Frequency and Types of Hyponatremia in Stroke Patients Admitted in a Referral Neuroscience Institute of Dhaka
Clinical Neurology and Neuroscience
Volume 3, Issue 2, June 2019, Pages: 46-49
Received: May 8, 2019; Accepted: Jun. 11, 2019; Published: Jun. 20, 2019
Views 210      Downloads 26
Authors
Maliha Hakim, Department of Neurology, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
Mashfiqul-Hasan, Department of Neurology, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
Mahmudul Islam, Department of Neurology, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
Mohammad Akter Hossain, Department of Neurology, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
Jobaida Naznin, Department of Neurology, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
Saifur Rahman Khan, Department of Neurology, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh
Article Tools
Follow on us
Abstract
Background: Hyponatremia is a common electrolyte abnormality in acute stroke patients and may be related to variable etiology. Objective: To observe the frequency and types of hyponatremia in hospitalized acute stroke patients. Materials and methods: This cross-sectional study, carried out in a referral neuroscience institute of Dhaka during February to November 2017, included 209 patients admitted with acute stroke (65 ischemic, age 61.5±13.3 years, M/F: 45/20; 144 hemorrhagic, age 59.2±13.1 years, M/F: 80/64). The clinical and laboratory values on admission were recorded. Those having hyponatremia (serum sodium <135 mmol/L) on admission were evaluated by clinical features (history of vomiting or diarrhoea, volume status, urine output) and laboratory parameters (urine osmolality, urine sodium, plasma osmolality, blood urea, hematocrit) to determine the types of hyponatremia. Results: Four patients died before the serum could be sent for electrolytes. Among the rest, 36 (17.6%) had hyponatremia on admission. Serum sodium level was <125 mmol/L in 7 (19.4%) and 125-134 mmol/L in rest of the patients having hyponatremia (29; 80.6%). The frequency of hyponatremia was similar in ischemic and hemorrhagic stroke (17.2% vs. 17.7%, p=0.925). Syndrome of inappropriate antidiuresis (SIAD) was most frequent cause of hyponatremia (50.0%), followed by cerebral salt wasting (CSW; 30.6%). The rest had either hyponatremia related to gastrointestinal (GI) fluid loss (2.8%) or died before a cause of hyponatremia could be ascertained (11.1%). There was no significant difference of age, gender, NIHSS score and GCS score on admission as well as in hospital stay and in-hospital mortality between patients with or without hyponatremia (p=ns for all). Frequency of CSW was relatively higher in hemorrhagic stroke (hemorrhagic vs. ischemic: 32.0% vs. 27.3%) and SIAD in ischemic stroke (hemorrhagic vs. ischemic: 40.0% vs. 72.7%) but did not reach level of statistical significance. Conclusion: Frequency of hyponatremia seems remarkable in hospitalized acute stroke patients, SIAD and CSW being the most frequent cause.
Keywords
Hyponatremia, Stroke, Dhaka
To cite this article
Maliha Hakim, Mashfiqul-Hasan, Mahmudul Islam, Mohammad Akter Hossain, Jobaida Naznin, Saifur Rahman Khan, Frequency and Types of Hyponatremia in Stroke Patients Admitted in a Referral Neuroscience Institute of Dhaka, Clinical Neurology and Neuroscience. Vol. 3, No. 2, 2019, pp. 46-49. doi: 10.11648/j.cnn.20190302.14
Copyright
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
[1]
Padhi R, Panda BN, Jagati S, Patra SC. Hyponatremia in critically ill patients. Indian J Crit Care Med. 2014; 18 (2): 83-87.
[2]
Sterns RH, Silver SM. Cerebral salt wasting versus SIADH: What difference? (Clinical commentary). J Am Soc Nephrol 2008; 19: 194-96.
[3]
Zomp A, Alexander E. Syndrome of inappropriate antidiuretic hormone and cerebral salt wasting in critically ill patients. AACN Adv Crit Care. 2012; 23 (3): 233-39
[4]
Albanese A, Hindmarsh P, Stanhope R. Management of hyponatremia in patients with acute cerebral insults. Arch Dis Child 2001; 85: 246-51.
[5]
Natarajan K, Prasad M. Hyponatremia in stroke: cerebral salt wasting versus syndrome of inappropriate anti-diuresis. IOSR-JDMS 2016; 15: 1-11.
[6]
Saleem S, Yousuf I, Gul A, Gupta S, Verma S. Hyponatremia in stroke. Ann Indian Acad Neurol. 2014; 17 (1): 55-57.
[7]
Alam MN, Uddin MJ, Rahman KM, Ahmed S, Akhter M et al. Electrolyte changes in stroke. Mymensingh Med J. 2012; 21 (4): 594-99.
[8]
Bandyopadhyay M, Jatua SK, Adhikari M, Bhandari A. Study of electrolyte abnormality in acute stroke. Ann. Int. Med. Den. Res. 2017; 3 (5): 4-9.
[9]
Siddiqui MR, Islam QT, Haque MA, Iqbal MJ, Hossain A et al. Dyselectrolytaemia in acute stroke patients, an observational study. Bangladesh J Medicine. 2011; 22: 30-34.
[10]
Kuramatsu JB, Bobinger T, Volbers B, Staykov D, Lucking H et al. Hyponatremia is an independent predictor of in-hospital mortality in spontaneous intracerebral hemorrhage. Stroke. 2014; 45: 1285-91.
[11]
Kembuan MAHN, Sekeon SAS. Electrolyte disturbances among acute stroke patients in Manado, Indonesia. GJMEDPH. 2014; 3 (1).
[12]
Amin S. Haq A, Faraz M, Wazir MN. Syndrome of inappropriate antidiuretic hormone secretion and neurological stroke. KJMS. 2014; 7 (1): 162-65.
[13]
Karunanandham S, Rajappa T, Selvaraju K. Hyponatremia in Patients Admitted with Stroke. Journal of Clinical & Diagnostic Research. 2018 Aug 1; 12 (8).
[14]
Rodrigues B, Staf I, Fortunato G, McDullouhg LD. Hyponatremia in the prognosis of acute ischemic stroke. Journal of Stroke and Cerebrovascular Disease. 2014; 23 (5): 850-54.
[15]
Soiza RL, Cumming K, Clark AB, Bettencourt‐Silva JH, Metcalf AK, Bowles KM, Potter JF, Myint PK. Hyponatremia predicts mortality after stroke. International Journal of Stroke. 2015; 10: 50-5.
ADDRESS
Science Publishing Group
1 Rockefeller Plaza,
10th and 11th Floors,
New York, NY 10020
U.S.A.
Tel: (001)347-983-5186