Mejia Herrera F, Marino L, Bilotta F. Hydroelectrolytic syndromes in neuroanesthesia and neurocritical care. World J Crit Care Med 2025; 14(4): 108744 [DOI: 10.5492/wjccm.v14.i4.108744]
Corresponding Author of This Article
Federico Bilotta, MD, PhD, Professor, Department of Anesthesiology, Critical Care and Pain Medicine, University of Rome “La Sapienza”, Piazzale Aldo Moro 5, Rome 00185, Italy. federico.bilotta@uniroma1.it
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Anesthesiology
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Minireviews
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 9, 2025 (publication date) through Dec 9, 2025
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World Journal of Critical Care Medicine
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2220-3141
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Mejia Herrera F, Marino L, Bilotta F. Hydroelectrolytic syndromes in neuroanesthesia and neurocritical care. World J Crit Care Med 2025; 14(4): 108744 [DOI: 10.5492/wjccm.v14.i4.108744]
World J Crit Care Med. Dec 9, 2025; 14(4): 108744 Published online Dec 9, 2025. doi: 10.5492/wjccm.v14.i4.108744
Hydroelectrolytic syndromes in neuroanesthesia and neurocritical care
Felipe Mejia Herrera, Luca Marino, Federico Bilotta
Felipe Mejia Herrera, Facultad de Ciencias de la Salud, Universidad Icesi, Cali 760000, Valle del Cauca, Colombia
Luca Marino, Department of Mechanical and Aerospace Engineering, “Sapienza” University of Rome, Roma 00185, Italy
Federico Bilotta, Department of Anesthesiology, Critical Care and Pain Medicine, University of Rome “La Sapienza”, Rome 00185, Italy
Author contributions: Mejia Herrera F and Bilotta F wrote the paper; Marino L validated the manuscript; Bilotta F designed the outline and supervised the paper; All authors thoroughly reviewed and endorsed the final manuscript.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Federico Bilotta, MD, PhD, Professor, Department of Anesthesiology, Critical Care and Pain Medicine, University of Rome “La Sapienza”, Piazzale Aldo Moro 5, Rome 00185, Italy. federico.bilotta@uniroma1.it
Received: April 22, 2025 Revised: May 26, 2025 Accepted: September 1, 2025 Published online: December 9, 2025 Processing time: 220 Days and 20.9 Hours
Abstract
Electrolyte disorders are pivotal determinants of morbidity and mortality in neurocritical care and exacerbated by acute brain injury, neuroendocrine dysfunction, and therapeutic interventions. This narrative review synthesized contemporary evidence on the pathophysiology, diagnosis, and management of hydroelectrolytic disturbances in neuroanesthesia and neurocritical populations. Dysnatremias (hyponatremia and hypernatremia) are prevalent with emerging data challenging historical correction paradigms: Rapid sodium normalization may reduce mortality without increasing complications. Distinct strategies are required for syndromes of inappropriate antidiuretic hormone secretion (fluid restriction, vaptans) vs cerebral salt wasting (volume resuscitation). Chloride dysregulation, driven by cation-chloride cotransporter imbalances, exacerbates cytotoxic edema and seizures, warranting trials of bumetanide and balanced crystalloids. Hypokalemia, prevalent in traumatic brain injury, demands proactive surveillance to prevent arrhythmias while hyperkalemia management prioritizes membrane stabilization and renal clearance. Hypocalcemia correlates with adverse outcomes in subarachnoid hemorrhage, necessitating timely replacement. Magnesium disorders lack consistent prognostic associations in neurocritical cohorts, contrasting with general critical care. Current evidence underscores the need for individualized, pathophysiology-driven correction, integrating endocrine and neurological principles. Innovations such as point-of-care testing and targeted therapies (e.g., acetate-buffered hypertonic saline) show promise, yet reliance on observational data and preclinical models highlights the urgency for randomized controlled trials. This review advocated for protocolized monitoring, dynamic assessments, and research to define optimal correction thresholds and validate emerging interventions in this high-risk population.
Core Tip: The aim of the present review was to report the latest evidence on the pathophysiology, diagnosis, approach, and targeted management of electrolyte disorders in neuroanesthesia and neurocritical care. Endocrine, neurological, and resuscitation issues will be treated to provide clinical strategies to mitigate secondary neuronal injury and improve outcomes in these critical patients.
