Disorders of Water Homeostasis in Neurosurgical Patients

Context:

Disorders of water balance are common in neurosurgical patients and usually manifest as hypo- or hypernatremia. They are most commonly seen after subarachnoid hemorrhage, traumatic brain injury, with intracranial tumors, and after pituitary surgery.

Setting:

We reviewed the experience of endocrine evaluation and management of disorders of salt and water balance in a large cohort of inpatients attending the national neurosciences referral centre in Dublin, Ireland, and compared this experience with findings from other studies.

Patients:

The study group included unselected neurosurgical patients admitted to our centre and requiring endocrine evaluation.

Interventions:

We conducted investigations to determine the underlying mechanistic basis for disorders of salt and water balance in neurosurgical patients and treatment to restore normal metabolism.

Main Outcome Measures:

Morbidity and mortality associated with deranged salt and water balance were measured.

Results:

The underlying pathophysiology of disordered water balance in neurosurgical patients is complex and varied and dictates the optimal therapeutic approach.

Conclusions:

A systematic and well-informed approach is needed to properly diagnose and manage disorders of salt and water balance in neurosurgical patients.