Hypernatremia Predicts Adverse Cardiovascular and Neurological Outcomes After SAH

Fisher, Landis A.; Ko, Nerissa; Miss, Jacob C.; Tung, Poyee P.; Kopelnik, Alexander; Banki, Nader M.; Gardner, David; Smith, Wade S.; Lawton, Michael T.; Zaroff, Jonathan G.

doi:10.1385/ncc:5:3:180

Cited by 68 publications

(46 citation statements)

References 22 publications

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“…On the other side of the spectrum, the lack of significant problems with overshoot into hypernatremia with our protocol may be clinically important, as hypernatremia in SAH patients has been found to associate with poor cardiac and neurological outcomes [21]. Although our study was not designed to address this, it is possible that regulation of the hypertonic saline infusion rate by sliding-scale adjustment might have a lower risk of overshoot into hypernatremia than would be encountered with empiric physician adjustment.…”

Section: Discussionmentioning

confidence: 98%

Performance Characteristics of a Sliding-Scale Hypertonic Saline Infusion Protocol for the Treatment of Acute Neurologic Hyponatremia

et al. 2009

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Section: Discussionmentioning

confidence: 98%

Performance Characteristics of a Sliding-Scale Hypertonic Saline Infusion Protocol for the Treatment of Acute Neurologic Hyponatremia

et al. 2009

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“…Dysnatremia is a frequent dysbalance of effective osmolality in acute brain diseases [1,2,3,4,5,6]. In our neurologic care unit, dysnatremia occurred in 54.5% of patients with a variety of neurological diseases.…”

Section: Discussionmentioning

confidence: 99%

“…Sodium disturbances are frequent and serious complications in neurointensive care [1,2,3,4,5,6]. Approximately, one third of patients with neurologic symptoms present with severe hypernatremia and two thirds of patients with hyponatremia due to the electrolyte disorder [7].…”

Section: Introductionmentioning

confidence: 99%

Incidence and Mortality Prognosis of Dysnatremias in Neurologic Critically Ill Patients

2014

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Background: Dysnatremia, which is associated with increased mortality in general intensive care units (ICU), has not been thoroughly studied in neurologic ICU (NICU). Methods: Prevalence of dysnatremia was retrospectively assessed. The multivariable binary logistic regression model was used to determine the influence of dysnatremia on mortality. Results: Of 519 patients, 106 (20.4%) were admitted with hyponatremia and 177 (34.10%) with hypernatremia. Hypernatremia was detected in 69 (13.29%) patients on admission to NICU and in 108 patients (20.81%) during the ICU stay. However, the incidence of dysnatremia did not differ across the neurological categories (p = 0.4690). ICU stay in patients with acquired hypernatremia (22.3 w 25.35 days) was longer than those with admission hypernatremia (13.5 w 12.8 days) or with consistent normonatremia (16.16 w 20.06 days). The other indicators such as Acute Physiology and Chronic Health Evaluation II, Glasgow Coma Scale score, urinary catheterization, and incidence of pneumonia were also associated with the serum sodium concentrations. Hypernatremia both on admission and acquired in NICU could significantly differentiate between survivors and nonsurvivors (p = 0.002 and <0.0001). However, only NICU-acquired hypernatremia was the independent risk factor for mortality with high sensitivity (p = 0.000). Conclusions: Dysnatremia is more common in NICU, whereas only acquired-hypernatremia was independently associated with outcome. i 2014 S. Karger AG, Basel

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“…278 However, hypernatremia after SAH is independently associated with adverse outcomes and death. 278,283 Partial hypopituitarism is also seen in these patients, again it is possibly due to pituitaryhypothalamic ischemia secondary to various possible causes including: vasospasm, decreased CPP, and elevated ICP, resulting in reduced CPP. 284,285 …”

Section: Neuroendocrine Abnormalitiesmentioning

confidence: 90%

Aneurysmal Subarachnoid Hemorrhage

2011

Encyclopedia of Clinical Neuropsychology

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Aneurysmal subarachnoid hemorrhage (SAH) is a worldwide health burden with high fatality and permanent disability rates. The overall prognosis depends on the volume of the initial bleed, rebleeding, and degree of delayed cerebral ischemia (DCI). Cardiac manifestations and neurogenic pulmonary edema indicate the severity of SAH. The International Subarachnoid Aneurysm Trial (ISAT) reported a favorable neurological outcome with the endovascular coiling procedure compared with surgical clipping at the end of 1 year. The ISAT trial recruits were primarily neurologically good grade patients with smaller anterior circulation aneurysms, and therefore the results cannot be reliably extrapolated to larger aneurysms, posterior circulation aneurysms, patients presenting with complex aneurysm morphology, and poor neurological grades. The role of hypothermia is not proven to be neuroprotective according to a large randomized controlled trial, Intraoperative Hypothermia for Aneurysms Surgery Trial (IHAST II), which recruited patients with good neurological grades. Patients in this trial were subjected to slow cooling and inadequate cooling time and were rewarmed rapidly. This methodology would have reduced the beneficial effects of hypothermia. Adenosine is found to be beneficial for transient induced hypotension in 2 retrospective analyses, without increasing the risk for cardiac and neurological morbidity. The neurological benefit of pharmacological neuroprotection and neuromonitoring is not proven in patients undergoing clipping of aneurysms. DCI is an important cause of morbidity and mortality following SAH, and the pathophysiology is likely multifactorial and not yet understood. At present, oral nimodipine has an established role in the management of DCI, along with maintenance of euvolemia and induced hypertension. Following SAH, hypernatremia, although less common than hyponatremia, is a predictor of poor neurological outcome.Key Words: subarachnoid hemorrhage, intracranial aneurysm, delayed cerebral ischemia (J Neurosurg Anesthesiol 2015;27:222-240) SUBARACHNOID HEMORRHAGE (SAH) IS A WORLDWIDE HEALTH BURDEN WITH HIGH RATES OF FATALITY AND PERMANENT DISABILITYThe estimated worldwide incidence of SAH is 9/ 100,000 persons/y with regional variation. 1 One systematic review found the incidence to be lower in South and Central America (4.2/100,000 persons/y) and higher in Japan (22.7/100,000 persons/y) and Finland (19.7/100,000 persons/y). 1 Interestingly, the prevalence of intracranial aneurysm is not found to be higher in Japan or Finland, 2 but the risk for rupture is higher. 3 The incidence is also reported lower in China (2.0 //100,000 persons/y). 4 SAH accounts for only 5% of all strokes, 5 but it has high mortality and permanent disability rates. A retrospective cohort study in 2 large Norwegian populations between 1984 and 2007 reported a 30-day case fatality rate of 36%. 6 A nationwide Danish study reported a similar 30-day mortality at 38%. 7 World Health Organization Multinational Monitoring Trends...

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Hypernatremia Predicts Adverse Cardiovascular and Neurological Outcomes After SAH

Abstract: In the acute period after SAH, hypernatremia is associated with adverse cardiac outcomes and death. SAH patients with hypernatremia should be monitored for evidence of cardiac dysfunction.

Cited by 68 publications

References 22 publications

Performance Characteristics of a Sliding-Scale Hypertonic Saline Infusion Protocol for the Treatment of Acute Neurologic Hyponatremia

Performance Characteristics of a Sliding-Scale Hypertonic Saline Infusion Protocol for the Treatment of Acute Neurologic Hyponatremia

Incidence and Mortality Prognosis of Dysnatremias in Neurologic Critically Ill Patients

Aneurysmal Subarachnoid Hemorrhage

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