Clinical review: Disorders of water homeostasis in neurosurgical patients.

CONTEXT: Disorders of water balance are common in neurosurgical patients and usually manifest as hypo- or hypernatremia. They are most commonly seen after subarachnoid hemorrhage, traumatic brain injury, with intracranial tumors, and after pituitary surgery.

SETTING

We reviewed the experience of endocrine evaluation and management of disorders of salt and water balance in a large cohort of inpatients attending the national neurosciences referral centre in Dublin, Ireland, and compared this experience with findings from other studies.

PATIENTS: The study group included unselected neurosurgical patients admitted to our centre and requiring endocrine evaluation.

INTERVENTIONS: We conducted investigations to determine the underlying mechanistic basis for disorders of salt and water balance in neurosurgical patients and treatment to restore normal metabolism.

MAIN OUTCOME MEASURES: Morbidity and mortality associated with deranged salt and water balance were measured.

RESULTS

The underlying pathophysiology of disordered water balance in neurosurgical patients is complex and varied and dictates the optimal therapeutic approach.

CONCLUSIONS

A systematic and well-informed approach is needed to properly diagnose and manage disorders of salt and water balance in neurosurgical patients.