This review outlines the etiologies and management strategies for hyponatremia in neurosurgical patients, emphasizing a maximum correction rate of 8 mmol/L per 24 hours to prevent osmotic demyelination syndrome.
Hyponatremia is an important electrolyte imbalance condition in neurosurgical patients. It is a common disorder in subarachnoid hemorrhage, brain tumors and traumatic brain injury. Although there are many etiologies of hyponatremia in the neurosurgical patients, it is frequently caused by syndrome of inappropriate of ADH (SIADH), cerebral salt wasting (CSW) or Adrenal insufficiency. Keys for treatment include cause, onset and symptoms of hyponatremia.Severe symptomatic hyponatremia is recommended to treat with 3%NaCl. Moreover, alternative treatments for asymptomatic hyponatremia consist of fluid restriction for SIADH, Demeclocycline, Urea, Vasopressin receptor antagonist (Vaptans), or Fludrocortisone. For unknown duration of hyponatremia, correction of hyponatremia with maximal 8 mmol/L rise in 24 hours is proposed to prevent osmotic demyelination syndrome (ODS).
Prachya Punyarat (2018) studied this question.