Acute symptomatic hyponatremia and cerebral salt wasting after head injury: An important clinical entity

Donati-Genet, P.; Dubuis, Jean-Michel; Girardin, Éric; Rimensberger, Peter C.

doi:10.1053/jpsu.2001.24770

Cited by 50 publications

(28 citation statements)

References 18 publications

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“…We also observed hyponatremia (sodium <130 meq/l), in 9 (34.6%) patients. Hyponatremia following brain injury is frequent 13 and in this study it occurred between the second and the tenth day of trauma, more frequently on the sixth and seventh days as observed by other authors 14 . The nine hyponatremic patients had the CSWS as a probable etiology because of brain injury, natriuresis and hyponatremia 7 .…”

Section: Discussionsupporting

confidence: 83%

Hyponatremia and brain injury: absence of alterations of serum brain natriuretic peptide and vasopressin

Costa

Nakamura

Cruz

et al. 2009

Arq. Neuro-Psiquiatr.

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-Objective: To study any possible relation between hyponatremia following brain injury and the presence of cerebral salt-wasting syndrome (CSWS) or the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), and if vasopressin, brain natriuretic peptide (BNP) and aldosterone have a role in its mechanism. Method: Patients with brain injury admitted to the intensive care unit were included and had their BNP, aldosterone and vasopressin levels dosed on day 7. Results: Twenty six adult patients were included in the study. Nine (34.6%) had hyponatremia and presented with a negative water balance and higher values of urinary sodium, serum potassium and diuresis than patients with normonatremia. The serum levels of BNP, aldosterone, and vasopressin were normal and no relation was observed between plasma sodium and BNP, aldosterone or vasopressin. Conclusion: The most likely cause of hyponatremia was CSWS and there was no correlation between BNP, aldosterone and vasopressin with serum sodium level.Key WorDS: hyponatremia, brain injury, natriuretic peptide, aldosterone, vasopressin.Hiponatremia e traumatismo cranioencefálico: ausência de alteração sanguínea do peptídeo natriurético cerebral e hormônio antidiurético resumo -Objetivo: estudar a possível relação entre a hiponatremia seguindo traumatismo cranioencefálico e a presença da síndrome cerebral perdedora de sal (SCPS) ou a síndrome da secreção inapropriada do hormônio antidiurético (SSIHAD), e se a vasopressina, peptídeo natriurético cerebral (BNP) e aldosterona têm um papel nesse mecanismo. Método: Foram incluídos pacientes com traumatismo cranioencefálico admitidos na unidade de terapia intensiva e foram dosados no sétimo dia seguindo o trauma, BNP, aldosterona e vasopressina. Resultados: Vinte e seis pacientes foram incluídos no estudo. Nove (34,6%) tiveram hiponatremia e apresentaram um balanço hídrico mais negativo e altos valores de sódio urinário, potássio sérico e diurese quando comparados com o grupo que apresentou normonatremia. os níveis séricos de BNP, aldosterona e vasopressina foram normais e não foi observada relação entre o sódio sérico e BNP, aldosterona e vasopressina. Conclusão: A causa mais provável da hiponatremia foi a SCPS e não houve correlação entre BNP, aldosterona e vasopressina com o nível sérico de sódio.

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Section: Discussionsupporting

confidence: 83%

Hyponatremia and brain injury: absence of alterations of serum brain natriuretic peptide and vasopressin

Costa

Nakamura

Cruz

et al. 2009

Arq. Neuro-Psiquiatr.

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“…This is in contrast with our patients, in whom hyponatremia became apparent on days 5, 2 and 6, respectively, but is consistent with other reports of CSWS in children. Kappy and Ganong [17]reported the development of hyponatremia within 48 h of injury in two children with CSWS, Bussmann et al [2]reported the development of hyponatremia within 5 days of insult in 7 patients with CSWS and Donati-Genet et al [18]reported the discovery of symptomatic CSWS on day 6 after CNS injury in a single patient. These data, combined with our own findings, suggest that CSWS may run a different clinical course in children compared to adults.…”

Section: Discussionmentioning

confidence: 99%

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

Berkenbosch¹,

Lentz²,

Jimenez³

et al. 2002

Pediatr Neurosurg

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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.

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“…26,71,80 Arieff, et al, 6 found that following TBI, the acute onset of severe hyponatremia was associated with either poor neurological outcome or death in those patients with a sudden onset of seizures, followed by coma, apnea, and brainstem compression. Horn and Glenn 32 screened patients with severe head injury and found that 20% suffered from one or more hormone disturbances.…”

Section: Traumatic Brain Injurymentioning

confidence: 99%

Hyponatremia in the neurosurgical patient: diagnosis and management

Cole¹,

Gottfried²,

Liu³

et al. 2004

FOC

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Hyponatremia is frequently encountered in patients who have undergone neurosurgery for intracranial processes. Making an accurate diagnosis between the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and cerebral salt wasting (CSW) in patients in whom hyponatremia develops is important because treatment differs greatly between the conditions. The SIADH is a volume-expanded condition, whereas CSW is a volume-contracted state that involves renal loss of sodium. Treatment for patients with SIADH is fluid restriction and treatment for patients with CSW is generally salt and water replacement. In this review, the authors discuss the differential diagnosis of hyponatremia, distinguish SIADH from CSW, and highlight the diagnosis and management of hyponatremia, which is commonly encountered in patients who have undergone neurosurgery, specifically those with traumatic brain injury, aneurysmal subarachnoid hemorrhage, recent transsphenoidal surgery for pituitary tumors, and postoperative cranial vault reconstruction for craniosynostosis.

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Acute symptomatic hyponatremia and cerebral salt wasting after head injury: An important clinical entity

Cited by 50 publications

References 18 publications

Hyponatremia and brain injury: absence of alterations of serum brain natriuretic peptide and vasopressin

Hyponatremia and brain injury: absence of alterations of serum brain natriuretic peptide and vasopressin

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

Hyponatremia in the neurosurgical patient: diagnosis and management

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