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Impact of hypernatremia on patients with severe traumatic brain injury


Hypernatremia is frequently encountered in the neurocritical ICU and its effect can badly affect mortality. The objective of this study was to verify whether the occurrence of hypernatremia during the ICU stay increases the risk of death in patients with severe traumatic brain injury (TBI).


Randomized prospective study of 100 patients with TBI in neurocritical care units at Cairo University Hospital. Hypernatremia is defined as serum sodium above 145 mmol/l. The major outcome was death in the ICU. Logistic regression models were used to assess independent factors that could affect patients' mortality including hypernatremia, age, desmopressin and Glasgow Coma Score.


We included in the study 100 TBI patients (mean age 35.8 ± 21.3 years); males 86%. Extradural hematoma (EDH) was documented in 27 patients (27%), subarachnoid (SAH) in 20 patients (20%), intracerebral (ICH) in 19 patients (19%), cerebral contusion in 17 patients (17%), brain oedema in 15 patients (15%), and subdural hematoma in two patients (2%). Glasgow Coma Scores (range 3 to 10); 60 patients were mechanically ventilated; 10% were diabetic and 22% were hypertensive. Hypernatremia was documented in 40 patients (40%) of the total TBI patients. The total inhospital mortality was 36/100 (36%), 10 of them had normal sodium levels all through their in-hospital course and 26 patients were hypernatremic. After adjustment for the baseline risk, the incidence of hypernatremia over the course of the ICU stay was significantly related to increased mortality (hazard ratio 3.2 (P = 0.0001)). However, there was positive correlation between serum sodium levels and duration of the ICU stay (Spearman correlation coefficient 0.5 and P = 0.002).


Hypernatremia in patients with severe TBI is associated with an increased risk of death, and a longer ICU stay. This association is independent of other outcome predictors including age and Glasgow Coma Score. Strategies to prevent hypernatremia in neurocritical ICUs should be encouraged.


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Correspondence to M Shehata.

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Shehata, M., Ragab, D., Khaled, M. et al. Impact of hypernatremia on patients with severe traumatic brain injury. Crit Care 14, P355 (2010).

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  • Traumatic Brain Injury
  • Serum Sodium
  • Sodium Level
  • Subdural Hematoma
  • Desmopressin