HYPONATREMIA AND SYNDROME OF INAPPROPRIATE ANTIDIURETIC-HORMONE SECRETION IN ADULT SPINAL SURGERY

Study Design. Patients undergoing spinal surgery were monitored for sodium balance, fluid type, and volume input and output during surgery and for the first 3 postoperative days. Objective. To prospectively document the true incidence of the syndrome of inappropriate antidiuretic hormone secretion and hyponatremia, and identify risk and protective factors for the development of the syndrome of inappropriate antidiuretic hormone secretion after spinal surgery. Methods. Data on medical history, surgical procedure, estimated blood loss, and volumes and types of intraoperative and postoperative fluids were collected on 116 consecutive spinal surgery patients during March to July 1992. Results. One hundred one spinal operations in 96 patients were evaluated. There were 48 males and 48 females, with a mean age of 52 years (range, 16 to 90 years). Hyponatremia developed in 45 (44.6%) patients. The etiology of hyponatremia was the syndrome of inappropriate antidiuretic hormone secretion in seven patients (6.9%), hypovolemia in 19 patients (18%), and other causes in six patients. Conclusions. Spine patients are at risk for hyponatremia and the syndrome of inappropriate antidiuretic hormone secretion. The incidence of the syndrome of inappropriate antidiuretic hormone secretion was 6.9%. Serum sodium should be monitored postoperatively. Patients who undergo a revision operation have an approximately two to four times greater risk of being affected by the syndrome of inappropriate antidiuretic hormone secretion than those who have primary surgery.