Simple Algorithm about Hyponatremia in Neurosurgery patients and the management

1. HYPONATREMIA IN NEUROSURGERY
NEUROSURGERY UNIT
FEDERAL TEACHING HOSPITAL GOMBE
PRESENTER: DR. MOSES CLETUS G.

2. OUTLINE
INTRODUCTION
CLASSIFICATION
ETIOLOGIES
CLINICAL PRESENTATIONS
GENERAL PRINCIPLES OF TREATMENT
REFERENCE
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3. INTRO
• Defined as serum(Na) below 135meq/l
• Most common electrolyte disorder occurring in 27% of hospitalized patients
• Adverse outcome worse with underlying diseases
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4. CLASSIFICATION
• BASE ON PLASMA OSMOLAITY –Isotonic
Hypotonic
Hypertonic
• BASE ON ECF VOLUME-Hypovolemic
Euvolemic
Hypervolemic
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5. • BASE ON SEVERITY
mild –Na 130-134, usually asymptomatic
moderate-Na 125-129, non-specific symptoms
severe <125, neurological symptoms from confusion to coma
• BASE ON DURATION
acute <48hours
chronic>48hours
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6. ETIOPATHOGENESIS
SIADH CSWS
• Head Trauma
• Cerebral Tumors
• Meningitis
• Cerebral Hemorrhage
• Spinal Surgery
• Drugs
• Closed Head injury
• CNS Surgery
• CNS Tumors
• CNS Infection
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7. CLINICAL PRESENTATION
SIADH CSWS
Low urine output
Nausea and vomiting
Mental Status changes(
Confusion
Convulsion
Coma
Polyuria
Weight loss
Dehydration
Hypovolemia
Hypotension
Low CVP
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8. TREATMENT GOAL
• Urgent correction by 1-2mmol/hr to prevent neurological damage
• Upper limit for correction 10-12mmol/l/day with every 2-4hours serum Na check
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9. PRINCIPLES OF TREATMENT
• Primarily determine by causes and severity of symptoms
 if symptomatic e.g seizure, coma in acute and severe cases
aggressive therapy is required
If less severe, but symptomatic e.g nausea, vomiting
do not mandate aggressive therapy
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10. • Water restrictions
Primary therapy in SIADHs, End stage renal disease,
Primary polydipsia
Edematous state
• Sodium chloride administration as isotonic saline or increase dietary salt
in CSWS
and in some SIADH cases
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11. MANAGEMENT
SIADH CSWS
Fluid restriction
If symptomatic replace Nacl
If severe hypertonic saline
Diuretics
Drugs demechlocycline
vaptans(v1, v2 antagonist
Lithium
In severe case hemodialysis
Volume for volume
Replacement of Na loss
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12. SUPPORTIVE MANAGEMENT
• Close intake/output monitoring
• Frequent hemodynamic monitoring
• Frequent neurological status assessment
• Serial labs; serum electrolytes,serum osmolarity
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13. REFERENCE
• F. Charlse Brunicardi Et al Schwatz:s Principle of Surgery “Hyponatremia” fluid and
electrolyte, 10th ed. Chpt 3 pg.68-69
• Beauchamp Et al Sabiston Ttextbook of Surgery “ Fluid and Electrolyte-
Hyponatremia” 21st ed. Sect 1 pg 84-85
• Sherlock M Et al CJ2009 “Incidence and Pathophysiology of severe hyponatremia
in Neurosurgery patients” Post gradua Med J85 ;171-175
• Mark J Et al JCEM2012 “ Disorders of water hemostasis in Neurosurgery patients’
Vol 97 pg 123-124
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14. • THANK YOU FOR LISTENING
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