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Management of hyponatraemia in patients with acute cerebral insults


Hyponatraemia is a common finding in patients with acute cerebral insults. The main differential diagnosis is between syndrome of inappropriate ADH secretion and cerebral salt wasting. Our aim is to review the topic of hyponatraemia in patients with acute cerebral insults and suggest a clinical approach to diagnosis and management.

Key messages

Key messages

  • Careful adjustment of dose of desmopressin, cortisol, and some anticonvulsants, as all three interact

  • Provided that fluid replacement is maintained. DI is not life threatening

  • Excessive administration of desmopressin can result in hyponatraemia with fatal fluid overload and may require dialysis

  • The only biochemical difference between CSW and SIADH is the extracellular volume, decreased in the former and increased in the latter

  • In euvolaemic and hyponatraemic patients with cerebral insults: give sodium supplement and maintenance fluid intake first. If no improvement or deterioration, assess volume state with central venous pressure monitoring

  • Limit the rate of correction of plasma sodium to less than 12 mmol/l/day

  • hyponatraemia
  • cerebral salt wasting
  • diabetes insipidus

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