Cerebral Salt Wasting Syndrome following Brain Injury in Three Pediatric Patients: Suggestions for Rapid Diagnosis and Therapy

Abstract

The association between hyponatremia and intracranial pathology has been well described. When accompanied by natriuresis, hyponatremia has most commonly been attributed to inappropriate secretion of antidiuretic hormone. However, there is growing evidence to suggest that many of these patients may actually have cerebrally mediated salt losses, a disorder referred to as the cerebral salt wasting syndrome (CSWS). While this syndrome has been reasonably well described in adults, data regarding CSWS in pediatric-aged patients remains sparse. Since fluid management of these disorders is different, it is important that the clinician be able to rapidly differentiate between them. We report three cases of CSWS in acutely brain-injured children and comment on the role that early quantitation of urine volume and urine sodium concentration had in rapidly establishing the correct diagnosis.

Uric acid changes in urine and plasma: An effective tool in screening for purine inborn errors of metabolism and other pathological conditions

“…SIADH (syndrome of inappropriate antidiuretic hormone) and CSWS (cerebral salt-wasting syndrome): Increased UA fractional excretion (Berkenbosch et al 2002;Maesaka et al 1999;Milionis et al 2002;Springate 2006)(Maesaka et al 1993;Milionis et al 2002).…”

A case of cerebral salt-wasting syndrome associated with aseptic meningitis in an 8-year-old boy

“…Thus far, most CSWS cases have been reported in neurosurgical patients [5,[7][8][9]; reports on CSWS in children with infectious diseases of the central nervous system are limited. Although tuberculous meningitis complicated by hydrocephalus or brain infarction can be a condition associated with CSWS [5,[10][11][12][13], the development of CSWS associated with aseptic meningitis is extremely rare.…”

Etiology of postoperative hyponatremia following pediatric intracranial tumor surgery

“…7,9,11,15,20,25,28,29,31 CSW is generally regarded as a hypo-osmolar hyponatremic state characterized by primary natriuresis, diuresis, and subsequent volume depletion. 1,4,7,8,11,15,20,28,29,32 SIADH is generally regarded as a hypo-osmolar hyponatremic state characterized by inappropriate free water retention, subsequent onset of natriuresis, and euvolemia. 1,4,7,8,15,32 The principal defining feature distinguishing the entities is the patient's volume status, with CSW identified by high urine output and hypovolemia.…”

“…1,4,7,8,11,15,20,28,29,32 SIADH is generally regarded as a hypo-osmolar hyponatremic state characterized by inappropriate free water retention, subsequent onset of natriuresis, and euvolemia. 1,4,7,8,15,32 The principal defining feature distinguishing the entities is the patient's volume status, with CSW identified by high urine output and hypovolemia. 1,5,[7][8][9]15,17,21,25 Other markers of volume status, including heart rate, central venous pressure (CVP), hemoconcentration, red blood cell or plasma volume, and abbreviations CSW = cerebral salt wasting; CVP = central venous pressure; DDAVP = desmopressin; IQR = interquartile range; RR = relative risk; SIADH = syndrome of inappropriate antidiuretic hormone secretion.obJective Cerebral salt wasting (CSW) and the syndrome of inappropriate antidiuretic hormone secretion (SIADH) cause postoperative hyponatremia in neurosurgery patients, can be difficult to distinguish clinically, and are associated with increased morbidity.…”

“…body weight changes, are inconsistently used for definitions, and some markers are infrequently available or of questionable value in clinical practice. 4,7,10,11,13,15,17,[25][26][27][30][31][32] Urine sodium concentration is the most common reported laboratory value. Both diagnoses require natriuresis with urine sodium > 20 mEq/L.…”