Cerebral Salt Wasting: Pathophysiology, Diagnosis, and Treatment

Yee, Alan; Burns, Joseph D.; Wijdicks, Eelco F. M.

doi:10.1016/j.nec.2009.10.011

Cited by 144 publications

(166 citation statements)

References 124 publications

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“…In addition, an increase in fractional excretion of phosphate has been reported in CSWS but not in SIADH [11]. A compilation of the main characteristics to distinguish CSWS from SIADH is shown in Table 2 [5,11]. In the present patient, clinical findings suggested a volume-contracted state without clear evidence, but the laboratory data did not show an increase in fractional excretion of phosphate.…”

Section: Discussionmentioning

confidence: 42%

“…The rostral ventrolateral medulla (RVLM) oblongata region contains neurons that have a key role in determining peripheral sympathetic activity. Increased activity of RVLM neurons is transmitted to the intermediolateral cell column at each level of the spinal cord, where peripheral sympathetic nerves to the heart, arterioles, and kidneys are activated [5]. In the present patient, neural imaging showed multiple areas of demyelinating lesions, including the medulla oblongata and cervical cord, suggesting the possibility of impaired efferent pathways of sympathetic nerves.…”

Section: Discussionmentioning

confidence: 46%

“…In the present patient, neural imaging showed multiple areas of demyelinating lesions, including the medulla oblongata and cervical cord, suggesting the possibility of impaired efferent pathways of sympathetic nerves. According to this theory, loss of adrenergic tone to the nephron leads to a decrease in renin secretion, thereby, causing decreased levels of aldosterone and decreased sodium reabsorption at the proximal convoluted tubule [5]. This mechanism could explain why the present patient demonstrated suppressed renin and aldosterone levels in spite of volume contraction.…”

Section: Discussionmentioning

confidence: 71%

“…CSWS is defined as a renal loss of sodium during intracranial disorders, leading to hyponatremia and a decrease in extracellular fluid volume [5]. CSWS has been most often described in patients with subarachnoid hemorrhage [6].…”

Section: Discussionmentioning

confidence: 99%

“…This mechanism could explain why the present patient demonstrated suppressed renin and aldosterone levels in spite of volume contraction. In addition, decreased sympathetic tone leads to dilatation of the afferent arteriole, causing increased glomerular filtration of plasma and sodium [5].…”

Section: Discussionmentioning

confidence: 99%

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Hyponatremia associated with demyelinating disease of the nervous system

et al. 2013

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A 63-year-old man was diagnosed with periodontitis and underwent tooth extraction. Several days later, he suffered a high fever, ischuria, a change in personality, and disorientation. A urologist examined him and found severe hyponatremia (117 mEq/L), and he was then transferred to our hospital. On admission, physical findings revealed dysfunction of the bladder and bowel, altered mental status, and hypovolemia. Blood chemistry showed serum sodium of 120 mEq/L, a serum urate of 1.4 mg/dL, urinary Na of 61 mEq/L, and fractional urate excretion of 16 %. Examination of the cerebrospinal fluid (CSF) showed monocytosis. Magnetic resonance imaging (MRI) of the brain and spinal cord showed multiple lesions characterized by hyperintensity on T2-weighted sequences, suggesting demyelinating disease. His sodium concentration normalized 3 days after volume replacement therapy, and his altered mental status along with the dysfunction of the bladder and bowel were promptly improved after the initiation of high-dose glucocorticoids. Additionally, the abnormal lesions on MRI markedly

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Section: Discussionmentioning

confidence: 42%

Section: Discussionmentioning

confidence: 46%

Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Hyponatremia associated with demyelinating disease of the nervous system

et al. 2013

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Surgical Management of Sellar Masses

Owen¹,

Chen-Allen²,

Martin³

2023

Advanced Techniques in Canine and Feline Neurosurgery

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Hypernatremia in brain‐dead patients

Guo

Wang

et al. 2022

Brain and Behavior

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Objectives: Hypernatremia often occurs in patients with brain death. This study summarizes its characteristics. Methods:We recorded 57 patient's highest blood sodium value, as well as daily NT-proBNP, blood creatinine, and urine output. Further, we analyzed the time of the first rise in blood sodium, and the relationship between NT-proBNP, serum creatinine, urine output, and serum sodium.Results: There was no hyponatremia in these patients, and only seven of the 53 patients registered blood sodium between 137 and 150 mmol/L. We found that blood sodium started to rise at 36.0 (28.5-52.3) h, reaching the highest value in 79.0 (54.0-126.0) h. Urine volume and creatinine have no correlation with serum sodium level, while NT-proBNP has a significant correlation with serum sodium level. Conclusion:It is necessary to conduct volume assessments and urine electrolyte testing on patients with brain death. BNP has a protective effect on water and electrolytes to prevent hypernatremia.

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Cerebral Salt Wasting: Pathophysiology, Diagnosis, and Treatment

Cited by 144 publications

References 124 publications

Hyponatremia associated with demyelinating disease of the nervous system

Hyponatremia associated with demyelinating disease of the nervous system

Surgical Management of Sellar Masses

Hypernatremia in brain‐dead patients

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