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Logo of aicSpringerOpen.comThis journalSubmit a manuscriptRegisterSpringerOpen.comAnnals of Intensive Care
 
Ann Intensive Care. 2012; 2: 13.
Published online May 30, 2012. doi:  10.1186/2110-5820-2-13
PMCID: PMC3488535
Urea for treatment of acute SIADH in patients with subarachnoid hemorrhage: a single-center experience
Charalampos Pierrakos,1 Fabio Silvio Taccone,corresponding author1,3 Guy Decaux,2 Jean-Louis Vincent,1 and Serge Brimioulle1
1Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
2Department of Internal Medicine, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
3Department of Intensive Care, Erasme University Hospital, Route de Lennik, 808, Brussels, B-1070, Belgium
corresponding authorCorresponding author.
Charalampos Pierrakos: charalampos_p/at/hotmail.com; Fabio Silvio Taccone: ftaccone/at/ulb.ac.be; Guy Decaux: gdecaux/at/ulb.ac.be; Jean-Louis Vincent: jlvincen/at/ulb.ac.be; Serge Brimioulle: sbrimi/at/ulb.ac.be
Received December 30, 2011; Accepted April 4, 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
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