PACULit Daily Literature Update: Fludrocortisone to treat patients with aneurysmal subarachnoid haemorrhage Protocol for an international phase 3 randomised placebocontrolled multicentre trial Quiz

John is a 55-year-old male admitted to the ICU with aneurysmal subarachnoid haemorrhage. His medical history includes hypertension and no known drug allergies. He is currently receiving nimodipine and hypertonic saline for cerebral vasospasm and hyponatraemia management. His serum sodium has dropped to 128 mmol/L, and he shows signs of volume depletion. The neurology team is considering pharmacologic options to manage his hyponatraemia.

Based on current evidence and ongoing clinical trials, what is the most appropriate pharmacist recommendation regarding the use of fludrocortisone in John’s treatment plan?

Maria is a 62-year-old female recovering from aneurysmal subarachnoid haemorrhage in the neurocritical care unit. She was recently started on fludrocortisone 0.1 mg twice daily to manage cerebral salt wasting syndrome. Her past medical history includes type 2 diabetes and mild chronic kidney disease. She is on insulin, lisinopril, and aspirin. The pharmacist is reviewing her medication regimen for potential adverse effects and monitoring parameters.

Which monitoring parameter is most critical for the pharmacist to recommend during fludrocortisone therapy in Maria?

David is a 48-year-old male admitted with aneurysmal subarachnoid haemorrhage complicated by hyponatraemia. The neurosurgery team asks the pharmacist about the impact of fludrocortisone on long-term neurological outcomes and mortality based on current literature. David’s family is concerned about prognosis and potential benefits of new treatments.

What is the most accurate summary of current evidence regarding fludrocortisone’s effect on clinical outcomes after aSAH that the pharmacist should communicate?