusions were used first line in more than half of treated patients with the majority having a positive response at 24 h. Further studies are needed to evaluate the impact of various treatments on patient outcomes.

Original languageEnglish (US)
Pages (from-to)242-248
Number of pages7
JournalNeurocritical Care
Volume27
Issue number2
DOIs
StatePublished - Oct 1 2017

Fingerprint

Hyponatremia
Wounds and Injuries
Sodium
Intensive Care Units
Subarachnoid Hemorrhage
Therapeutics
APACHE
Coma
Length of Stay
Intracranial Hemorrhages
Practice Management
Brain Edema
Serum
Sodium Chloride
Tablets
Multicenter Studies
Observational Studies
Neoplasms
Demography

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

Human, T., Cook, A. M., Anger, B., Bledsoe, K., Castle, A., Deen, D., ... Brophy, G. (2017). Treatment of Hyponatremia in Patients with Acute Neurological Injury. Neurocritical Care, 27(2), 242-248. https://doi.org/10.1007/s12028-016-0343-x

Treatment of Hyponatremia in Patients with Acute Neurological Injury. / Human, Theresa; Cook, Aaron M.; Anger, Brian; Bledsoe, Kathleen; Castle, Amber; Deen, David; Gibbs, Haley; Lesch, Christine; Liang, Norah; McAllen, Karen; Morrison, Christopher; Parker, Dennis; Rowe, Anthony; Rhoney, Denise; Sangha, Kiranpal; Santayana, Elena; Taylor, Scott; Tesoro, Eljim; Brophy, Gretchen.

In: Neurocritical Care, Vol. 27, No. 2, 01.10.2017, p. 242-248.

Research output: Contribution to journalArticle

Human, T, Cook, AM, Anger, B, Bledsoe, K, Castle, A, Deen, D, Gibbs, H, Lesch, C, Liang, N, McAllen, K, Morrison, C, Parker, D, Rowe, A, Rhoney, D, Sangha, K, Santayana, E, Taylor, S, Tesoro, E & Brophy, G 2017, 'Treatment of Hyponatremia in Patients with Acute Neurological Injury', Neurocritical Care, vol. 27, no. 2, pp. 242-248. https://doi.org/10.1007/s12028-016-0343-x
Human T, Cook AM, Anger B, Bledsoe K, Castle A, Deen D et al. Treatment of Hyponatremia in Patients with Acute Neurological Injury. Neurocritical Care. 2017 Oct 1;27(2):242-248. https://doi.org/10.1007/s12028-016-0343-x
Human, Theresa ; Cook, Aaron M. ; Anger, Brian ; Bledsoe, Kathleen ; Castle, Amber ; Deen, David ; Gibbs, Haley ; Lesch, Christine ; Liang, Norah ; McAllen, Karen ; Morrison, Christopher ; Parker, Dennis ; Rowe, Anthony ; Rhoney, Denise ; Sangha, Kiranpal ; Santayana, Elena ; Taylor, Scott ; Tesoro, Eljim ; Brophy, Gretchen. / Treatment of Hyponatremia in Patients with Acute Neurological Injury. In: Neurocritical Care. 2017 ; Vol. 27, No. 2. pp. 242-248.
@article{250ccc871a364f6ba824dd4631a33856,
title = "Treatment of Hyponatremia in Patients with Acute Neurological Injury",
abstract = "Background: Little data exist regarding the practice of sodium management in acute neurologically injured patients. This study describes the practice variations, thresholds for treatment, and effectiveness of treatment in this population. Methods: This retrospective, multicenter, observational study identified 400 ICU patients, from 17 centers, admitted for ≥48 h with subarachnoid hemorrhage (SAH), traumatic brain injury (TBI), intraparenchymal hemorrhage, or intracranial tumors between January 1, 2011 and July 31, 2012. Data collection included demographics, APACHE II, Glascow Coma Score (GCS), serum sodium (Na+), fluid rate and tonicity, use of sodium-altering therapies, intensive care unit (ICU) and hospital length of stay, and modified Rankin score upon discharge. Data were collected for the first 21 days of ICU admission or ICU discharge, whichever came first. Sodium trigger for treatment defined as the Na+ value prior to treatment with response defined as an increase of ≥4 mEq/L at 24 h. Results: Sodium-altering therapy was initiated in 34 {\%} (137/400) of patients with 23 {\%} (32/137) having Na+ >135 mEq/L at time of treatment initiation. The most common indications for treatment were declining serum Na+ (68/116, 59 {\%}) and cerebral edema with mental status changes (21/116, 18 {\%}). Median Na+ treatment trigger was 133 mEq/L (IQR 129–139) with no difference between diagnoses. Incidence and treatment of hyponatremia was more common in SAH and TBI [SAH (49/106, 46 {\%}), TBI (39/97, 40 {\%}), ICH (27/102, 26 {\%}), tumor (22/95, 23 {\%}); p = 0.001]. The most common initial treatment was hypertonic saline (85/137, 62 {\%}), followed by oral sodium chloride tablets (42/137, 31 {\%}) and fluid restriction (15/137, 11 {\%}). Among treated patients, 60 {\%} had a response at 24 h. Treated patients had lower admission GCS (12 vs. 14, p = 0.02) and higher APACHE II scores (12 vs. 10, p = 0.001). There was no statistically significant difference in outcome when comparing treated and untreated patients. Conclusion: Sodium-altering therapy is commonly employed among neurologically injured patients. Hypertonic saline infusions were used first line in more than half of treated patients with the majority having a positive response at 24 h. Further studies are needed to evaluate the impact of various treatments on patient outcomes.",
author = "Theresa Human and Cook, {Aaron M.} and Brian Anger and Kathleen Bledsoe and Amber Castle and David Deen and Haley Gibbs and Christine Lesch and Norah Liang and Karen McAllen and Christopher Morrison and Dennis Parker and Anthony Rowe and Denise Rhoney and Kiranpal Sangha and Elena Santayana and Scott Taylor and Eljim Tesoro and Gretchen Brophy",
year = "2017",
month = "10",
day = "1",
doi = "10.1007/s12028-016-0343-x",
language = "English (US)",
volume = "27",
pages = "242--248",
journal = "Neurocritical Care",
issn = "1541-6933",
publisher = "Humana Press",
number = "2",

}

TY - JOUR

T1 - Treatment of Hyponatremia in Patients with Acute Neurological Injury

AU - Human, Theresa

AU - Cook, Aaron M.

AU - Anger, Brian

AU - Bledsoe, Kathleen

AU - Castle, Amber

AU - Deen, David

AU - Gibbs, Haley

AU - Lesch, Christine

AU - Liang, Norah

AU - McAllen, Karen

AU - Morrison, Christopher

AU - Parker, Dennis

AU - Rowe, Anthony

AU - Rhoney, Denise

AU - Sangha, Kiranpal

AU - Santayana, Elena

AU - Taylor, Scott

AU - Tesoro, Eljim

AU - Brophy, Gretchen

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Background: Little data exist regarding the practice of sodium management in acute neurologically injured patients. This study describes the practice variations, thresholds for treatment, and effectiveness of treatment in this population. Methods: This retrospective, multicenter, observational study identified 400 ICU patients, from 17 centers, admitted for ≥48 h with subarachnoid hemorrhage (SAH), traumatic brain injury (TBI), intraparenchymal hemorrhage, or intracranial tumors between January 1, 2011 and July 31, 2012. Data collection included demographics, APACHE II, Glascow Coma Score (GCS), serum sodium (Na+), fluid rate and tonicity, use of sodium-altering therapies, intensive care unit (ICU) and hospital length of stay, and modified Rankin score upon discharge. Data were collected for the first 21 days of ICU admission or ICU discharge, whichever came first. Sodium trigger for treatment defined as the Na+ value prior to treatment with response defined as an increase of ≥4 mEq/L at 24 h. Results: Sodium-altering therapy was initiated in 34 % (137/400) of patients with 23 % (32/137) having Na+ >135 mEq/L at time of treatment initiation. The most common indications for treatment were declining serum Na+ (68/116, 59 %) and cerebral edema with mental status changes (21/116, 18 %). Median Na+ treatment trigger was 133 mEq/L (IQR 129–139) with no difference between diagnoses. Incidence and treatment of hyponatremia was more common in SAH and TBI [SAH (49/106, 46 %), TBI (39/97, 40 %), ICH (27/102, 26 %), tumor (22/95, 23 %); p = 0.001]. The most common initial treatment was hypertonic saline (85/137, 62 %), followed by oral sodium chloride tablets (42/137, 31 %) and fluid restriction (15/137, 11 %). Among treated patients, 60 % had a response at 24 h. Treated patients had lower admission GCS (12 vs. 14, p = 0.02) and higher APACHE II scores (12 vs. 10, p = 0.001). There was no statistically significant difference in outcome when comparing treated and untreated patients. Conclusion: Sodium-altering therapy is commonly employed among neurologically injured patients. Hypertonic saline infusions were used first line in more than half of treated patients with the majority having a positive response at 24 h. Further studies are needed to evaluate the impact of various treatments on patient outcomes.

AB - Background: Little data exist regarding the practice of sodium management in acute neurologically injured patients. This study describes the practice variations, thresholds for treatment, and effectiveness of treatment in this population. Methods: This retrospective, multicenter, observational study identified 400 ICU patients, from 17 centers, admitted for ≥48 h with subarachnoid hemorrhage (SAH), traumatic brain injury (TBI), intraparenchymal hemorrhage, or intracranial tumors between January 1, 2011 and July 31, 2012. Data collection included demographics, APACHE II, Glascow Coma Score (GCS), serum sodium (Na+), fluid rate and tonicity, use of sodium-altering therapies, intensive care unit (ICU) and hospital length of stay, and modified Rankin score upon discharge. Data were collected for the first 21 days of ICU admission or ICU discharge, whichever came first. Sodium trigger for treatment defined as the Na+ value prior to treatment with response defined as an increase of ≥4 mEq/L at 24 h. Results: Sodium-altering therapy was initiated in 34 % (137/400) of patients with 23 % (32/137) having Na+ >135 mEq/L at time of treatment initiation. The most common indications for treatment were declining serum Na+ (68/116, 59 %) and cerebral edema with mental status changes (21/116, 18 %). Median Na+ treatment trigger was 133 mEq/L (IQR 129–139) with no difference between diagnoses. Incidence and treatment of hyponatremia was more common in SAH and TBI [SAH (49/106, 46 %), TBI (39/97, 40 %), ICH (27/102, 26 %), tumor (22/95, 23 %); p = 0.001]. The most common initial treatment was hypertonic saline (85/137, 62 %), followed by oral sodium chloride tablets (42/137, 31 %) and fluid restriction (15/137, 11 %). Among treated patients, 60 % had a response at 24 h. Treated patients had lower admission GCS (12 vs. 14, p = 0.02) and higher APACHE II scores (12 vs. 10, p = 0.001). There was no statistically significant difference in outcome when comparing treated and untreated patients. Conclusion: Sodium-altering therapy is commonly employed among neurologically injured patients. Hypertonic saline infusions were used first line in more than half of treated patients with the majority having a positive response at 24 h. Further studies are needed to evaluate the impact of various treatments on patient outcomes.

UR - http://www.scopus.com/inward/record.url?scp=85008194208&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85008194208&partnerID=8YFLogxK

U2 - 10.1007/s12028-016-0343-x

DO - 10.1007/s12028-016-0343-x

M3 - Article

C2 - 28054290

AN - SCOPUS:85008194208

VL - 27

SP - 242

EP - 248

JO - Neurocritical Care

JF - Neurocritical Care

SN - 1541-6933

IS - 2

ER -