Fludrocortisone Treatment in a Child with Severe Cerebral Salt Wasting

Abstract

Hyponatremia is a common complication of intracranial disease or surgery. An evaluation should be undertaken to determine whether cerebral salt wasting (CSW) or inappropriate secretion of antidiuretic hormone is present as a cause. Since the treatment principles are completely different in the two pathological states, differential diagnosis is very important. CSW is defined as the renal loss of sodium leading to hyponatremia and decreased extracellular fluid volume. In the literature, it has been noted that mineralocorticoid administration can be useful in CSW cases. We herein present an 11-year-old boy who developed hyponatremic seizures after intracranial tumor resection. He was diagnosed with CSW on the basis of high urinary sodium excretion and increased urine output, together with signs and symptoms of dehydration. Despite intensive fluid and salt therapy, we were unable to decrease the urinary output. Therefore, fludrocortisone therapy was administered and his urinary output and sodium excretion were decreased and his serum sodium level was normalized. In conclusion, in addition to fluid and salt replacement, mineralocorticoid supplementation also seems to be a safe and effective treatment for CSW.

Management of Electrolyte and Fluid Disorders after Brain Surgery for Pituitary/Suprasellar Tumours

“…A strict fluid regime of ‘millilitre for millilitre' replacement should be avoided as a vicious cycle of replacing fluids might result in polyuria. Although water and salt supplementation is the primary therapy, mineralocorticoid administration (fludrocortisone) has been used for the treatment of CSW at doses of 0.025-1 mg/day [43,45,46]. The commonest adverse effects of fludrocortisone are hypokalaemia, which was observed in 73% of patients [43,47,] and hypertension [46,47].…”

“Hyponatremia in Stroke: Cerebral Salt Wasting Versus Syndrome of Inappropriate Anti-Diuresis”

“…Intravenous saline (isotonic or hypertonic), salt tablets or agent with mineralocorticoid activity like fluodrocortisone are the various treatment options [11,12] On the other hand, SIADH requires fluid restriction as the treatment. Intravenous saline given in this volume-expanded state could lead to symptomatic hyponatremia, and worsening clinical condition.…”

Distúrbios na secreção e ação do hormônio antidiurético

“…Em doses de 0,1-0,3mg duas vezes ao dia, promove retenção de sódio e parece também inibir parcialmente a sede e a ingestão de líqüidos (12,13,65,66). Os principais efeitos colaterais são hipocalemia e hipertensão, que podem requerer suplementação de potássio ou redução da dose (7,13).…”