Prevalence and Impact of Hyponatremia on Hospital Stay in Subarachnoid Hemorrhage Patients


  • Zeeshan Ullah
  • Ihtisham Ullah
  • Imad Majeed
  • Muhammad Fawad Khan
  • Saad Ali Department of Neurology, Lady Reading Hospital, Peshawar
  • Hina Nawaz
  • Asim Ali Shah



Introduction:  This research study was designed to ascertain the prevalence of hyponatremia and its impact on the duration of hospital stay in patients with subarachnoid hemorrhage (SAH) in our local population.

Materials & Methods:   We carried out this study at the Department of Neurology, Lady Reading Hospital Peshawar for 1 year, which started in March 2022. The total sample size was 90 and a consecutive sampling method was used for sampling the study population. Patients aged between 20 to 70 years and who had a diagnosis of SAH were involved in included in the study, while those with confounding conditions were put in the exclusion criteria.

Results:  Our study showed a high prevalence of hyponatremia (42%) in patients with SAH, and it was associated with a prolonged duration of hospital stays of 8.2 days (SD±3.5). There was a statistical difference in the mean hospital stay between the patients with hyponatremia and those without hyponatremia (t=3.2, p<0.002).

Conclusion:  Our study reported a high prevalence of hyponatremia in SAH patients and has established an association with longer hospital stays. Thus, identifying and managing patients of hyponatremia with SAH promptly should be emphasized for better results and to lessen the financial burden on families and the hospital.


Ziu E, Khan Suheb MZ, Mesfin FB. Subarachnoid Hemorrhage. In: StatPearls. Treasure Island (FL): StatPearls Publishing; June 1, 2023.

Dority JS, Oldham JS. Subarachnoid hemorrhage: an update. Anesthesiol Clin. 2016;34(3):577-600.

Müller TB, Vik A, Romundstad PR, Sandvei MS. Risk factors for unruptured intracranial aneurysms and subarachnoid hemorrhage in a prospective population-based study. Stroke. 2019;50(10):2952-5.

Ridwan S, Zur B, Kurscheid J, Esche J, Kristof R, Klingmüller D, et al. Hyponatremia After Spontaneous Aneurysmal Subarachnoid Hemorrhage—A Prospective Observational Study. World Neurosurg. 2019;129:e538-e44.

Hoffman H, Ziechmann R, Gould G, Chin LS. The impact of aneurysm location on incidence and etiology of hyponatremia following subarachnoid hemorrhage. World Neurosurg. 2018;110:e621-e6.

Kieninger M, Kerscher C, Bründl E, Bele S, Proescholdt M, Zeman F, et al. Acute hyponatremia after aneurysmal subarachnoid hemorrhage: Frequency, treatment, and outcome. J Clin Neurosci. 2021;88:237-42.

Alabbas F, Hadhiah K, Al-Jehani H, Al-Qahtani SY. Hyponatremia as predictor of symptomatic vasospasm in aneurysmal subarachnoid hemorrhage. Interdisciplinary Neurosurgery. 2020;22:100843.

Mapa B, Taylor BE, Appelboom G, Bruce EM, Claassen J, Connolly ES. Impact of hyponatremia on morbidity, mortality, and complications after aneurysmal subarachnoid hemorrhage: a systematic review. World Neurosurg. 2016;85:305-14.

Escamilla-Ocañas CE, Rao CPV, Bershad E, Damani R. Temporal Relationship between Hyponatremia and Development of Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage Patients: A Retrospective Observational Study. J Stroke Cerebrovasc Dis. 2020;29(6):104789.

Saramma P, Menon RG, Srivastava A, Sarma PS. Hyponatremia after aneurysmal subarachnoid hemorrhage: Implications and outcomes. J Neurosci Rural Pract. 2013;4(1):24-28.

Sherlock M, O’Sullivan E, Agha A, Behan LA, Rawluk D, Brennan P, et al. The incidence and pathophysiology of hyponatraemia after subarachnoid hemorrhage. Clin Endocrinol. 2006;64:250–4.

Qureshi AI, Suri MF, Sung GY, Straw RN, Yahia AM, Saad M, et al. Prognostic significance of hypernatremia and hyponatremia among patients with aneurysmal subarachnoid hemorrhage. Neurosurg. 2002;50:749–55.

Chandy D, Sy R, Aronow WS, Lee WN, Maguire G, Murali R. Hyponatremia and cerebrovascular spasm in aneurysmal subarachnoid hemorrhage. Neurol India. 2006;54:273–5.

Kao L, Al-Lawati Z, Vavao J, Steinberg GK, Katznelson L. Prevalence and clinical demographics of cerebral salt wasting in patients with aneurysmal subarachnoid hemorrhage. Pituitary. 2009;12:347–51.

Benvenga S. What is the pathogenesis of hyponatremia after subarachnoid hemorrhage? Nat Clin Pract Endocrinol Metab. 2006;2:608–9.

See AP, Wu KC, Lai PM, Gross BA, Du R. Risk factors for hyponatremia in aneurysmal subarachnoid hemorrhage. J Clin Neurosci. 2016 Oct;32:115-8.

Marupudi NI, Mittal S. Diagnosis and Management of Hyponatremia in Patients with Aneurysmal Subarachnoid Hemorrhage. J Clin Med. 2015;4(4):756-67.






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