Hyponatremia—What Is Cerebral Salt Wasting?

Momi, Jasminder; Tang, Christopher; Abcar, Antoine; Kujubu, Dean A.; Sim, John J.

doi:10.7812/tpp/08-066

Cited by 45 publications

(39 citation statements)

References 15 publications

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“…Cisplatin stimulates AVP secretion to cause SIADH, but it can also directly damage renal tubules to interfere with sodium reabsorption, which in rare cases may lead to hyponatremia via salt wasting nephropathy [41]. Similarly, excessive sodium loss resulting from cerebral salt wasting may develop in patients with brain metastases, head trauma, or meningitis, or after CNS surgery [42]. These salt wasting syndromes are often difficult to distinguish from SIADH because each is characterized by low plasma and sodium osmolality, high urine sodium concentration, and higher urine than plasma osmolality.…”

Section: Causes Of Hyponatremia In Cancer Patientsmentioning

confidence: 99%

Diagnosis and Management of Hyponatremia in Cancer Patients

Castillo

Vincent

Justice³

2012

The Oncologist

209

201

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Hyponatremia, a common electrolyte abnormality in oncology practice, may be a negative prognostic factor in cancer patients based on a systematic analysis of published studies. The largest body of evidence comes from small-cell lung cancer (SCLC), for which hyponatremia was identified as an independent risk factor for poor outcome in six of 13 studies. Hyponatremia in the cancer patient is usually caused by the syndrome of inappropriate antidiuretic hormone (SIADH), which develops more frequently with SCLC than with other malignancies. SIADH may be driven by ectopic production of arginine vasopressin (AVP) by tumors or by effects of anticancer and palliative medications on AVP production or action. Other factors may cause hypovolemic hyponatremia, including diarrhea and vomiting caused by cancer therapy. Hyponatremia may be detected on routine laboratory testing before or during cancer treatment or may be suggested by the presence of mostly neurological symptoms. Treatment depends on several factors, including symptom severity, onset timing, and extracellular volume status. Appropriate diagnosis is important because treatment differs by etiology, and choosing the wrong approach can worsen the electrolyte abnormality. When hyponatremia is caused by SIADH, hypertonic saline is indicated for acute, symptomatic cases, whereas fluid restriction is recommended to achieve a slower rate of correction for chronic asymptomatic hyponatremia. Pharmacological therapy may be necessary when fluid restriction is insufficient. The orally active, selective AVP receptor 2 (V 2 )-receptor antagonist tolvaptan provides a mechanism-based option for correcting hyponatremia caused by SIADH or other conditions with inappropriate AVP elevations. By blocking AVP effects in the renal collecting duct, tolvaptan promotes aquaresis, leading to a controlled increase in serum sodium levels. The Oncologist 2012;17:756 -765

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Section: Causes Of Hyponatremia In Cancer Patientsmentioning

confidence: 99%

Diagnosis and Management of Hyponatremia in Cancer Patients

Castillo

Vincent

Justice³

2012

The Oncologist

209

201

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“…La EPS se ha descrito en pacientes con meningitis, traumatismos craneanos, tumores cerebrales, hemorragia sub-aracnoídea, encefalitis, tubercu- losis meníngea, poliomielitis bulbar, adenomas hipofisiarios, hemorragias cerebrales, carcinomatosis meníngea y cirugía intracraneana 1,12,15,16,17,18,19 . También se ha comunicado en patologías extracraneanas como infecciones por HIV, enfermedad de Hodgkin, fractura de cadera y carcinomas metastásicos, razón por lo cual se ha sugerido cambiar el nombre de "cerebral salt wasting syndrome" por "renal salt wasting syndrome" 14,20 .…”

Section: Discussionunclassified

“…El ácido úrico generalmente está bajo (< 4 mg/dl), como también sucede en el SIADH. En SIADH se debe al VEC aumentado, en la EPS a la disminución en la reabsorción proximal por el tono simpático reducido y al aumento en la secreción tubular por la estimulación de los receptores V1 por la ADH 18,21 . También se ha encontrado defectos en la reabsorción de fosfatos en el túbulo proximal 14,21 .…”

Section: Discussionunclassified

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Encefalopatía perdedora de sal en romboencefalitis por listeria

Vega

Matamala

2013

Rev. méd. Chile

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“…Differentiation between these two forms is difficult, and primarily it is diagnosed on the basis of volume change observation. 5,6 Differential diagnosis between dilution and depletion hyponatremia is essential for appropriate therapy. Patients with sodium loss would benefit only from sodium provision, whereas those with fluid overload would benefit from fluid restriction or water diuresis.…”

Section: Introductionmentioning

confidence: 99%

Hyponatremia in spinal cord injury patients: new insight into differentiating between the dilution and depletion forms

2015

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Study design: This is a retrospective study. Objectives: The objectives of this study were to present a new model for differentiating between the dilution and depletion forms of hyponatremia in patients in the postacute phase after spinal cord injury (SCI), and to identify possible etiological factors contributing to hyponatremia in these patients. Setting: University Hospital Motol, Prague, Czech Republic. Methods: Eighty-seven of 352 patients hospitalized in 2008-2012 in the Spinal Cord Unit were hyponatremic. Seventy-four patients had S Na+ = 130-135 mmol l − 1 and 13 patients had S Na+ below 130 mmol l − 1 . We propose a simple model of an electrolyte solution in which the Na + concentration is higher than the Cl − concentration, making it possible to compare the effects of dilution and depletion of Na + and Cl − on the Na + concentration. The depletion of Na + and Cl − leads to a significant increase in the Na + /Cl − ratio, with the Na + -Cl − value remaining unchanged. Dilution with water results in a decrease of Na + -Cl − with the Na + /Cl − ratio remaining unchanged. Results: In patients with S Na+ below 130 mmol l − 1 , hyponatremia was consistent with the depletion model in 46% and with the dilution model in 32%. In patients with S Na+ ranging between 130 and 135 mmol l − 1 , the respective rates were 34 and 12%. Conclusion: Examination of S Na+ -S Cl − and S Na+ /S Cl − in patients with SCI could be helpful in considering whether hyponatremia is consistent either with the NaCl dilution model or with the NaCl depletion model. Further studies are needed for more accurate interpretation of the results, particularly with respect to volume and acid-base disorders.

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Hyponatremia—What Is Cerebral Salt Wasting?

Cited by 45 publications

References 15 publications

Diagnosis and Management of Hyponatremia in Cancer Patients

Diagnosis and Management of Hyponatremia in Cancer Patients

Encefalopatía perdedora de sal en romboencefalitis por listeria

Hyponatremia in spinal cord injury patients: new insight into differentiating between the dilution and depletion forms

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