How to improve low sodium levels after a brain aneurysm repair surgery?

Question

Hello doctor,

My father underwent a brain aneurysm repair one and a half years ago, after which, he is having a constant loss of sodium. He is taking one Tolsama 15 mg tablet every alternate day to stabilize his sodium levels. He is also currently taking Encorate Chrono 500, Absolut 3G, Nexfolin and Tamlocept D. I enquired with the neurosurgeon about this, as it is unusual for the sodium loss to continue for such an extended period post-surgery. I was told to contact an endocrinologist for my concerns. What do you suggest to reduce this prolonged sodium loss?

Answer 1

Hello,

Welcome to icliniq.com.

I read your query about your father and it appears that he has SIADH (syndrome of inappropriate antidiuretic hormone secretion). It commonly occurs after a brain surgery, due to excessive fluids and use of diuretics. The sodium levels usually return to normal soon, but in some elderly patients, it does not stabilize as they are less likely to suppress AVP (arginine vasopressin), the hormone causing diuresis. I suggest he continue with Tolsama 15 mg (Tolvaptan) as it is given for the treatment of resistant hyponatremia. As for the other endocrine related factors, he can have these tests done:

Plasma and serum osmolalities and biochemistry.
Thyroid function tests.
Synacthen test.
Chest x-ray.

I would like to add that these tests will only confirm his diagnosis and the treatment plan is likely to be the same. Hope this helps.