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Effect of Early Correction of Hyponatremia on Neurological Outcome in Traumatic Brain Injury Patients

Khalil Ahmad, Zeyad Faoor Alrais, Hesham Mohamed Elkholy, Adel Elsaid Elkhouly, Maged Mohsen Beniamein, Ammar Abdel Hadi, Sohail Majeed and Ahmad Shoaib

Background: Hyponatremia is common in neurocritical care. If it is timely corrected, it can prevent deadly complication like brain edema and may improve overall prognosis in these patients.

Methods: Retrospective analysis of 150 patients of traumatic brain injuries who developed hyponatremia during stay in intensive care unit (ICU) was performed. Neurological outcome was defined on the basis of Glasgow Coma Scale (GCS), comparing GCS on admission and GCS at the time of discharge from ICU. Good neurological outcome was defined, if GCS improved significantly as compared to admission and poor neurological outcome if GCS remained same or deteriorated than admission or patient died during ICU stay. On the basis of correction of serum sodium within 48 h of onset of hyponatremia, two groups (correction achieved or not) were compared to the neurological outcome groups, as defined earlier. Chi Square test and Multiple Logistic Regression Model were used to assess association between correction of hyponatremia within 48 h & neurological outcome. Data was analyzed by SPSS Version 21 and Stata Statistical Package 13. P value<0.05 was considered significant.

Results: Majority of patients were male, 88% versus 12% of females. Mean age remained 32.7 years. In 108 patients correction of hyponatremia was achieved within 48 h and in 42 cases it took longer time to correct. Good neurological outcome was seen in 83% cases and poor outcome in 17%. Statistically significant association was seen between serum sodium correction within 48 h of onset and neurological outcome (Chi Square, P<0.0001), (Logistic Regression analysis, P<0.001 in univariate & 0.007 in multivariate analysis).

Conclusion: There is significant association between early correction of hyponatremia and neurological outcome in traumatic brain injury patients.