The Correlation of Hyponatremia with Neurological Features in Adult Patients Admitted in an ICU Setting in a Tertiary Care Centre

Abstract

Background: Hyponatremia is the most prevalent electrolyte abnormality worldwide, presenting at even higher rates in the ICU setting. It is one of the leading causes of metabolic encephalopathy and can present with a myriad of neurological features. It is defined by a serum sodium level <135 mEq/L. The present study is designed to evaluate the neurological symptoms in a patient with hyponatremia and to correlate them with the degree of hyponatremia. Aims and Objectives: 1) To study the neurological manifestations in ICU patients found to have hyponatremia 2) To study the correlation between neurological manifestations and serum sodium level. Materials and Methods: This is Prospective Observational study of 2 years duration in which 90 patients were studied with the following criteria: Age ≥18 years, either sex admitted in the ICU having sodium Level of < 135 mMol/L on admission. A thorough neurological examination including Mini Mental Status Examination (MMSE) and Glasgow Coma Scale (GCS) was done at presentation. The data was then analyzed. Results: There was a male predominance (64.44%) amongst the study population. Most patients belonged to the age group of 51-60 years (73.3%) followed by > 60 years (31.1%). Disorientation (41.11%) was the most common neurological features followed by drowsiness (31.11%).Maximum number (48.7%) of patients having mild hyponatremia were asymptomatic. At presentation, most had a normal Mini Mental Status Examination (MMSE) score (28.89%) followed by moderate cognitive impairment (27.78%), GCS scores ≥13 was seen in 56.67% population followed by GCS 9-12 (41.11 %). 2 (2.2%) patients succumbed in the study population. Conclusion: Hyponatremia is a common electrolyte abnormality causing significant morbidity and mortality, especially in the older age group. It is one of the leading causes of metabolic encephalopathy. As it can be asymptomatic in the initial stages, and is treatable, it should evaluated in all patients with subtle as well as overt neurological signs to prevent further neurological deterioration. MMSE scoring is a useful tool for neurological assessment in hyponatremia.