Prevalence and factors associated with dysnatremia among patients presenting with head injury to the Accident and Emergency Unit, Mulago Hospital

Abstract

Background: Abnormal serum sodium levels also known as dysnatremia can occur after head injury. This is due to the impairment of the normal homeostasis of the body with resultant alteration in the sodium regulation. The Accident and Emergency Unit at Mulago hospital receives an average of twenty patients per week with head injury. On arrival, proper preparation of these patients and baseline investigations such as electrolyte levels especially sodium are hardly done. If such a patient has undiagnosed dysnatremia, and is exposed to some of the anesthetic drugs or rapidly infused with intravenous fluids while undergoing emergency surgery in the casualty theatre, it may lead to various complications such as a further increase in intracranial pressure or seizures postoperatively. This gradually leads to poor outcomes when they are on the wards, due to lack of surveillance depending on overcrowding or a shortage of the medical personnel. The study looked at the prevalence and factors associated with dysnatremia among patients presenting with head injury at Mulago hospital’s Accident and Emergency unit, which is not known. Methodology: A descriptive cross sectional study was conducted in the Accident and Emergency Unit at Mulago National Referral and Teaching Hospital. A total of 227 patients presenting with head injury, during the study period, of nine months were recruited. Permission to waiver off consent for the unconscious or confused patients was sought and granted by Executive Director Mulago Hospital Complex and Makerere University research and ethics committee. The data obtained was then compiled, coded, cleaned in excel and analyzed using STATA and the Statistical Package for Social Scientists computer software. Results: Among the 227 head injury patients who were recruited in the study, the prevalence of dysnatremia was 26 (11.5%). Those presenting with hypernatremia were 16 (7.10%) while those with hypornatremia were 10(4.40%). The factors which were found to be associated with dysnatremia were the presence of seizure activity with a p-value of 0.001, odds ratio of 1.78 (C/I) and age with a p-value of 0.003.Hyponatremia was more prevalent in age groups less than 16 years and over 35 years and hypernatremia in the age group of 26 to 35 years of age. Conclusion: The study showed that more patients in the study group that presented at the Accident and Emergency Unit had hypernatremia. A high index of suspicion that the head injury patient could have dysnatremia on admission was the presence of seizure activity. Recommendations: Before patients are taken to the casualty theatre for anesthesia and surgery or transferred to the wards or Intensive Care Unit, they should have their baseline electrolytes done together with other necessary tests.