Hyponatremia in the Patient With Subarachnoid Hemorrhage

Ellen Dooling; Chris Winkelman


J Neurosci Nurs. 2004;36(3) 

In This Article

Abstract and Introduction


Hyponatremia commonly occurs in patients with aneurysmal subarachnoid hemorrhage. Two mechanisms have been proposed as causes: syndrome of inappropriate anti-diuretic hormone and cerebral salt wasting. Physical examination and laboratory results can assist a clinician in identifying which mechanism is responsible and thus determine proper treatment. When hyponatremia is treated promptly and appropriately, patients' sodium levels return to normal without detrimental effects.


Hyponatremia is seen in 10%-40% of the patients with subarachnoid hemorrhage (SAH) admitted to the neuro critical care unit (NCCU; Mayberg et al., 1994; Woo & Kale-Pradhan, 1997). Controversy exists regarding both cause and treatment. Nonetheless, it is imperative that nurses, whether in an advanced practice role or at the bedside, understand the potential causes and effective treatment. Missing diagnostic clues or providing inappropriate treatment could be detrimental to the patient. This article reviews the probable causes of, suggested treatment for, and the role of the nurse in managing hyponatremia in the patient with SAH.