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Clinical evaluation of hyponatremia and hypovolemia in critically ill adult neurologic patients: contribution of the use of cumulative balance of sodium

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Abstract

Purpose

Knowledge of the cumulative balance of sodium (CBS) is important for the diagnosis of salt disorders and water homeostasis and has the potential to predict hypovolemic status in acute neurological patients. However, an extensive application of the use of CBS is still lacking in the intensive care setting, where salt and water homeostasis represents a priority.

Methods

Records of consecutive series of acute neurological patients admitted to a neurointensive care unit over a 6-month period were retrospectively reviewed. CBS was calculated at the admission to the Emergency Department. Discrimination between cerebral salt-wasting syndrome (CSWS) and the syndrome of inappropriate antidiuretic hormone secretion (SIADH) was performed on the basis of the classical criteria. Additionally, we used the findings of a negative CBS exceeding 2 mEq/kg for the diagnosis of CSWS. Two independent clinicians who were blinded to the CBS results performed diagnosis of the causes of hyponatremia and estimated the daily volemic status of the patients on the basis of clinical parameters. Logistic regression analysis was used to determine the independent prognostic factors of hypovolemia.

Results

Thirty-five patients were studied for a total of 418 days. Four patients (11.4 %) fitted the criteria of CSWS and three patients (8.5 %) had SIADH. The unavailability of the CBS led to a wrong diagnosis in three of the eight hyponatremic patients (37.5 %). The risk of developing hypovolemia in patients with negative CBS was 7.1 times higher (CI 3.86–13.06; p < 0.001). Multivariate analysis revealed that negative cumulative fluid balance, negative CBS >2 mEq/kg, and CVP ≤5 cmH2O were independent prognostic factors for hypovolemia.

Conclusions

CBS is likely to be a useful parameter in the diagnosis of CSWS and a surrogate parameter for estimating hypovolemia in acute neurological patients.

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Acknowledgments

We would like to thank Dr Benvenuto Antonini, from the Anesthesia and Intensive Care Department of Manerbio Hospital, Brescia. The authors wish to dedicate this work to Nicola Motterlini, outstanding researcher and statistician, gentle and brave man.

Conflict of interest

The authors have no funding or conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Department of Anesthesia and Intensive Care, Ospedale Papa Giovanni XXIII°, Bergamo, Italy

    Paolo Gritti, Lidia Rotasperti & Ferdinando Luca Lorini

  2. Department of Neuroscience and Surgery of the Nervous System, Ospedale Papa Giovanni XXIII°, Bergamo, Italy

    Luigi Andrea Lanterna & Carlo Brembilla

  3. Department of Anesthesia and Intensive Care II, Spedali Civili di Brescia, Brescia, Italy

    Matteo Filippini

  4. Centro Studi GISED, Fondazione per la Ricerca Ospedale Maggiore, Bergamo, Italy

    Simone Cazzaniga

  5. Faculty of Health, Medicine, and Life Science, Maastricht University, Maastricht, The Netherlands

    Tatyana Sarnecki

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  1. Paolo Gritti
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  2. Luigi Andrea Lanterna
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  3. Lidia Rotasperti
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  8. Ferdinando Luca Lorini
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Correspondence to Paolo Gritti.

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Gritti, P., Lanterna, L.A., Rotasperti, L. et al. Clinical evaluation of hyponatremia and hypovolemia in critically ill adult neurologic patients: contribution of the use of cumulative balance of sodium. J Anesth 28, 687–695 (2014). https://doi.org/10.1007/s00540-014-1814-x

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  • DOI: https://doi.org/10.1007/s00540-014-1814-x

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