Hyponatremia usually indicates underlying disorders that disrupt fluid homeostasis. In most patients with TBI, hyponatremia is a feature of the syndrome of inappropriate antidiuretic hormone (SIADH) secretion due to pituitary dysfunction after head injury.
A prospective study on hyponatremia in patients with traumatic brain injury is a timely and valuable study. Hyponatremia, which causes brain edema, is associated with a poor neurological outcome. This study aims to improve treatment options for traumatic brain injury patients.
Glucocorticoid insufficiency
Glucocorticoid insufficency and hyponatremia are common complications of traumatic brain injury. While a patient may not experience hyponatremia immediately, it may develop later. It is important for neurosurgeons and critical care physicians to recognize this condition and treat it appropriately.
It is also important to evaluate the patient for endocrine dysfunction, which includes failure of the thyroid, adrenal, or growth hormone. While the mechanisms of this disease are unclear, identifying hyponatremia early in the course of traumatic brain injury is important to a proper diagnosis and treatment.
Patients with glucocorticoid ineffectiveness have elevated AVP levels in plasma, which may be more important than the levels of glucocorticoids. Vasopressin receptor antagonists almost completely restore urinary dilution, which further supports the role of AVP in hyponatremia.
Hypertonic saline
Although the use of hypertonic saline solutions is not new, questions have been raised about their efficacy and safety. This study investigated the effects of hypertonic saline solution on patients suffering severe head trauma. Its results contrasted with previous studies.
Hypertonic saline solutions can effectively reduce the risk of cerebral oedema in patients with severe traumatic brain injury. However, this treatment should be done only in patients who are able to tolerate it. In patients who are unable to tolerate hypertonic saline solutions, salt tablet supplements can be given.
The optimal dose of hypertonic saline should be tailored to the severity of the injury. Its duration of effect should not exceed 8-10 mmol litres/day. Regardless of the level of hypertonic saline administered, the aim is to maintain the sodium level in the blood. However, it is important to consider the underlying cause of hyponatremia.
Osmotic transport device
This study evaluated the effects of hyponatremia and osmotherapy on cerebral blood flow in patients with traumatic brain injury. Patients were evaluated in the Emergency Department using the recommended guidelines from the Brain Trauma Foundation and then transferred to the Neurology/Neurosurgery Intensive Care Unit. The recommended therapeutic measures included the implantation of an intraventricular catheter, an ICP monitor, and Camino implantable transducer. The patients were also treated with sedation and osmotic agents.
Osmotic agents, like mannitol, are used to improve cerebral blood flow to hypoperfused areas. These agents are often used in patients with traumatic brain injury. Their use has been linked to improved outcome.
Life threatening hyponatraemia is a rare postoperative complication of surgical evacuation of chronic subdural haematoma. The diagnosis of acute SIADH should be considered in patients deteriorating following surgery for CSDH, particularly in younger patients.
In acute hyponatremia, sodium levels drop rapidly — resulting in potentially dangerous effects, such as rapid brain swelling, which can result in a coma and death. Premenopausal women appear to be at the greatest risk of hyponatremia-related brain damage
Hyponatremia occurs when your blood sodium level goes below 135 mEq/L. When the sodium level in your blood is too low, extra water goes into your cells and makes them swell. This swelling can be dangerous especially in the brain, since the brain cannot expand past the skull.
Treatment
- Intravenous fluids. Your doctor may recommend IV sodium solution to slowly raise the sodium levels in your blood. …
- Medications. You may take medications to manage the signs and symptoms of hyponatremia, such as headaches, nausea and seizures.