The pattern of serum sodium and osmolality in patients with severe head injury admitted in the intensive care unit at the Kenyatta National Hospital

Abstract

A prospective study on the pattern of serum sodium and osmolality in patients with severe head injury admitted to the Kenyatta National Hospital, ICU was carried out between January 2007- April 2007. During this period, a total of 428 patients were admitted to the intensive care unit. Of these, 132 patients (30.84%) met the inclusion criteria and were recruited in the study. The patients' ages ranged from 6 years t070 years with the median age being 31 years. 88.6% of the participants were males while only 11.4% were females, with children comprising 11.9%. The commonest mechanism of injury was road traffic accidents which accounted for 82.20/0 of the cases in the study. Majority of the patients lost consciousness on impact (76%) while the remainder were either conscious (0.1 %) or their level of consciousness was unknown (23.9) upon impact. On presentation in casualty these patients had Glascow coma scales ranging from 3 to nine. Majority of the patients had glascow coma scales between 4- 6 (86%». Majority of the patients (96.3) had no lateralizing signs while 3.7% had lateralizing signs. Only 25% of the patients had surgery while the rest had conservative management. 120 (90.9%) study subjects died while still in the ICU and only 12(9.10/0) were discharged from the unit. The duration of stay for the patients in ICU ranged from I day to 79 days. The serum sodium and serum osmolality of the patients in the study ranged from I II to 180 mmol/kg and 213-372.5 mosmol/kg liter respectively. The mean and median sodium levels were 139.8 mmol/kg and 139.0mmoVkg respectively, while the mean and median serum osmolality was 290.3 mosmol/kg and 290.9 mosmol/kg respectively.