Association Between Serum Sodium Abnormalities and Clinico-radiologic Parameters in Severe Traumatic Brain Injury

Philip Mwachaka1,2, Angela Amayo3, Nimrod Mwang’ombe1, Peter Kitunguu1
1Department of Surgery, Neurosurgery Unit, University of Nairobi, Nairobi, Kenya.
2Department of Human Anatomy, University of Nairobi, Kenya.
3Department of Pathology, University of Nairobi, Nairobi, Kenya.

Correspondence to: Dr. Philip Mwachaka; Email:

Received: 16 June 2020; Revised: 13 October 2020; Accepted: 9th January 2021; Available online: 3rd March 2021


Background: Secondary brain insults after traumatic brain injury such as electrolyte dysfunctions are associated with poor outcomes. This study aimed at determining the incidence of serum sodium ion abnormalities and their association with clinico-radiological parameters. Methods: A prospective cross-sectional study of one hundred and seventeen patients with severe head injury. Data collected included patient demographics, prehospital interventions, clinical examination findings, computed tomography (CT) scan head findings, serum sodium ion levels (at admission and 48 h later), and outcome (30 days). Results: At admission, 93(79.5%) patients had normal serum sodium ion levels. However, 48 h post-admission, hypernatremia was prevalent in 56(63.6%) patients (p < 0.001). Hypernatremia was significantly associated with the use of mannitol (p = 0.036), lower Glasgow Coma Score (p = 0.047), higher Injury Severity Score (p = 0.015), presence of subdural hematoma (p = 0.044), midline shift >5 mm (p = 0.048), compressed/absent basal cistern (p = 0.010), and higher Rotterdam CT Score (p = 0.003). Hypernatremia reported 48 h post-admission was associated with a high 30-day mortality rate [odds ratio (OR) 3.55, p = 0.0095]. Risk of mortality associated with hyponatremia and hypernatremia at admission was not statistically significant. Conclusion: While both hyponatremia and hypernatremia can occur in serious TBI patients, hypernatremia predominates 48 hours post-admission and is associated with statistically significant increased risk of death.

Keywords: Traumatic brain injury, hyponatremia, hypernatremia, outcomes, clinico-radiologic parameters


Conflicts of Interest: None

Funding: None

© 2021 Author. This work is licensed under the Creative Commons Attribution 4.0 International License.


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