ISSN 2415-3060 (print), ISSN 2522-4972 (online)
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УЖМБС 2019, 4(1): 118–128
Clinical Medicine

Clinical and Pathogenetic Values of Hyponatryemia in Patients with Subarachnoidal Hemorrhage of Atramatic Genesis

Polkovnikova K. Yu.

Subarachnoid hemorrhage is one of the most severe types of cerebral circulation disorders, characterized by pre-hospital mortality in primary hemorrhage due to aneurysm rupture of 10-15%. The purpose of the study was to evaluate the clinical and pathogenetic significance of the development of hyponatremia, as a manifestation of SIADH syndrome in patients, hospitalized with subarachnoid hemorrhage of aneurysmal and spontaneous etiology. Material and methods. 87 patients with subarachnoid hemorrhage were examined. Distribution by age is typical for this disease - the majority of patients was at the age from 30 to 60 years, with prevalence of patients aged 40-60 years, the elderly (over 60 years old) - 20.7%. The average age was 49, 97 years old. The men were 44 and women were 43. All patients were clinically and neurologically evaluated by the modified Fisher scale, the WFNS scale, the Hunt & Hess scale, the GOSE score scale (Glasgow Outcome Scale Extended), and the summary grading scale for assessing the outcomes of the SAH score (C.S. Ogilvy to B.S. Carter). Results and discussion. The greatest number of patients with severe hyponatremia – 14 people – correlates with pronounced degrees of severity according to the modified Fisher scale – 3-4 degrees. Statistically significant (p<0.05) hyponatremia was diagnosed in 7 patients with grade 3-5 severity of subarachnoid hemorrhage according to WFNS (3-13 points on the Glasgow scale and the presence/absence of motor and/or speech deficiency). These patients accounted for 41.18% of the total number of patients in these groups. At 3-4 degrees of severity according to the Hunt&Hess scale, statistically significant hyponatremia (p <0.05) was confirmed in 11 patients of this group (40.74% of the total). The level of sodium in patients with 3-4 severity grades on the GOSE (Glasgow Outcome Scale Extended) score was 131.36 ± 1.53 mmol/L and hyponatremia was found in 5 people of this group (45.45%). The lightest severity of subarachnoid hemorrhage in patients according to the GOSE results scale corresponds to the smallest number of patients with hyponatremia. Half of the patients with a severe clinical condition (54.55%) according to a generalizing classification scale for evaluating the prognosis of the subarachnoid hemorrhage result (C.S. Ogilvy et B.S. Carter) had hyponatremia. Conclusion. The clinical and pathogenetic significance of the development of hyponatremia, as a manifestation of the SIADH syndrome in patients hospitalized with subarachnoid hemorrhage of aneurysmal and spontaneous etiology, suggests a close, statistically significant relationship between a decrease in the level of this electrolyte and the severity of the clinical course of subarachnoid hemorrhage according to the modified Fisher scale, Нуnt & Нess scales, GOSE scale (Glasgow Outcome Scale Extended) and according to the generalizing classification scale for the estimation of the subarachnoid hemorrhage result forecast (C.S. Ogilvy et B.S. Carter). At subarachnoid hemorrhage in patients with hyponatremia, conjugation of the serum sodium level and serum copeptin is adequately and statistically significant approximated by the logarithmic regression (base 10), while with copper values greater than 0.70 ng/ml, in more than 50% of cases was observed the moderate hyponatremia.

Keywords: aneurysmal subarachnoid hemorrhage, SIADH syndrome, WFNS scale, hyponatremia, copeptin

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