title: Hyponatremia in the neurocritical care patient: An approach based on current evidence.
abstract: In the neurocritical care setting, hyponatremia is the commonest electrolyte disorder, which is associated with significant morbimortality. Cerebral salt wasting and syndrome of inappropriate antidiuretic hormone have been classically described as the 2 most frequent entities responsible of hyponatremia in neurocritical care patients. Nevertheless, to distinguish between both syndromes is usually difficult and useless as volume status is difficult to be determined, underlying pathophysiological mechanisms are still not fully understood, fluid restriction is usually contraindicated in these patients, and the first option in the therapeutic strategy is always the same: 3% hypertonic saline solution. Therefore, we definitively agree with the current concept of "cerebral salt wasting", which means that whatever is the etiology of hyponatremia, initially in neurocritical care patients the treatment will be the same: hypertonic saline solution.
authors.affiliation: Cátedra de Medicina Intensiva, Centro de Tratamiento Intensivo, Hospital de Clínicas, Facultad de Medicina, Universidad de la República (UdeLaR), Montevideo, Uruguay. Electronic address: wmanzanares@adinet.com.uy.
authors.forename: W
authors.initials: W
authors.lastname: Manzanares
authors.affiliation: Cátedra de Medicina Intensiva, Centro de Tratamiento Intensivo, Hospital de Clínicas, Facultad de Medicina, Universidad de la República (UdeLaR), Montevideo, Uruguay.
authors.forename: I
authors.initials: I
authors.lastname: Aramendi
authors.affiliation: Hôpital Fleurimont, Centre Hospitalier Universitaire de Sherbrooke, Département d'Anesthésie-Réanimation, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Québec, Canadá
authors.forename: P L
authors.initials: PL
authors.lastname: Langlois
authors.affiliation: Cátedra de Medicina Intensiva, Centro de Tratamiento Intensivo, Hospital de Clínicas, Facultad de Medicina, Universidad de la República (UdeLaR), Montevideo, Uruguay.
authors.forename: A
authors.initials: A
authors.lastname: Biestro
mesh_terms: D065092:Antidiuretic Hormone Receptor Antagonists / Q000627:therapeutic use; D001927:Brain Diseases / Q000150:complications* / Q000503:physiopathology; D000070642:Brain Injuries, Traumatic / Q000150:complications / Q000503:physiopathology; D002545:Brain Ischemia / Q000150:complications / Q000503:physiopathology; D002560:Cerebrovascular Circulation; D003131:Combined Modality Therapy; D016638:Critical Illness; D042241:Early Diagnosis; D005438:Fludrocortisone / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D007010:Hyponatremia / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D007177:Inappropriate ADH Syndrome / Q000150:complications; D017590:Myelinolysis, Central Pontine / Q000209:etiology / Q000517:prevention & control; D009318:Natriuresis; D019635:Neurosurgical Procedures; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D014661:Vasoconstriction
chemical_list: D065092:Antidiuretic Hormone Receptor Antagonists; D012462:Saline Solution, Hypertonic; D005438:Fludrocortisone; C034635:fludrocortisone acetate
keywords: Cerebral salt wasting; Cerebro perdedor de sal; Cloruro de sodio hipertónico; Hiponatremias; Hypertonic saline solution; Hyponatremia; Neurocritically ill patient; Paciente neurocrítico; Secreción inadecuada de hormona antidiurética; Syndrome of inappropriate antidiuretic secretion