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Use of Venous Excess UltraSound (VExUS) score in hyponatraemia management in critically ill patient
  1. Rita Varudo,
  2. Inês Pimenta,
  3. Jacobo Bacariza Blanco and
  4. Filipe André Gonzalez
  1. Intensive Care Department, Hospital Garcia de Orta EPE, Almada, Portugal
  1. Correspondence to Dr Filipe André Gonzalez; filipeandregonzalez{at}


Hyponatraemia is the most prevalent electrolyte disorder in the neurocritical care setting and is associated with a significant morbimortality. Cerebral salt wasting and inappropriate antidiuretic hormone secretion syndrome have been classically described as the two most frequent entities responsible for hyponatraemia in neurocritical care patients. An accurate aetiological diagnosis of hypotonic hyponatraemia requires a proper volume status assessment. Nevertheless, determination of volume status based on physical examination, laboratory findings and imaging modalities have several limitations and can lead to improperly diagnosis and hyponatraemia mismanagement. Point-of-care ultrasound (POCUS), specifically Venous Excess UltraSound (VExUS) score, is a fast and valuable tool to evaluate venous congestion at the bedside and identify hypervolaemia, helping the physicians in therapeutic decision making in a patient with hyponatraemia. We report a case where the use of POCUS, and more specifically VExUS, can be helpful in volume status assessment, complementing the complex management of multifactorial hyponatraemia in a neurocritical patient.

  • medical management
  • fluid electrolyte and acid-base disturbances
  • ultrasonography

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  • Contributors All authors contributed to the writing of the article and were involved with the patient’s care. RV was responsible for conception of the article, revising intellectual content and drafting of the manuscript. IP contributed to writing of the initial draft. JBB participated in planning, development and design of the article. FAG contributed to revising and preparation of the final manuscript. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.