Treatment of Aneurysmal Subarachnoid Hemorrhage with Hyponatremia and Natriuresis

Hyponatremia and excess sodium excretion are recognised complications of the acute phase of aneurysmal subarachnoid hemorrhage (aSAH) and require a specific targeted approach distinct from routine SAH management.

Clinical Scenario

Aneurysmal subarachnoid hemorrhage presenting with natriuresis and hyponatremia — a sub-population in whom sodium balance is disrupted and warrants dedicated intervention.

Treatment Goals

Correction of hyponatremia with reduction in excess sodium excretion and urine volume during the acute aSAH period.

Approach Overview

The protocol involves a mineralocorticoid-based intervention directed at the underlying sodium-wasting process. Full agent selection, administration details, and monitoring parameters are available in the complete regimen below.

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References

DOI: 10.1161/str.0000000000000436

In patients with aSAH, use of mineralocorticoids is reasonable to treat natriuresis and hyponatremia.

Several moderately sized RCTs found fludrocortisone to be effective in reducing excess sodium excretion, urine volume, hyponatremia, and intravenous fluid use during acute aSAH, but fludrocortisone did not consistently reduce DCI or affect outcome.

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