Hyponatremia in the Patient With Subarachnoid Hemorrhage

Ellen Dooling; Chris Winkelman


J Neurosci Nurs. 2004;36(3) 

In This Article

Case Example

C.L. is a 37-year-old female admitted to the NCCU with a SAH resulting from the rupture of an anterior communicating artery aneurysm, grade 2. Upon admission she was loaded with phenytoin (Dilantin) and started on nimodipine (Nimotop) and aminocaproic acid (Amicar). Gastrointestinal ulcer and deep vein thrombosis prophylaxis was instituted. On day two of hospitalization, she underwent surgical clipping of the aneurysm without incident. Postoperatively she was treated with large amounts of fluid to maintain her blood pressure and promote therapeutic hypervolemia to prevent or minimize cerebral vasospasm.

Her examination on the seventh day postoperatively was as follows:

  • Morning Vital Signs: temperature 37.2°C, pulse 112 beats/minute, respirations 24 breaths/minute, blood pressure 115/56 mm Hg with a peripheral oxygen saturation of 99% on room air. Central venous pressure (CVP) measurement was 3 mm Hg. Weight was 56.3 kg (admission weight was 57.1 kg). Intake and output for previous 24 hours: 6,200 ml and 4,300 ml respectively.

  • Laboratory Values: glucose, 113 mg/dL; sodium, 128 mEq/L; potassium, 4.8 mEq/L; chloride, 100 mEq/L; BUN, 21mg/dL; creatinine, 1.0 mg/dL; uric acid, 3.0mg/dL; white blood cell count (CBC), 7.3; hematocrit, 48%.

  • Basic Physical Examination: Neurologically intact, heart rate rapid but regular, pulses weak, respirations even and unlabored, abdomen soft with positive bowel sounds, continent for clear yellow, urine, and skin intact, but dry.