Frequency of Dysnatremia in the First 24 Hours and Its Relationship with Mortality in Patients with Severe Brain Trauma

Dysnatremia and Head Trauma

Authors

  • Behrang Rezvani Kakhki Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
  • Sara Ghafari Toran Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
  • Amir Masoud Hashemian Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
  • Reza Akhavan Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
  • Maryam Mohammadi Mehrgan Hospital, Kerman, Iran
  • Arman Hakemi Bahar Hospital, Shahroud University of Medical Sciences, Shahroud, Iran
  • Roohie Farzaneh Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
  • Mahdi Foroughian Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

DOI:

https://doi.org/10.31661/gmj.vi.3591

Keywords:

Dysnatremia; Mortality; Brain Trauma

Abstract

Background: Dysnatremia is known to make hospitalized traumatic brain injury (TBI) patients vulnerable to morbidity and mortality. This investigation aimed at observing frequency of dysnatremia in the first 24 hours and its relationship with mortality in patients with traumatic brain injuries. Materials and Methods: This prospective descriptive-analytical study was conducted at Hashminejad Hospital in Mashhad from April 2023 to March 2024. The study sample included patients with severe traumatic brain injuries. Information about each patient, including age, sex, Glasgow coma score, blood pressure, plasma sodium, creatinine, serum sugar, calcium, potassium, blood urea nitrogen, and blood pressure at the beginning of admission. Results: A total of 81 patients with traumatic brain injuries, with an average age of 40.33 ± 19.47 years were included in the study; 85% were male and 15% were female. 32 patients (40%) died and the rest were discharged. Out of a total of 81 patients included in the study, 36 (44.5%) suffered from dysnatremia. 16 patients (19.8%) had hyponatremia and 20 (24.7%) had hypernatremia. The statistical results did not show any significant relationship between the sodium status of patients and their outcome. statistical analysis showed that the patient’s sodium level during hospitalization is not a predictor of mortality. Diastolic blood pressure and blood sugar in deceased patients were substantially higher than alive patients. the only factor that could predict the death of patients was blood sugar, so that every incremental rise in glucose level increased the chance of death by 1.018 times. Conclusion: The present study showed that although dysnatremia has no significant relationship with the outcome of brain trauma patients, it needs attention due to its high incidence rate (44.5%) in these patients. In addition, blood sugar was introduced as a factor that could predict the death of patients.

References

Ngatuvai M, Martinez B, Sauder M, Beeton G, Andrade R, Maka P, et al. Traumatic Brain Injury, Electrolyte Levels, and Associated Outcomes: A Systematic Review. Journal of Surgical Research. 2023;289:106-15.

https://doi.org/10.1016/j.jss.2023.03.029

PMid:37087837

Kolmodin L, Sekhon MS, Henderson WR, Turgeon AF, Griesdale DE. Hypernatremia in patients with severe traumatic brain injury: a systematic review. Annals of intensive care. 2013;3:1-7.

https://doi.org/10.1186/2110-5820-3-35

PMid:24196399 PMCid:PMC3826846

Rodríguez-Triviño CY, Castro IT, Dueñas Z. Hypochloremia in Patients with Severe Traumatic Brain Injury:A Possible Risk Factor for Increased Mortality. World Neurosurgery. 2019;124:e783-e8.

https://doi.org/10.1016/j.wneu.2019.01.025

PMid:30682506

Shanavas C, Basheer N, Alapatt JP, Kuruvilla R. A prospective study on hyponatremia in traumatic brain injury. Indian Journal of Neurotrauma. 2016:094-100.

https://doi.org/10.1055/s-0036-1592186

Maggiore U, Picetti E, Antonucci E, Parenti E, Regolisti G, Mergoni M, et al. The relation between the incidence of hypernatremia and mortality in patients with severe traumatic brain injury. Critical Care. 2009;13:1-9.

https://doi.org/10.1186/cc7953

PMid:19583864 PMCid:PMC2750153

Kiaei BA, Farsani DM, Ghadimi K, Shahali M. Evaluation of the relationship between serum sodium concentration and mortality rate in ICU patients with traumatic brain injury. Archives of Neuroscience. 2018;5(3):e67845.

https://doi.org/10.5812/ans.67845

Wright WL. Sodium and fluid management in acute brain injury. Current neurology and neuroscience reports. 2012;12:466-73.

https://doi.org/10.1007/s11910-012-0284-5

PMid:22622407

Bhardwaj A. Neurological impact of vasopressin dysregulation and hyponatremia. Annals of Neurology: Official Journal of the American Neurological Association and the Child Neurology Society. 2006;59(2):229-36.

https://doi.org/10.1002/ana.20788

PMid:16437573

Amini S, Heydari Z. Sodium disturbances and its relation with mortality and morbidity in. head trauma patients admitted to the general ICU at Zahedan Khatam-Al-Anbia Hospital : from May 2003 to September 2004; 2007.

Sean K, Kolmodin L, Sekhon MS, Qiao L, Zou J, Henderson WR, et al. The effect of continuous hypertonic saline infusion and hypernatremia on mortality in patients with severe traumatic brain injury: a retrospective cohort study. Canadian Journal of Anesthesia. 2016;63(6):664.

https://doi.org/10.1007/s12630-016-0633-y

PMid:27030131

Li M, Hu YH, Chen G. Hypernatremia severity and the risk of death after traumatic brain injury. Injury. 2013;44(9):1213-8.

https://doi.org/10.1016/j.injury.2012.05.021

PMid:22709549

Rayatdost E, Esaie M, Rashidi M. Morbidity and Mortality Associated with Dysnatremia in Patients with Severe Traumatic Brain‎ Injury. Updates in Emergency Medicine. 2022;2(1):46-50.

Vedantam A, Robertson CS, Gopinath SP. Morbidity and mortality associated with hypernatremia in patients with severe traumatic brain injury. Neurosurgical focus. 2017;43(5):E2.

https://doi.org/10.3171/2017.7.FOCUS17418

PMid:29088954

Moro N, Katayama Y, Igarashi T, Mori T, Kawamata T, Kojima J. Hyponatremia in patients with traumatic brain injury: incidence, mechanism, and response to sodium supplementation or retention therapy with hydrocortisone. Surgical neurology. 2007;68(4):387-93.

https://doi.org/10.1016/j.surneu.2006.11.052

PMid:17905062

Carney N, Totten AM, Reilly C, Ullman JS, Hawryluk GW, Bell MJ, et al. Guidelines for the management of severe traumatic brain injury. Neurosurgery. 2017;80(1):6-15.

https://doi.org/10.1227/NEU.0000000000001432

PMid:27654000

Alam HB, Vercruysse G, Martin M, Brown CVR, Brasel K, Moore EE, et al. Western Trauma Association critical decisions in trauma: management of intracranial hypertension in patients with severe traumatic brain injuries. Journal of Trauma and Acute Care Surgery. 2020;88(2):345-51.

https://doi.org/10.1097/TA.0000000000002555

PMid:31999657

American College of Surgeons. Acs TQIP. Best practices in the management of Traumatic brain injury: 2015 American College of Surgeons; Available from: https://www.facs.org/media/mkej5u3b/tbi_guidelines.pdf. Accessed March 12, 2024.

Hampton OP. The Committee on Trauma of the American College of Surgeons 1922-1972. Bull Am Coll Surg. 1972;57:7-13.

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Published

2025-08-01

How to Cite

Rezvani Kakhki, B., Ghafari Toran, S., Hashemian, A. M., Akhavan, R., Mohammadi, M., Hakemi, A., … Foroughian, M. (2025). Frequency of Dysnatremia in the First 24 Hours and Its Relationship with Mortality in Patients with Severe Brain Trauma: Dysnatremia and Head Trauma. Galen Medical Journal, e3591. https://doi.org/10.31661/gmj.vi.3591

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Original Article