Concurrence of Inappropriate Antidiuretic Hormone Secretion and Cerebral Salt Wasting Syndromes after Traumatic Brain Injury

Shen, Bo; Li, Lin; Li, Ting

doi:10.3389/fnins.2017.00499

Cited by 12 publications

(11 citation statements)

References 31 publications

(47 reference statements)

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“…So, there is a theoretical possibility as well as studies also to support that sometimes they both coexist in the same patient wherein the cause is labelled as mixed. Possibly, miscellaneous causes of hyponatremia in a few previous studies as summarized here might have included mixed cases too 1,2 . I suggest little elaboration of the mixed cause and strategy of its management should have been included as well.…”

Section: Open Peer Reviewmentioning

confidence: 91%

“…Hyponatremia is a disorder of water balance. The severity of hyponatremia has been categorized as mild (130-134mEq/L), moderate (120-129 mEq/L) and severe (<120 mEq/L) 2 , and serum sodium <125 mEq/L is regarded as an independent predictor of mortality, especially in critically ill patients;. In a review of hospitalized patients with hyponatremia, mortality increases by 1.5-60 times in the patients with hyponatremia compared to controls 3 .…”

Section: Introductionmentioning

confidence: 99%

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Mechanism, spectrum, consequences and management of hyponatremia in tuberculous meningitis

Misra

Kalita

2021

Wellcome Open Res

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Hyponatremia is the commonest electrolyte abnormality in hospitalized patients and is associated with poor outcome. Hyponatremia is categorized on the basis of serum sodium into severe (< 120 mEq/L), moderate (120-129 mEq/L) and mild (130-134mEq/L) groups. Serum sodium has an important role in maintaining serum osmolality, which is maintained by the action of antidiuretic hormone (ADH) secreted from the posterior pituitary, and natriuretic peptides such as atrial natriuretic peptide and brain natriuretic peptide. These peptides act on kidney tubules via the renin angiotensin aldosterone system. Hyponatremia <120mEq/L or a rapid decline in serum sodium can result in neurological manifestations, ranging from confusion to coma and seizure. Cerebral salt wasting (CSW) and syndrome of inappropriate secretion of ADH (SIADH) are important causes of hyponatremia in tuberculosis meningitis (TBM). CSW is more common than SIADH. The differentiation between CSW and SIADH is important because treatment of one may be detrimental for the other; evidence of hypovolemia in CSW and euvolemia or hypervolemia in SIADH is used for differentiation. In addition, evidence of dehydration, polyuria, negative fluid balance as assessed by intake output chart, weight loss, laboratory evidence and sometimes central venous pressure are helpful in the diagnosis of these disorders. Volume contraction in CSW may be more protracted than hyponatremia and may contribute to border zone infarctions in TBM. Hyponatremia should be promptly and carefully treated by saline and oral salt, while 3% saline should be used in severe hyponatremia with coma and seizure. In refractory patients with hyponatremia, fludrocortisone helps in early normalization of serum sodium without affecting polyuria or functional outcome. In SIADH, V2 receptor antagonist conivaptan or tolvaptan may be used if the patient is not responding to fluid restriction. Fluid restriction in SIADH has not been found to be beneficial in TBM and should be avoided.

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Section: Open Peer Reviewmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Mechanism, spectrum, consequences and management of hyponatremia in tuberculous meningitis

Misra

Kalita

2021

Wellcome Open Res

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“…Leonard et al (2015) found the incidence of CSWS varies widely in TBI patients, from 0.8 to 34.6%. Nevertheless, a recent report by Shen et al (2017) presented the concurrent syndrome of SIADH and CSWS after TBIs in four patients, which poses to clinicians new ideas for the diagnosis and treatment of TBI-associated HN.…”

Section: The Incidence and Clinical Characteristics Of Siadh And Cswsmentioning

confidence: 99%

Inappropriate Antidiuretic Hormone Secretion and Cerebral Salt-Wasting Syndromes in Neurological Patients

Cui

Yang

et al. 2019

Front. Neurosci.

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The differential diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH) and cerebral salt-wasting syndrome (CSWS) in patients with neurological disorders has been a perplexing clinical controversy. The purpose of this review is to summarize the characteristics and risk factors of patients with different types of neurological disorders complicated by hyponatremia (HN) and review various methods to distinguish SIADH from CSWS. Common neurological disorders with high rates of HN include subarachnoid hemorrhage (SAH), traumatic brain injuries, stroke, cerebral tumors, central nervous system (CNS) infections, and Guillain-Barré syndrome (GBS), which have their own characteristics. Extracellular volume (ECV) status of patients is a key point to differentiate SIADH and CSWS, and a comprehensive assessment of relevant ECV indicators may be useful in differentiating these two syndromes. Besides, instead of monitoring the urinary sodium excretion, more attention should be paid to the total mass balance, including Na+, K+, Cl−, and extracellular fluid. Furthermore, the dynamic detection of fractional excretions (FE) of urate before and after correction of HN and a short-term infusion of isotonic saline solution may be useful in identifying the etiology of HN. As for brain natriuretic peptide (BNP) or N-terminal prohormone of BNP (NT-proBNP), more prospective studies and strong evidence are needed to determine whether there is a pertinent and clear difference between SIADH and CSWS.

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“…Furthermore, the incidence of the disorders varies, in which transient DI was the most reported disorder, followed by SIADH and CSWS [ 2 , 3 ]. Additionally, DI, SIADH, and CSWS have been reported concurrently after neurosurgery, especially pituitary gland surgeries and post-traumatic brain injury [ 2 , 4 , 5 ]. In this case report, we present a rare case of a patient with triphasic DI and CSWS, presenting after neurosurgery, and there were difficulties in differentiating the second phase of DI, which resembles SIADH, and CSWS.…”

Section: Introductionmentioning

confidence: 99%

Coexistence of Triphasic Diabetes Insipidus and Cerebral Salt Wasting Syndrome Following Extraction of Sellar/Suprasellar Grade I Pilocytic Astrocytoma

Alghamdi

Albakri

Alotaibi

et al. 2021

Cureus

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Water homeostasis disorders, such as syndrome of inappropriate antidiuretic hormone secretion (SIADH), diabetes insipidus (DI), and cerebral salt-wasting syndrome (CSWS), can develop after neurosurgery. Additionally, DI, SIADH, and CSWS have been reported concurrently in association with some neurosurgical conditions, in particular after pituitary gland surgery or as sequelae of post-traumatic brain injury. Therefore, neurosurgeons should expect water homeostasis disorders after the removal of tumors of the sellar/suprasellar region and be prepared to aggressively manage them.

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Concurrence of Inappropriate Antidiuretic Hormone Secretion and Cerebral Salt Wasting Syndromes after Traumatic Brain Injury

Cited by 12 publications

References 31 publications

Mechanism, spectrum, consequences and management of hyponatremia in tuberculous meningitis

Mechanism, spectrum, consequences and management of hyponatremia in tuberculous meningitis

Inappropriate Antidiuretic Hormone Secretion and Cerebral Salt-Wasting Syndromes in Neurological Patients

Coexistence of Triphasic Diabetes Insipidus and Cerebral Salt Wasting Syndrome Following Extraction of Sellar/Suprasellar Grade I Pilocytic Astrocytoma

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