Management of Sodium Abnormalities in the Neurosurgical Intensive Care Unit

Patients with neurological injury commonly acquire changes in their sodium levels, both as a consequence of their disease process and iatrogenically. Hyper- or hyponatremia in the neurosurgical intensive care unit can easily be broken down to neurological causes, medical causes, and iatrogenic causes. Promptly diagnosing conditions in which sodium levels rapidly change are especially important in this patient population because of the effect on cerebral volume. When sodium levels change quickly, large shifts in water occur over the cellular membrane, which can lead to neuronal and cell swelling or shrinkage. Inappropriate or delayed diagnosis and treatment may lead to severe morbidity or even death. The rate of correction of these derangements depends on how rapidly the onset occurred. In this review, we will discuss hypernatremia and hyponatremia and their retrospective etiologies, diagnoses, treatments, and complications.