Severe Dehydration and Acute Renal Failure Associated with External Ventricular Drainage of Cerebrospinal Fluid in Children

Simpson, Steven Q.; Yung, Michael; Slater, Anthony

doi:10.1177/0310057x0603400502

Cited by 9 publications

(8 citation statements)

References 13 publications

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“…Hyponatremia has been well described in children following brain tumor resection, cranial vault remodeling and endoscopic third ventriculostomy with prevalence ranging from (8-30%) (3, 4, 20, 21). A case series of three patients reported EVD associated severe dehydration (22). In a series of children who suffered traumatic brain injury, severe hyponatremia < 125 meq/dL was associated with increased mortality (18).…”

Section: Discussionmentioning

confidence: 99%

Greater Fluctuations in Serum Sodium Levels Are Associated With Increased Mortality in Children With Externalized Ventriculostomy Drains in a PICU*

Topjian¹,

Stuart²,

Pabalan³

et al. 2014

Pediatric Critical Care Medicine

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Objective Dysnatremia is common in critically ill children due to disruption of hormonal homeostasis. Children with brain injury are at risk for SIADH, cerebral salt wasting and sodium losses due to externalized ventricular drain (EVD) placement. We hypothesized that among pediatric intensive care unit (PICU) patients managed with an EVD, hyponatremia is common, hyponatremia is associated with seizures and in-hospital mortality, and greater sodium fluctuations are associated with in-hospital mortality. Design Retrospective observational study Setting Tertiary care PICU Patients All pediatric patients treated in the PICU with an EVD from January 2005 to December 2009. Patients were identified by searching the physician order entry database for EVD orders. Hyponatremia was defined as the minimum sodium during patients’ EVD time and was categorized as mild (131-134 meq/L) or moderate-severe (≤130 meq/L). Magnitude of sodium fluctuation was defined as the difference between a patient’s highest and lowest sodium during the time in which an EVD was in use (up to 14 days). Seizure was defined as a clinically evident convulsion during EVD presence. A priori confounders were age, history of epilepsy, and EVD indication. Multivariable regression was performed to test the association between sodium derangements and outcomes. Interventions None. Measurements and Main Results Three hundred eighty patients were eligible. One hundred nine (29%) had mild hyponatremia, and 30 (8%) moderate-severe hyponatremia. Twenty eight (7%) patients had a seizure while hospitalized. Eighteen patients died (5%) prior to discharge. Survivors had a median daily sodium fluctuation of 1 [0, 5] vs non-survivors 9 [6, 11], (p< 0.001) and a median sodium fluctuation of 5 meq/L [interquartile range 2, 8] vs non-survivors 15 meq/L [9, 24] (p<0.001) during EVD management. After controlling for a priori covariates and potential confounders, hyponatremia was not associated with an increased odds of seizures or in-hospital mortality. However, greater fluctuations in daily sodium (OR 1.38, 95% CI (1.06, 1.8)) and greater fluctuations in sodium during EVD management were associated with increased odds of in-hospital mortality (OR 1.59, 95% CI (1.2, 2.11)). Conclusion Hyponatremia was common in PICU patients treated with EVDs but not associated with seizures or in-hospital mortality. Greater sodium fluctuations during EVD management were independently associated with increased odds of in-hospital mortality.

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Section: Discussionmentioning

confidence: 99%

Greater Fluctuations in Serum Sodium Levels Are Associated With Increased Mortality in Children With Externalized Ventriculostomy Drains in a PICU*

Topjian¹,

Stuart²,

Pabalan³

et al. 2014

Pediatric Critical Care Medicine

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“…The resultant osmotic gradient leads to the secondary active transport of chloride and water molecules (22). Therefore, excessive CSF loss by drainage is assumed to deplete total Na + and water composition of the body (14). The relationship between EVD and hyponatremia has generally been shown in pediatric cases with raised ICP and hydrocephalus, which demonstrates that over or uncontrolled drainage may cause severe dehydration and hyponatremia with life-threatening conditions in children.…”

Section: Discussionmentioning

confidence: 99%

“…Continuous EVD has certain complications, such as infection, technical obstructions, and recurrent hemorrhages, especially in SAH patients (10). In the current neurosurgical literature, there are sufficient data regarding the effects of continuous CSF drainage on serum Na + levels in children (11)(12)(13)(14)(15), but to the best of our knowledge, no report has been published regarding the same in case of adults.…”

Section: Introductionmentioning

confidence: 99%

Effects of External Ventricular Drainage on Serum Sodium Levels in Adult Neurosurgical Patients

Baran¹,

Kemerdere²,

Yuksel³

et al. 2018

Bezmialem Science

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Amaç: Hiponatremi; erişkin nöroşirurji hastalarında sık görülen elektrolit bozukluklarından birisidir. Çalışmamızın amacı, eksternal ventriküler drenajla BOS kaybı ile serum sodyum düzeyi arasındaki ilişkiyi ortaya koymaktır. Yöntemler: Çalışmada intrakranial patolojiler nedeniyle opere edilmiş ve eksternal ventriküler drenaj takılmış 67 hastanın (29 kadın, 38 erkek) serum sodyum düzeyleri retrospektif olarak çalışılmıştır. Hastaların serum sodyum düzeyleri; erken, orta ve geç dönem olmak üzere 3 farklı zaman dilimine ayrılmıştır. Bulgular: Ortalama BOS drenaj süresi 10±6,4 gün olarak hesaplanmıştır. 15 hastada BOS drenajı süresince hiponatremi gelişmiştir. Bu hastaların 13'ünde (%86,6) cerrahi öncesi sınırda hiponatremi bulunmaktaydı. Hipofiz makroadenomu olan bir hasta ile subaraknoid kanama tanısı ile takip edilen bir hastanın serum sodyumu postoperatif 3-7. günler arasında ortalama 129 mmol/L olarak hesaplanmıştır. BOS drenajı ile serum sodyum düzeyi arasında postoperative erken, orta veya geç dönemde anlamlı ilişki saptanmamıştır. Sonuç: BOS drenajı ile hiponatremi arasından anlamlı bir farklılık saptanmamış olması nedeniyle; EVD, hiponatremi yaratabilecek intrakranial patolojiler haricinde erişkin nöroşirurji hastalarında güvenle kullanılabilir.

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“…The rates of hyponatremia were also similar between TBI and hydrocephalus patients, despite EVDs in situ for a greater period of time in hydrocephalus patients. Indeed, hyponatremia is a documented complication of EVDs in hydrocephalus patients, likely secondary to ongoing cerebrospinal fluid drainage (12,33,41). As there seems to be no statistical difference between the TBI and hydrocephalus groups, interventions aiming to decrease the complication rates of EVD insertion can likely be applied widely, regardless of indication.…”

Section: Discussionmentioning

confidence: 99%

“…Hyponatremia is a potential complication of EVD drainage (12,33) and was defined as a serum sodium level of Ͻ135 mmol/L documented at any time blood electrolyte measurements were taken while the EVD was in situ. Ventricular volumes were measured before EVD insertion in a subpopulation of patients based solely on compatibility between neuroimaging files and the GE Healthcare Centricity Radiology Solutions Advantage Workstation (AW4.2.07).…”

Section: Methodsmentioning

confidence: 99%

External ventricular drains in pediatric patients*

Ngo

Ranger

Singh

et al. 2009

Pediatric Critical Care Medicine

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Severe Dehydration and Acute Renal Failure Associated with External Ventricular Drainage of Cerebrospinal Fluid in Children

Cited by 9 publications

References 13 publications

Greater Fluctuations in Serum Sodium Levels Are Associated With Increased Mortality in Children With Externalized Ventriculostomy Drains in a PICU*

Greater Fluctuations in Serum Sodium Levels Are Associated With Increased Mortality in Children With Externalized Ventriculostomy Drains in a PICU*

Effects of External Ventricular Drainage on Serum Sodium Levels in Adult Neurosurgical Patients

External ventricular drains in pediatric patients*

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