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Syndrome of inappropriate antidiuresis common cause of hyponatremia after SAH
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The most common cause of hyponatremia after acute nontraumatic aneurysmal subarachnoid hemorrhage is syndrome of inappropriate antidiuresis, according to data in a recent study. Researchers also reported that acute glucocorticoid insufficiency explains a small but significant number of episodes of hyponatremia.
Although hyponatremia is common after acute subarachnoid hemorrhage (SAH), the etiology has been unclear until now, according to Mark J. Hannon, MD, of the department of endocrinology at Beaumont Hospital/Royal College of Surgeons in Ireland Medical School, and colleagues.
Mark J. Hannon
A number of small studies have suggested that cerebral salt wasting syndrome (CSWS) is the most common cause of hyponatraemia following SAH, due to the finding that plasma atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) concentrations both rise after SAH, “although we believe that SIAD is the most common cause,” they wrote.
The researchers sought to determine the etiology of hyponatremia after SAH among 100 patients (61% women; median age 53 years) with acute nontraumatic aneurysmal SAH.
Prospective data indicate that 49 of 100 developed hyponatremia (plasma sodium <135 mmol/L), including 14 who developed clinically significant hyponatremia (plasma sodium <130 mmol/L). Furthermore, 36 of 49 (73.4%) developed hyponatremia between days 1 and 3 post-SAH, six of 49 (12.2%) developed hyponatremia between 4 and 7 days after SAH, and seven of 49 (14.3%) developed hyponatremia more than 7 days after SAH, researchers wrote.
Hyponatremia was caused by syndrome of inappropriate antidiuresis in 36 of 49 (71.4%) patients, acute glucocorticoid insufficiency in four of 49 (8.2%) patients, incorrect IV fluids in five of 49 (10.2%) patients, and hypovolemia in five of 49 (10.2%) patients, according to data.
The researchers said there was no evidence of CSWS, adding that the data raise questions about acute cortisol deficiency as a consequence of SAH.
Disclosure: The researchers report no relevant financial disclosures.
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