Hyponatremia in a pediatric stroke patient: Syndrome of inappropriate antidiuretic hormone secretion or cerebral salt wasting?*

Berger, Thomas M.; Kistler, Walter; Berendes, Elmar; Raufhake, Carsten; Walter, Michael

doi:10.1097/00003246-200204000-00012

Cited by 37 publications

(16 citation statements)

References 18 publications

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“…The clinical findings are more consistent with CSW than SIADH as the cause of postoperative and postinjury fluid and electrolyte changes. Berger et al showed that the release of one or more natriuretic factors could also play a role in renal salt wasting seen in CSW, in addition to decreased neural input to the kidney (6). Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are important factors in clinically diagnosing CSW.…”

Section: Introductionmentioning

confidence: 99%

Cerebral Salt Wasting Syndrome After Calvarial Remodeling in Craniosynostosis

Byeon

Yoo

2005

J Korean Med Sci

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Hyponatremia and increased urine output after calvarial remodeling have been noted in pediatric patients with craniosynostosis. If not treated properly, patients develop hypoosmotic conditions that can lead to cerebral edema, increased intracranial pressure, and collapsed circulation. Postoperative hyponatremia after central nervous system surgery is considered as the syndrome of inappropriate antidiuretic hormone (SIADH) secretion. Recently, however, cerebral salt wasting syndrome (CSWS) instead of SIADH has been reported frequently. CSWS is associated with a decreased serum sodium level, increased urinary sodium level, increased urine output, decreased ECF volume, increased atrial natriuretic peptide (ANP) level, and increased brain natriuretic peptide (BNP) level. We experienced nine patients with craniosynostosis who underwent calvarial remodeling. By postoperative day 1, the ANP and BNP levels increased by 3-6 folds compared with the preoperative levels. They returned to the normal levels by postoperative day 5. The ADH level was within the normal range even after operation. The urinary sodium level increased in all patients by postoperative day 1 and 3. But the serum sodium level, and serum and urine osmolarity were normal due to appropriate replacement of sodium and fluid. After calvarial remodeling, the potential development of CSWS should be considered and distinguished from SIADH. The patients with CSWS require normal saline resuscitation and should prophylactically receive normal saline.

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Section: Introductionmentioning

confidence: 99%

Cerebral Salt Wasting Syndrome After Calvarial Remodeling in Craniosynostosis

Byeon

Yoo

2005

J Korean Med Sci

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“…The physiological effects of these peptides include natriuresis and diuresis, aldosterone antagonism, relaxation of vascular smooth muscle cells, and direct antiproliferative effects on cardiac myocytes counteracting hypertrophy and destruction of sarcomere structure (1,2). Increased plasma concentrations of ANP and BNP are associated with hypertension, myocardial hypertrophy, arrhythmias, renal insufficiency, and cerebral salt wasting (3)(4)(5)(6)(7)(8). In myocardial infarction, concentrations of ANP, and especially BNP, were reported as a prognostic risk indicator independent from left ventricular ejection fraction (9 -14).…”

mentioning

confidence: 99%

A-Type and B-Type Natriuretic Peptides in Cardiac Surgical Procedures

Berendes¹,

Schmidt²,

Aken³

et al. 2004

Anesthesia & Analgesia

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“…CSWS is frequently associated with CNS hemorrhagic diseases, but only a few cases of CSWS in brain infarction have been reported [11-13]. The previous case reports of cerebral infarction had the characteristics of severe physical stress including systemic autoimmune disease, serious infection, and trauma (Table 2) [11,13].…”

Section: Discussionmentioning

confidence: 99%

“…The previous case reports of cerebral infarction had the characteristics of severe physical stress including systemic autoimmune disease, serious infection, and trauma (Table 2) [11,13]. These systemic complications might be more susceptible to developing CSWS than localized involvement in patients with cerebral infarction.…”

Section: Discussionmentioning

confidence: 99%

Cerebral salt-wasting syndrome due to hemorrhagic brain infarction: a case report

2014

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IntroductionCerebral salt-wasting syndrome is a condition featuring hyponatremia and dehydration caused by head injury, operation on the brain, subarachnoid hemorrhage, brain tumor and so on. However, there are a few reports of cerebral salt-wasting syndrome caused by cerebral infarction. We describe a patient with cerebral infarction who developed cerebral salt-wasting syndrome in the course of hemorrhagic transformation.Case presentationA 79-year-old Japanese woman with hypertension and arrhythmia was admitted to our hospital for mild consciousness disturbance, conjugate deviation to right, left unilateral spatial neglect and left hemiparesis. Magnetic resonance imaging revealed a broad ischemic change in right middle cerebral arterial territory. She was diagnosed as cardiogenic cerebral embolism because atrial fibrillation was detected on electrocardiogram on admission. She showed hyponatremia accompanied by polyuria complicated at the same time with the development of hemorrhagic transformation on day 14 after admission. Based on her hypovolemic hyponatremia, she was evaluated as not having syndrome of inappropriate secretion of antidiuretic hormone but cerebral salt-wasting syndrome. She fortunately recovered with proper fluid replacement and electrolyte management.ConclusionsThis is a rare case of cerebral infarction and cerebral salt-wasting syndrome in the course of hemorrhagic transformation. It may be difficult to distinguish cerebral salt-wasting syndrome from syndrome of inappropriate antidiuretic hormone, however, an accurate assessment is needed to reveal the diagnosis of cerebral salt-wasting syndrome because the recommended fluid management is opposite in the two conditions.

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Hyponatremia in a pediatric stroke patient: Syndrome of inappropriate antidiuretic hormone secretion or cerebral salt wasting?*

Abstract: Cerebral salt wasting is associated with elevated plasma concentrations of ANP and BNP. Natriuretic peptides may play a role in the pathogenesis of this syndrome.

Cited by 37 publications

References 18 publications

Cerebral Salt Wasting Syndrome After Calvarial Remodeling in Craniosynostosis

Cerebral Salt Wasting Syndrome After Calvarial Remodeling in Craniosynostosis

A-Type and B-Type Natriuretic Peptides in Cardiac Surgical Procedures

Cerebral salt-wasting syndrome due to hemorrhagic brain infarction: a case report

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