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VOLUME 27 , ISSUE 4 ( April, 2023 ) > List of Articles

Original Article

Sonographic Optic Nerve Sheath Diameter as a Guide for Correction of Hyponatremia in the Emergency Department: A Cross-sectional Study

Sangeeta Sahoo, Satyabrata Guru, Nitish Topno, Nishit Kumar Sahoo

Keywords : Electrolyte imbalance, Emergency department, Hyponatremia, Optic nerve sheath diameter, Ultrasonography

Citation Information : Sahoo S, Guru S, Topno N, Sahoo NK. Sonographic Optic Nerve Sheath Diameter as a Guide for Correction of Hyponatremia in the Emergency Department: A Cross-sectional Study. Indian J Crit Care Med 2023; 27 (4):265-269.

DOI: 10.5005/jp-journals-10071-24438

License: CC BY-NC 4.0

Published Online: 31-03-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Background: Monitoring sodium levels during the correction of hyponatremia is essential. There is cell swelling due to the movement of water from extracellular to intracellular by osmotic effect in hyponatremia. The cellular swelling in a closed space causes increased intracranial pressure (ICP). The raised ICP correlates with the optic nerve sheath diameter (ONSD). So, the research question was whether the ONSD can be used as a guide for the correction of hyponatremia. Methods: It was a prospective observational study conducted on patients with serum sodium below 135 mEq/L presented to the emergency department (ED). The ONSD was measured at the time of presentation and discharge of the patient. The receiver operating characteristic curve (ROC) and area under the curve (AUC) were used to test the predictive ability of the ONSD to diagnose hyponatremia. Results: A total of 54 subjects were included in the study. The mean sodium level was 109.3 mEq/L at presentation. The mean ONSD on the right side was 6.24 ± 0.71 mm and on the left side was 6.26 ± 0.64 mm at presentation to ED. The mean ONSD on the right side was 5.81 ± 0.58 mm and on the left side was 5.79 ± 0.56 mm at discharge. The ONSD was not able to predict the sodium level measured both by laboratory and POC methods. Conclusion: The ONSD failed to predict the sodium level in patients with hyponatremia during the correction. The change in ONSD did not correlate with the change in sodium level.

  1. Olsson K, Öhlin B, Melander O. Epidemiology and characteristics of hyponatremia in the emergency department. Eur J Intern Med 2013;24(2):110–116. DOI: 10.1016/j.ejim.2012.10.014.
  2. Lampl C, Yazdi K. Central pontine myelinolysis. Eur Neurol 2002;47(1):3–10. DOI: 10.1159/000047939.
  3. Hoorn EJ, Zietse R. Diagnosis and Treatment of Hyponatremia: Compilation of the Guidelines. J Am Soc Nephrol 2017;28(5): 1340–1349. DOI: 10.1681/ASN.2016101139.
  4. Demir TA, Yılmaz F, Sönmez BM, Karadaş MA, Okudan RN, Keskin O. Association of optic nerve sheath diameter measurement with hyponatremia in emergency department. Am J Emerg Med 2019;37(10):1876–1879. DOI: 10.1016/j.ajem.2018.12.054.
  5. Killer HE, Jaggi GP, Flammer J, Miller NR, Huber AR, Mironov A. Cerebrospinal fluid dynamics between the intracranial and the subarachnoid space of the optic nerve. Is it always bidirectional? Brain 2007;130(Pt 2):514–520. DOI: 10.1093/brain/awl324.
  6. Kishk NA, Ebraheim AM, Ashour AS, Badr NM, Eshra MA. Optic nerve sonographic examination to predict raised intracranial pressure in idiopathic intracranial hypertension: The cut-off points. Neuroradiol J 2018;31(5):490–495. DOI: 10.1177/1971400918789385.
  7. Hansen HC, Helmke K. Validation of the optic nerve sheath response to changing cerebrospinal fluid pressure: Ultrasound findings during intrathecal infusion tests. J Neurosurg 1997;87(1):34–40. DOI: 10.3171/jns.1997.87.1.0034.
  8. Chen LM, Wang LJ, Hu Y, Jiang XH, Wang YZ, Xing YQ. Ultrasonic measurement of optic nerve sheath diameter: A non-invasive surrogate approach for dynamic, real-time evaluation of intracranial pressure. Br J Ophthalmol 2019;103(4):437–441. DOI: 10.1136/bjophthalmol-2018-312934.
  9. Toscano M, Spadetta G, Pulitano P, Rocco M, Piero VD, Mecarelli O, et al. Optic nerve sheath diameter ultrasound evaluation in intensive care unit: Possible role and clinical aspects in neurological critical patients’ daily monitoring. Biomed Res Int 2017;2017:1621428. DOI: 10.1155/2017/1621428.
  10. Du J, Deng Y, Li H, Qiao S, Yu M, Xu Q, et al. Ratio of optic nerve sheath diameter to eyeball transverse diameter by ultrasound can predict intracranial hypertension in traumatic brain injury patients: A prospective study. Neurocrit Care 2020;32(2):478–485. DOI: 10.1007/s12028-019-00762-z.
  11. Munawar K, Khan MT, Hussain SW, Hussain SW, Qadeer A, Shad ZS, et al. Optic nerve sheath diameter correlation with elevated intracranial pressure determined via ultrasound. Cureus 2019; 11(2):e4145. DOI: 10.7759/cureus.4145.
  12. Dubost C, Le Gouez A, Zetlaoui PJ, Benhamou D, Mercier FJ, Geeraerts T. Increase in optic nerve sheath diameter induced by epidural blood patch: A preliminary report. Br J Anaesth 2011;107(4):627–630. DOI: 10.1093/bja/aer186.
  13. Geeraerts T, Merceron S, Benhamou D, Vigué B, Duranteau J. Non-invasive assessment of intracranial pressure using ocular sonography in neurocritical care patients. Intensive Care Med 2008;34(11):2062–2067. DOI: 10.1007/s00134-008-1149-x.
  14. Amini A, Kariman H, Dolatabadi AA, Hatamabadi HR, Derakhshanfar H, Mansouri B, et al. Use of the sonographic diameter of optic nerve sheath to estimate intracranial pressure. Am J Emerg Med 2013;31(1):236–239. DOI: 10.1016/j.ajem.2012.06.025.
  15. Hylkema C. Optic nerve sheath diameter ultrasound and the diagnosis of increased intracranial pressure. Crit Care Nurs Clin North Am 2016;28(1):95–99. DOI: 10.1016/j.cnc.2015.10.005.
  16. Robba C, Santori G, Czosnyka M, Corradi F, Bragazzi N, Padayachy L, et al. Optic nerve sheath diameter measured sonographically as non-invasive estimator of intracranial pressure: A systematic review and meta-analysis. Intensive Care Med 2018;44(8):1284–1294. DOI: 10.1007/s00134-018-5305-7.
  17. Al-Hassani A, Strandvik G, Abayazeed S, Ahmed K, El-Menyar A, Mahmood I, et al. Relationship of optic nerve sheath diameter and intracranial hypertension in patients with traumatic brain injury. J Emerg Trauma Shock 2020;13(3):183–189. DOI: 10.4103/JETS.JETS_103_19.
  18. Ohle R, McIsaac SM, Woo MY, Perry JJ. Sonography of the optic nerve sheath diameter for detection of raised intracranial pressure compared to computed tomography: A systematic review and meta-analysis. J Ultrasound Med 2015;34(7):1285–1294. DOI: 10.7863/ultra.34.7.1285.
  19. Bäuerle J, Schuchardt F, Schroeder L, Egger K, Weigel M, Harloff A. Reproducibility and accuracy of optic nerve sheath diameter assessment using ultrasound compared to magnetic resonance imaging. BMC Neurol 2013;13:187. DOI: 10.1186/1471-2377-13-187.
  20. Zeiler FA, Ziesmann MT, Goeres P, Unger B, Park J, Karakitsos D, et al. A unique method for estimating the reliability learning curve of optic nerve sheath diameter ultrasound measurement. Crit Ultrasound J 2016;8(1):9. DOI: 10.1186/s13089-016-0044-x.
  21. Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O'Neal PV, Keane KA, et al. The Richmond Agitation Sedation Scale: Validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 2002;166(10):1338–1344. DOI: 10.1164/rccm.2107138.
  22. Reith FC, van den Brande R, Synnot A, Gruen R, Maas AI. The reliability of the Glasgow Coma Scale: A systematic review. Intensive Care Med 2016;42(1):3–15. DOI: 10.1007/s00134-015-4124-3.
  23. Padhi R, Panda B, Jagati S, Patra S. Hyponatremia in critically ill patients. Indian J Crit Care Med 2014;18(2):83–87. DOI: 10.4103/0972-5229.126077.
  24. Babaliche P, Madnani S, Kamat S. Clinical profile of patients admitted with hyponatremia in the medical intensive care unit. Indian J Crit Care Med 2017;21(12):819–824. DOI: 10.4103/ijccm.IJCCM_257_17.
  25. Kengne FG. Physiopathology, clinical diagnosis, and treatment of hyponatremia. Acta Clin Belg 2016;71(6):359–372. DOI: 10.1080/17843286.2016.1258508.
  26. Turkmen E, Karatas A, Altindal M. Factors affecting prognosis of the patients with severe hyponatremia. Nefrologia (Engl Ed) 2022;42(2):196–202. DOI: 10.1016/j.nefroe.2022.05.002.
  27. Sahoo S, Sahoo J, Singh N, Hansda U, Guru S, Topno N. Point-of-care versus central laboratory measurements of electrolytes and hemoglobin: A prospective observational study in critically ill patients in a tertiary care hospital. Int J Crit Illn Inj Sci 2022;12(3): 160–164. DOI: 10.4103/ijciis.ijciis_2_22.
  28. Geoghegan P, Harrison AM, Thongprayoon C, Kashyap R, Ahmed A, Dong Y, et al. Sodium correction practice and clinical outcomes in profound hyponatremia. Mayo Clin Proc 2015;90(10):1348–1355. DOI: 10.1016/j.mayocp.2015.07.014.
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