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The Role Of The Pharmacist In Neurocritical Care

The Role Of The Pharmacist In Neurocritical Care

Hyponatremia is the most common electrolyte imbalance encountered in clinical practice. Defined as serum sodium levels of less than 135 mmol/L or 135 mEq/L, hyponatremia occurs in up to 30% of hospitalized patients.1,2 It is common in intensive care units and neurosurgical care units, but also in patients receiving anti-seizure medications, antidepressants and thiazide diuretics.3 Among hospitalized patients, hyponatremia significantly increases mortality risk, length of stay and cost of care. Severe hyponatremia can lead to cerebral edema, seizures, coma and death.4

Clinical pharmacists significantly contribute to the care of patients with hyponatremia by identifying patients at risk and the source of hyponatremia, monitor serum sodium concentration and advise on the selection of appropriate therapeutic agent, dosage and duration. Many drugs may contribute to hyponatremia; therefore, a careful review of prescribed medications may identify the cause of the electrolyte imbalance and contribute to prompt resolution.


1. Wald, R. et al. Impact of hospital-associated hyponatremia on selected outcomes. Arch Intern Med. 2010; 170: 294–302.

2. Verbalis JG et al. Diagnosis, Evaluation, and Treatment of Hyponatremia: Expert Panel Recommendations Am J Med. 2013;126:S1-S42

3. Liamis G, Milionis H, Elisaf M. A review of drug-induced hyponatremia. Am J Kidney Dis. 2008;52:144-53.

4. Patterson JH. The impact of hyponatremia. Pharmacotherapy 2011;31(5 Suppl):5S-8S.

*Dr Rhoney is a paid consultant of Otsuka Pharmaceutical Development & Commercialization, Inc. (OPDC). Dr Lambert is an employee of OPDC.


Hannah N. Lambert

Hannah N. Lambert, PharmD

Nephrology Medical Science Liaison

Otsuka Pharmaceutical Development & Commercialization, Inc.*

Hannah N. Lambert is a Medical Science Liaison at Otsuka Pharmaceutical Development and Commercialization. She earned her Doctor of Pharmacy and completed her clinical residency training at Xavier University of Louisiana College of Pharmacy in New Orleans, LA. Prior to joining Otsuka, Dr Lambert was a clinical pharmacist at Ochsner Health in Digital Medicine.

Denise H. Rhoney

Denise H. Rhoney, PharmD, FCCP, FCCM, FNCS

Ron & Nancy McFarlane Distinguished Professor, Division of Practice Advancement & Clinical Education

UNC Eshelman School of Pharmacy *

Denise H. Rhoney, PharmD, is Professor within the Division of Practice Advancement and Clinical Education at the University of North Carolina (UNC) Eshelman School of Pharmacy in Chapel Hill, North Carolina. Dr Rhoney received her Doctor of Pharmacy at the University of Kentucky College of Pharmacy in Lexington. She completed a residency in general clinical pharmacy and another residency in critical care specialty at the Albert B. Chandler Medical Center at the University of Kentucky. She also completed a clinical research fellowship at UNC at Chapel Hill/Glaxo. After completing her fellowship, she spent 17 years at Wayne State University in Detroit, Michigan, working with the Neurocritical Care Team at Detroit Receiving Hospital before coming to UNC Eshelman School of Pharmacy in 2012.

Dr Rhoney is a fellow of the American College of Critical Care Medicine, American College of Clinical Pharmacy, and the Neurocritical Care Society and belongs to many other professional organizations, including the Neurocritical Care Society, where she served on the Board of Directors. She is a member of the Critical Care Practice and Research Network and the Central Nervous System Practice and Research Network of the American College of Clinical Pharmacists, as well as a member of the clinical pharmacology section of the Society of Critical Care Medicine. She served as Chair of the American College of Clinical Pharmacy Research Institute Board of Trustees. Dr Rhoney has been an investigator on numerous clinical trials, many as Principal Investigator.

Dr Rhoney’s research has focused mainly on traumatic brain injury and acute stroke. She has expertise in cerebrospinal fluid pharmacokinetics of pharmacologic agents. She has authored or coauthored 9 book chapters, 5 book reviews, and more than 100 articles and abstracts published in peer-reviewed journals such as Pharmacotherapy, Neurology, and Neurocritical Care. Dr Rhoney is the recipient of numerous honors and awards, including the Presidential Award of Teaching Excellence at Wayne State University and the American Association of Colleges of Pharmacy Innovations in Teaching Award. Dr Rhoney’s current focus is using this strong clinical background and research dedication and translating this to the interface between practice and education.

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