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Differential Diagnosis of Hyponatremia Following Subarachnoid Hemorrhage Kuniaki OGAWASARA 1 , Hiroyuki KINOUCHI 1 , Yoshihide NAGAMINE 1 , Keiji KOSHU 1 , Satoru FUJIWARA 1 1Department of Neurosurgery, Kohnan Hospital Keyword: subarachnoid hemorrhage , hyponatremia , cerebral salt wasting syndrome , SIADH pp.501-505
Published Date 1998/6/10
DOI https://doi.org/10.11477/mf.1436901577
  • Abstract
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Hyponatremia is a common complication after subarachnoid hemorrhage (SAH). Although the mechan-ism of hyponatremia is still controversial, cerebral salt-wasting syndrome (CSNS) is currently regarded asbeing more responsible than the syndrome of inappropriate secretion of antidiuretic hormone (SIADH).The aim of our study was to assess the plasma volume status of a patient with hyponatremia followingsubarachnoid hemorrhage. In doing this it may be possible to indirectly differentiate its pathogenesis.

Fifty patients with SAH were studied. Twenty patients demonstrated hyponatremia (serum sodium<135mEq/L) during day 7 to 13 after subarachnoid hemorrhage. Patients with hyponatremia were categorizedon the basis of their daily body weight, and central venous pressure. Group A consisted of patients withhypovolemia (16 patients), with the onset time of hyponatremia being clay 7 to 9. Group B included thosewith hypervolemia (4 patients); hyponatremia was observed during clay 10 to 11 and was corrected in allpatients within 72 hours after induction of fluid restriction.

Our findings suggest that hyponatremia following subarachnoid hemorrhage usually occurs due toCSWS, although SIADH remains as a minor pathogenesis. We conclude that the combination of dailybody weight and CVP measurements is a simple and practical method to distinguish promptly SIADHfrom CSWS.


Copyright © 1998, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院

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