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61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

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The correlation of clinical grading with serum osmolarity and sodium levels in patients suffering from subarachnoid hemorrhage

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  • Kerim Beseoglu - Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf, Germany
  • Hans-Jakob Steiger - Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf, Germany
  • Daniel Hänggi - Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf, Germany

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP1875

doi: 10.3205/10dgnc346, urn:nbn:de:0183-10dgnc3464

Published: September 16, 2010

© 2010 Beseoglu et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Influence of aneurysmal subarachnoid hemorrhage (SAH) on water and electrolyte balance through disturbance of hypothalamic function has been described previously. Especially hyponatremia as syndrome of inadequate antidiuretic hormone secretion (SIADH) as well as diabetes insipidus are disorders that usually affect patients some days after the initial ictus. The purpose of the present study was to correlate the clinical grading according to WFNS and the GOS with serum osmolarity and sodium levels immediately after SAH.

Methods: 69 patients with aneurysmal SAH in 2009 were included retrospectively (mean age 54.85yrs, 17m:52f). The clinical grade was determined using the WFNS scale on admission. Serum osmolarity (SO) and sodium levels (SL) were controlled every eight hours beginning from admission until five days after SAH. Results were statistically analyzed and correlated using SPSS.

Results: Within 32 to 40 hours after SAH SO significantly rose for poor grade SAH patients (WFNS 5) compared to good grade SAH (WFNS grade 1) (32 hours: SO 297.2mosml/l vs. 287.8mosml/l, p=0.029). This effect was not contributable to mannitol or corticosteroid administration. After 4 days SO reached balance between all grades.. Difference between WFNS grade 2 to 4 was less pronounced and therefore showed no statistical significance. With a delay of one day SL significantly rose in poor grade SAH compared to good grades (56 hours: 145.1 vs. 141.1, p=0.001). Elevated SO after 72 and 96 hours correlated significantly with worse outcome measured by Glasgow outcome score (GOS) at time of discharge (p<0.01 both).

Conclusions: The current study demonstrates that there is a significant correlation of clinical grading at time of admission and discharge with osmolarity and sodium levels in patients suffering from aneurysmal SAH. As a consequence there should be attention in the treatment guideline for patients in severe clinical condition.