Urea Therapy for Hyponatremia in Subarachnoid Hemorrhage
Status:
Recruiting
Trial end date:
2023-01-01
Target enrollment:
Participant gender:
Summary
Hyponatremia is defined as a plasma sodium concentration below 135 mmol / L. This is a common
occurrence (20-50%) during subarachnoid hemorrhage (SAH). Its appearance is often associated
with vasospasm. It is associated with an increase in morbidity and mortality linked to
induced neurological disorders. Hyponatremia is caused by two etiologies: the syndrome of
inappropriate secretion of anti-diuretic hormone (SIADH), and the cerebral salt wasting
syndrome, CSWS. Theoretically, these two entities are differentiated by the patient's
volemia; in practice, this parameter is difficult to measure. In addition, the correction of
hyponatremia is diametrically opposed according to its mechanism: water restriction in the
case of SIADH, sodium intake in the event of CSWS. Urea is offered as a second-line treatment
in the event of treatment failure to correct hyponatremia. However, the efficacy of this
treatment is based on small, observational, retrospective studies. Moreover, the mechanism of
action of urea remains poorly understood: it could be a hyperosmolar effect or passive renal
reabsorption of sodium.