SYNDROMES RELATED TO SODIUM AND ARGININE-VASOPRESSIN ALTERATIONS IN NEUROSURGERY AND NEUROINTENSIVISM

• DOI: https://doi.org/10.22533/at.ed.1595142512037

• Palavras-chave: Neurosurgery; Hyponatremia; Hypernatremia; Inappropriate Antidiuretic Hormone Secretion Syndrome; Cerebral Salt Loss;

• Keywords: Neurosurgery; Hyponatremia; Hypernatremia; Inappropriate Antidiuretic Hormone Secretion Syndrome; Cerebral Salt Loss;

• Abstract:

  Postoperative dysnatremias, characterized by imbalances in serum sodium levels, have been associated with increased resource use and mortality in surgical and intensive care patients. The treatment of dysnatremias can involve medical interventions based on changes in sodium levels. In this sense, hyponatremia is an important and common electrolyte disorder in critically ill neurosurgical patients that has been reported in association with several different primary diagnoses. Making an accurate diagnosis between syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and cerebral salt loss (CSW) in patients in whom hyponatremia develops is important because treatment differs greatly between the conditions. Whereas, correctly predicting postoperative hypernatremia can alert the postoperative nursing team to initiate preventive procedures such as providing adequate hydration and frequent monitoring and potentially reduce the risk of hypernatremia in postoperative neurosurgery patients. The aim of this article is to develop a literature review on syndromes related to hydroelectrolytic disorders and arginine-vasopressin alterations in the neurosurgical setting. This original article constitutes a bibliographic review, with several original articles, which were observed in scientific databases such as LILACS, Scientific Electronic Library Online (Scielo), National Library of Medicine (NIH), Nature, Medline, during the period from 2020 to 2024. SIADH is an expanded volume condition, while CSW is a contracted volume state involving renal sodium loss. The treatment for patients with SIADH is fluid restriction and the treatment for patients with CSW is usually salt and water replacement. Therefore, hyponatremia is commonly found in patients who have undergone neurosurgery, specifically those with traumatic brain injury, aneurysmal subarachnoid hemorrhage, recent transsphenoidal surgery for pituitary tumors and postoperative cranial vault reconstruction for craniosynostosis. With regard to hypernatremia, although less frequent, it can have a high incidence after surgical resection such as craniopharyngioma, which can be associated with hypothalamic lesions. It can be concluded that hyponatremia is a serious comorbidity in neurosurgical patients that requires special attention, as its treatment varies according to the cause and its consequences can affect the neurological outcome.