| Peer-Reviewed

Frequency and Types of Hyponatremia in Stroke Patients Admitted in a Referral Neuroscience Institute of Dhaka

Received: 8 May 2019     Accepted: 11 June 2019     Published: 20 June 2019
Views:       Downloads:
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.

Published in Clinical Neurology and Neuroscience (Volume 3, Issue 2)
DOI 10.11648/j.cnn.20190302.14
Page(s) 46-49
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Hyponatremia, Stroke, Dhaka

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.
Cite This Article
  • APA Style

    Maliha Hakim, Mashfiqul-Hasan, Mahmudul Islam, Mohammad Akter Hossain, Jobaida Naznin, et al. (2019). Frequency and Types of Hyponatremia in Stroke Patients Admitted in a Referral Neuroscience Institute of Dhaka. Clinical Neurology and Neuroscience, 3(2), 46-49. https://doi.org/10.11648/j.cnn.20190302.14

    Copy | Download

    ACS Style

    Maliha Hakim; Mashfiqul-Hasan; Mahmudul Islam; Mohammad Akter Hossain; Jobaida Naznin, et al. Frequency and Types of Hyponatremia in Stroke Patients Admitted in a Referral Neuroscience Institute of Dhaka. Clin. Neurol. Neurosci. 2019, 3(2), 46-49. doi: 10.11648/j.cnn.20190302.14

    Copy | Download

    AMA Style

    Maliha Hakim, Mashfiqul-Hasan, Mahmudul Islam, Mohammad Akter Hossain, Jobaida Naznin, et al. Frequency and Types of Hyponatremia in Stroke Patients Admitted in a Referral Neuroscience Institute of Dhaka. Clin Neurol Neurosci. 2019;3(2):46-49. doi: 10.11648/j.cnn.20190302.14

    Copy | Download

  • @article{10.11648/j.cnn.20190302.14,
      author = {Maliha Hakim and Mashfiqul-Hasan and Mahmudul Islam and Mohammad Akter Hossain and Jobaida Naznin and Saifur Rahman Khan},
      title = {Frequency and Types of Hyponatremia in Stroke Patients Admitted in a Referral Neuroscience Institute of Dhaka},
      journal = {Clinical Neurology and Neuroscience},
      volume = {3},
      number = {2},
      pages = {46-49},
      doi = {10.11648/j.cnn.20190302.14},
      url = {https://doi.org/10.11648/j.cnn.20190302.14},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cnn.20190302.14},
      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.},
     year = {2019}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Frequency and Types of Hyponatremia in Stroke Patients Admitted in a Referral Neuroscience Institute of Dhaka
    AU  - Maliha Hakim
    AU  - Mashfiqul-Hasan
    AU  - Mahmudul Islam
    AU  - Mohammad Akter Hossain
    AU  - Jobaida Naznin
    AU  - Saifur Rahman Khan
    Y1  - 2019/06/20
    PY  - 2019
    N1  - https://doi.org/10.11648/j.cnn.20190302.14
    DO  - 10.11648/j.cnn.20190302.14
    T2  - Clinical Neurology and Neuroscience
    JF  - Clinical Neurology and Neuroscience
    JO  - Clinical Neurology and Neuroscience
    SP  - 46
    EP  - 49
    PB  - Science Publishing Group
    SN  - 2578-8930
    UR  - https://doi.org/10.11648/j.cnn.20190302.14
    AB  - 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.
    VL  - 3
    IS  - 2
    ER  - 

    Copy | Download

Author Information
  • Department of Neurology, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh

  • Department of Neurology, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh

  • Department of Neurology, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh

  • Department of Neurology, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh

  • Department of Neurology, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh

  • Department of Neurology, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh

  • Sections