Electrolyte derangements and outcome after moderate and severe traumatic brain injury: A prospective cohort study from Nigeria

Background: Traumatic brain injury (TBI) remains a major cause of morbidity and mortality worldwide, with the burden particularly high in low- and middle-income countries. Electrolyte disturbances are common metabolic complications following head injury and may significantly influence neurological outcomes. Among these abnormalities, disturbances in plasma sodium and potassium are frequently encountered in patients with moderate and severe traumatic brain injury. 

Objective: To evaluate the relationship between plasma sodium and potassium abnormalities and clinical outcomes among adult patients with moderate and severe traumatic brain injury in Ado-Ekiti, Nigeria. 

Methods: This prospective observational study included 70 adult patients aged 18 years and above who presented with moderate or severe traumatic brain injury at a tertiary hospital in South-Western Nigeria between March 2025 and February 2026. Clinical data including demographics, injury severity, and Glasgow Coma Score (GCS) at presentation were recorded. Serial measurements of plasma sodium and potassium were obtained at admission, 12 hours, 24 hours, and daily for the first ten days of hospitalization. Outcome was assessed at three months using the Glasgow Outcome Score (GOS). Statistical analysis was performed using SPSS version 22. Associations between electrolyte abnormalities and outcomes were evaluated using Fisher’s exact test, independent sample t-tests, and logistic regression analysis. 

Results: The study population comprised 54 males and 16 females (male-to-female ratio 3.4:1). Electrolyte abnormalities occurred in 34 patients (48.6%). Hypernatremia was the most frequent disturbance (21.4%), followed by hyponatremia (12.8%), hyperkalemia (11.4%), and hypokalemia (2.9%). At three months, good recovery was observed in 20 patients (28.6%), while 18 patients (25.7%) died. Electrolyte derangements were significantly associated with poorer outcomes (p < 0.001). Patients who died or remained in a vegetative state had the highest frequency of electrolyte abnormalities. Severe traumatic brain injury was associated with lower mean admission sodium and potassium levels compared with moderate injury (p < 0.05). Logistic regression analysis demonstrated that electrolyte derangement was an independent predictor of mortality (OR = 6.0; 95% CI: 1.8–19.7; p = 0.004). Most electrolyte abnormalities were detected within the first 24 hours after admission. 

Conclusion: Electrolyte abnormalities, particularly disturbances in plasma sodium, are common in patients with moderate and severe traumatic brain injury and are strongly associated with poor clinical outcomes. Early identification and prompt correction of electrolyte derangements may improve survival and neurological recovery in patients with traumatic brain injury.