Neurocritical Care
Serum Sodium
<120 mEq/L
Serum Sodium
120–130 mEq/L
Serum Sodium
130–135 mEq/L
| • | Headache |
|---|---|
| • | Restlessness |
| • | Lethargy |
| • | Seizures |
| • | Brain stem herniation |
| • | Respiratory arrest |
| • | Death |
| • | Malaise |
| • | Unsteadiness |
| • | Headache |
| • | Nausea |
| • | Vomiting |
| • | Fatigue |
| • | Confusion |
| • | Anorexia |
| • | Muscle cramps |
| • | Asymptomatic |
| • | Headache |
| • | Nausea |
| • | Vomiting |
| • | Fatigue |
| • | Confusion |
| • | Anorexia |
| • | Muscle cramps |
| • | Depressed reflexes |
SIADH: Increased secretion of ADH (or vasopressin) results in increased water retention at the renal distal
tubules.
Neurologic & Pulmonary Disorders
TBI
Brain tumor
Stroke
Brain infection
Subarachnoid hemorrhage
Intracerebral hemorage
Pneumonia/tuberculosis
Lung cancer
Medications
Desmopressin/vasopressin
Selective serotonin reuptake inhibitors
Tricyclic antidepressants
Carbamazepine
Oxcarbazepine
Chlorpropamide
Cyclophosphamide/iphosphamide
Methylenedioxymethamphetamine
Nicotine
Opioids
Phenothiazine antipsychotic medications
Nonsteroidal anti-inflammatory drugs
MDMA (ecstasy)
MDMA = 3,4-methylenedioxymethamphetamine; TBI = traumatic brain injury.
2014;40:320-31).
Fluid
Restriction
PO Sodium
IV Sodium
Demeclocycline
Vasopressin
(V)-Antagonists
Mechanism
of action
Restriction
of free water
results in
increased impact
of insensible
losses,
permitting
sodium
concentration to
rise
Sodium
supplementa-
tion
Sodium
supplementation
Inhibition of
ADH activity,
possibly because
of inhibition of
aquaporin water
channels
Inhibition of renal
V2 vasopressin
receptors
(conivaptan V1A
+ V2 receptors;
tolvaptan V2
only)