Résumé
Background: hyponatremia is a common electrolyte imbalance in case of traumatic brain injury (TBI), and mainly caused cerebral salt wasting syndrome (CSW) and syndrome of inappropriate antidiuretic hormone secretion (SIADH). Enteral urea therapy (EUT) is used for decades in mild chronic hyponatremia, however its use in TBI patients has been poorly evaluated. This retrospective cohort aimed to assess EUT for the treatment of hyponatremia in TBI patients.Methods: in this retrospective monocentric cohort study, all traumatic brain injury patients (head AIS ≥1) admitted to our trauma ICU from January 2014 to December 2018 were analyzed, and those who experienced hyponatremia were included. Patients were divided into 2 groups according to they received: enteral urea administration to treat hyponatremia (EUT group) and no EUT group. Course of natremia was specifically assessed, considering sodium and free water intakes.Results: a total of 58 TBI patients with hyponatremia were included in our analysis. Among these patients, 12 received an EUT for hyponatremia. The median natremia upon diagnosis in EUT group was 142±1 mEq/L while it was 138±1 mEq/L in no EUT group (p=0.0013). Median dose of urea administered in EUT group was 60 g/day. The normalization of natremia with Kaplan-Meier analysis was significantly faster in the EUT group (p<0.001). No difference was observed in sodium intakes (p=0.058) whereas no EUT group seems to have received more free water intakes (p=0.003).Conclusion: in this retrospective monocentric cohort focused on TBI patients with hyponatremia, an EUT strategy seems to be safe and was associated with faster normalization. However, our study was designed to study direct consequences and adverse effects of EUT.