Administration of intravenous urea and normal saline for the treatment of hyponatremia in neurosurgical patients

R. F. Reeder, Robert Harbaugh

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Hyponatremia frequently complicates the care of neurosurgical patients and requires prompt effective therapy. These patients commonly fulfill the laboratory criteria of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) or cerebral salt wasting; the classification depends on the volume status of the patient. The authors have been dissatisfied with the standard therapy of fluid restriction for the critically ill neurosurgical patient because of 1) slow rates of sodium correction; 2) poor applicability in patients requiring multiple intravenous medications and/or nutritional support; and 3) possible dangers of inducing or enhancing cerebral ischemia in patients who already may be fluid-depleted. Reported successes in the treatment of hyponatremia due to SIADH by administration of urea and normal saline led to the authors' routine use of this therapy for hyponatremic neurosurgical patients. A retrospective review of an 18-month period revealed 48 patients (3% of all neurosurgical inpatients) with hyponatremia from various causes who received 62 treatments of urea and normal saline. Treatment consisted of 40 gm urea dissolved in 100 to 150 ml normal saline as an intravenous drip every 8 hours and an intravenous infusion of normal saline at 60 to 100 ml/hr for 1 to 2 days. The mean pretreatment serum sodium level (±standard deviation) was 130 ± 3 mmol/liter (range from 119 to 134 mmol/liter). There was a significant mean posttreatment elevation to 138 ± 4 mmol/liter (range 129 to 148 mmol/liter) (p<0.001, Student's t-test). Average daily fluid intake and output on treatment days were 2719 ± 912 and 2892 ± 1357 ml, respectively. There were no treatment complications in this group. It is concluded that urea and saline administration results in a rapid, safe, and effective correction of hyponatremia, making this method superior to fluid restriction in many neurosurgical patients.

Original languageEnglish (US)
Pages (from-to)201-206
Number of pages6
JournalJournal of neurosurgery
Volume70
Issue number2
DOIs
StatePublished - Jan 1 1989

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Hyponatremia
Intravenous Administration
Urea
Therapeutics
Intravenous Infusions
Sodium
Inappropriate ADH Syndrome
Nutritional Support
Fluid Therapy
Brain Ischemia
Vasopressins
Critical Illness
Inpatients
Patient Care
Salts
Students
Serum

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

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abstract = "Hyponatremia frequently complicates the care of neurosurgical patients and requires prompt effective therapy. These patients commonly fulfill the laboratory criteria of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) or cerebral salt wasting; the classification depends on the volume status of the patient. The authors have been dissatisfied with the standard therapy of fluid restriction for the critically ill neurosurgical patient because of 1) slow rates of sodium correction; 2) poor applicability in patients requiring multiple intravenous medications and/or nutritional support; and 3) possible dangers of inducing or enhancing cerebral ischemia in patients who already may be fluid-depleted. Reported successes in the treatment of hyponatremia due to SIADH by administration of urea and normal saline led to the authors' routine use of this therapy for hyponatremic neurosurgical patients. A retrospective review of an 18-month period revealed 48 patients (3{\%} of all neurosurgical inpatients) with hyponatremia from various causes who received 62 treatments of urea and normal saline. Treatment consisted of 40 gm urea dissolved in 100 to 150 ml normal saline as an intravenous drip every 8 hours and an intravenous infusion of normal saline at 60 to 100 ml/hr for 1 to 2 days. The mean pretreatment serum sodium level (±standard deviation) was 130 ± 3 mmol/liter (range from 119 to 134 mmol/liter). There was a significant mean posttreatment elevation to 138 ± 4 mmol/liter (range 129 to 148 mmol/liter) (p<0.001, Student's t-test). Average daily fluid intake and output on treatment days were 2719 ± 912 and 2892 ± 1357 ml, respectively. There were no treatment complications in this group. It is concluded that urea and saline administration results in a rapid, safe, and effective correction of hyponatremia, making this method superior to fluid restriction in many neurosurgical patients.",
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Administration of intravenous urea and normal saline for the treatment of hyponatremia in neurosurgical patients. / Reeder, R. F.; Harbaugh, Robert.

In: Journal of neurosurgery, Vol. 70, No. 2, 01.01.1989, p. 201-206.

Research output: Contribution to journalArticle

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