Doctors miss dangerous low sodium level after treating patient from brain bleed
Patients with a brain hematoma or swelling have an increased risk for developing hyponatremia
I recently met with the family of patient in her 40s who was in a neurorehabilitation facility, where she was receiving therapy to help her regain memory and cognitive function.
This woman’s problems began when her family noticed that she was acting a little unusual and seemed disoriented. They thought it could be a cold and would pass, but a few days later a family member found her on the floor and unresponsive and called 911.
The ambulance took her to a suburban Houston hospital, where she was diagnosed with a brain bleed. She was admitted to the hospital and had a procedure in which they placed a stent that relieved pressure and addressed the problem. She was in the hospital for a week and a half. After the stent procedure, she appeared to be recovering and the stent was removed. Then, the family explained, she started acting very strange and took a turn for the worse.
That got my attention.
Hyponatremia in head trauma or brain hematoma cases
As a Houston, Texas medical malpractice lawyer, I have represented a number of patients who sustained serious injuries under similar circumstances. Through the process of investigating and prosecuting these cases, I retained a medical expert in a condition called hyponatremia, which means a low serum (blood) sodium level.
This internal medicine expert explained that in any case involving a “space occupying lesion,” which includes a brain bleed or hematoma, swelling caused by trauma or a brain surgery, and tumors, there is an increased risk of developing hyponatremia. This happens through a complicated cascade of events leading to a low serum sodium level, which causes brain swelling. Considering that the head, and, in particular, cranial cavity, has a limited amount of space to accommodate brain swelling, hyponatremia can be a very dangerous condition.
One of the earliest signs of hyponatremia, in a patient with a brain bleed, hematoma, or other space occupying lesion, is what family members typically described as the patient is “acting weird.” Healthcare providers refer to it as altered mental status. When hyponatremia is involved, it is caused by brain swelling altering the normal function of the brain.
The treatment for hyponatremia is inexpensive. All that is required is hypertonic saline. The challenge, though, is to recognize this disorder quickly and to treat it slowly. Over correcting the sodium level leads to problems and so does under correcting sodium levels. The standard of care requires physicians to start a patient on hypertonic saline and then order serial serum levels, so this fluid resuscitation can be carefully managed.
The family continued their story of what happened. About a week into the patient’s hospital admission, the family expressed concerns about their loved one’s odd and unexpected change of behavior, and their perception that she was getting worse.
Unfortunately, despite three days of questions and complaints by family members, the doctors and hospital decided to transfer her to her neurorehabilitation facility.
When this lady was transferred to the new facility, she was nearly delirious, and was sent to another hospital for evaluation. At the new hospital, they found that she had a very low serum sodium level, and treated her for it.
Fortunately, this patient survived this ordeal of medical malpractice, but she continues to have problems related to her brain function, including memory and basic thinking processes.
In other cases that I have handled, the outcomes were much worse. In one case, a young patient had a sinus infection that spread to her brain. She was sent to the hospital on the Texas Medical Center, where they did a small craniotomy to drain an abscess near the frontal lobe of her brain. The patient was doing great after the surgery, but the healthcare providers did not keep an eye on her serum sodium level, despite the fact that such patients have a well-known increased risk of developing hyponatremia, which needs careful management.
In her case, her sodium levels got so low and her brain swelling became so severe that her brain almost herniated out of the back of her head, where the spinal cord begins. This would have instantly killed her. She amazingly survived this incident, but was left with a lifelong severe brain injury that should have been entirely avoided.
I have seen many of these cases happen at hospitals with good reputations for handling neurosurgical procedures. This has caused me to think that patients have to be aware of the risk of having hospitals and neurosurgeons save their lives through a surgical procedure, only to cause their death or severe injury in the follow-up care.
We are here to help
If you or someone you care for has been seriously injured as a result of medical malpractice, call the experienced attorneys at Painter Law Firm, in Houston, Texas, at 281-580-8800, for a free consultation about your potential case.
Robert Painter is a former hospital administrator and a medical malpractice lawyer at Painter Law Firm PLLC, in Houston, Texas. He represents patients and their families in medical negligence and wrongful death lawsuits against hospitals, doctors, surgeons, and other healthcare providers. In 2017, he was recognized as one of Houston’s top lawyers by both H Texas magazine and Houstonia magazine, and was awarded a 10/10 rating by Avvo.
Robert Painter is a medical malpractice lawyer at Painter Law Firm PLLC.
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Published in the July/August 2018 edition of "The Houston Lawyer" magazine