Hyponatremia in SAH

Q: The first step of management in hyponatremia related to subarachnoid hemorrhage (SAH) is fluid restriction?

A) True

B) False

Answer: B

 Although it is true that syndrome of inappropriate antidiuretic hormone secretion (SIADH) is more coomon in SAH than cerebral salt wasting (CSW), fluid restriction in SAH increases the risk of cerebral vasospasm. On the contrary, these patients benefit from volume expansion. 

Hypertonic (usually 3 percent) saline is preffered.

#neurology

#electrolytes

Reference:

1. Woo CH, Rao VA, Sheridan W, Flint AC. Performance characteristics of a sliding-scale hypertonic saline infusion protocol for the treatment of acute neurologic hyponatremia. Neurocrit Care 2009; 11:228.