Treatment of subarachnoid haemorrhage complicated by hyponatraemia

Background statement:Developing hyponatraemia after a subarachnoid haemorrhage is common, however it is known to worsen patient outcomes. This paper aims to review the practice of managing hyponatraemia in acute subarachnoid haemorrhage patients with administration of 3% hypertonic saline solution.Aim:To enquire into the practice and policy of one of Melbourne's large Metropolitan hospital's current management of hyponatraemia in subarachnoid haemorrhage patients, and determine if the policy is both current and evidenced based.Methods:A search of the terms "subarachnoid haemorrhage", "hyponatraemia" and "hypertonic saline" was used in databases including Pubmed, Medline and CINAHL. Literature was included if it discussed the use of hypertonic saline for hyponatraemia, the effect of hyponatraemia on subarachnoid haemorrhage patients and the potential causes of acute hyponatraemia. The articles and literature reviews were assessed for inclusion by the author.Results:Patients with a subarachnoid haemorrhage and hyponatraemia should not be fluid restricted, as this is contraindicated. Patients should be administered 3% hypertonic saline to avoid hypovolaemia and slowly increase serum sodium to prevent onset or exacerbation of cerebral oedema.Limitation:Lack of evidence based data and studies in regard to the dosing of hypertonic saline resulted in the lack of consensus with prescribing rates and volumes to be infused for severe hyponatraemia