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Open Access Research

Urea for treatment of acute SIADH in patients with subarachnoid hemorrhage: a single-center experience

Charalampos Pierrakos1, Fabio Silvio Taccone13*, Guy Decaux2, Jean-Louis Vincent1 and Serge Brimioulle1

Author Affiliations

1 Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium

2 Department of Internal Medicine, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium

3 Department of Intensive Care, Erasme University Hospital, Route de Lennik, 808, Brussels, B-1070, Belgium

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Annals of Intensive Care 2012, 2:13  doi:10.1186/2110-5820-2-13

Published: 30 May 2012

Abstract

Background

Hyponatremia occurring as a result of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) or cerebral salt wasting syndrome is a common complication in patients with subarachnoid hemorrhage (SAH). The efficacy and safety of urea as treatment for SIADH-induced hyponatremia has not been reported in this population.

Methods

This is a retrospective analysis of all patients admitted to our department for nontraumatic SAH between January 2003 and December 2008 (n = 368). All patients with SIADH-induced hyponatremia (plasma sodium < 135 mEq/L, urine sodium > 20 mEq/L, and osmolality > 200 mOsm/kg; absence of overt dehydration or hypovolemia; no peripheral edema or renal failure; no history of adrenal or thyroid disease) routinely received urea per os when hyponatremia was associated with clinical deterioration or remained less than 130 mEq/L despite saline solution administration.

Results

Forty-two patients developed SIADH and were treated with urea. Urea was started after a median of 7 (IQR, 5–10) days and given orally at doses of 15–30 g tid or qid for a median of 5 (IQR, 3–7) days. The median plasma sodium increase over the first day of treatment was 3 (IQR, 1–6) mEq/L. Hyponatremia was corrected in all patients, with median times to Na+ >130 and >135 mEq/L of 1 (IQR, 1–2) and 3 (IQR, 2–4) days, respectively. Urea was well tolerated, and no adverse effects were reported.

Conclusions

Oral urea is an effective and well-tolerated treatment for SIADH-induced hyponatremia in SAH patients.

Keywords:
Hyponatremia; SIADH; Sodium; Subarachnoid hemorrhage; Urea