Hyponatremia in the neurocritical care patient: An approach based on current evidence

Med Intensiva. 2015 May;39(4):234-43. doi: 10.1016/j.medin.2014.11.004. Epub 2015 Jan 13.
[Article in English, Spanish]


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.

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.

Publication types

  • Review

MeSH terms

  • Antidiuretic Hormone Receptor Antagonists / therapeutic use
  • Brain Diseases / complications*
  • Brain Diseases / physiopathology
  • Brain Injuries, Traumatic / complications
  • Brain Injuries, Traumatic / physiopathology
  • Brain Ischemia / complications
  • Brain Ischemia / physiopathology
  • Cerebrovascular Circulation
  • Combined Modality Therapy
  • Critical Illness*
  • Early Diagnosis
  • Fludrocortisone / analogs & derivatives
  • Fludrocortisone / therapeutic use
  • Humans
  • Hyponatremia / epidemiology
  • Hyponatremia / etiology
  • Hyponatremia / physiopathology
  • Hyponatremia / therapy*
  • Inappropriate ADH Syndrome / complications
  • Myelinolysis, Central Pontine / etiology
  • Myelinolysis, Central Pontine / prevention & control
  • Natriuresis
  • Neurosurgical Procedures
  • Postoperative Complications / etiology
  • Postoperative Complications / physiopathology
  • Saline Solution, Hypertonic / therapeutic use
  • Subarachnoid Hemorrhage / complications
  • Subarachnoid Hemorrhage / physiopathology
  • Subarachnoid Hemorrhage / therapy
  • Vasoconstriction


  • Antidiuretic Hormone Receptor Antagonists
  • Saline Solution, Hypertonic
  • Fludrocortisone
  • fludrocortisone acetate