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Pharmacotherapy of sodium disorders in neurocritical care

Mrozek, Ségolène; Rousset, David; Geeraerts, Thomas

Current Opinion in Critical Care: April 2019 - Volume 25 - Issue 2 - p 132–137
doi: 10.1097/MCC.0000000000000589
NEUROSCIENCE: Edited by Mauro Oddo

Purpose of review To describe the pathophysiology and pharmacotherapy of dysnatremia in neurocritical care patients.

Recent findings Sodium disorders may affect approximately half of the neurocritical care patients and are associated with worse neurological outcome and increased risk of death. Pharmacotherapy of sodium disorders in neurocritical care patients may be challenging and is guided by a careful investigation of water and sodium balance.

Summary In case of hyponatremia, because of excessive loss of sodium, fluid challenge with isotonic solution, associated with salt intake is the first-line therapy, completed with mineralocorticoids if needed. In case of hyponatremia because of SIADH, fluid restriction is the first-line therapy followed by urea if necessary. Hypernatremia should always be treated with hypotonic solutions according to the free water deficit, associated in case of DI with desmopressin. The correction speed should take into consideration the symptoms associated with dysnatremia and the rapidity of the onset.

Department of Anesthesiology and Critical Care, University Hospital of Toulouse, University Toulouse 3-Paul Sabatier, Toulouse, France

Correspondence to Thomas Geeraerts, Coordination d’anesthésie, Hôpital Pierre Paul Riquet, CHU Toulouse Purpan, 31059 Toulouse Cedex 9, France. E-mail:

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