A 20yearold man presented with reduced consciousness after head trauma and was found to have a fractured skull base with bilateral frontal contusions. The management of csw begins with treatment of the underlying neurological process. Discuss the treatment and nursing management for cndi, siadh, and csws. Differences between cerebral salt wasting and syndrome of. Hyponatremia in the postoperative craniofacial pediatric. Disorders of sodium balance after brain injury bja. Pdf differentiating siadh from cerebralrenal salt wasting. It is predominantly associated with sah and tbi but has also been described after brain tumour, ischaemic stroke, and tb meningitis. Fluid restriction should not be used for the prevention or treatment of hyponatremia in hospitalized patients with cns disease as it could lead to.
Patients with csws usually have normal adh levels and often develop urine sodium levels 100 meql. The laboratory findings are identical to siadh, and the distinction between these two entities is often. However, there are a few case reports in literature that describe the association of csw with infection. Nov 27, 2014 cerebral salt wasting syndrome csws cerebral saltwasting syndrome csws is a rare endocrine condition featuring a low blood sodium concentration and dehydration in response to traumainjury or the presence of tumors in or surrounding the brain. Frontiers syndrome of inappropriate antidiuretic hormone. Cerebral salt wasting csw is another potential cause of hyponatremia in those with the causes and diagnosis of hyponatremia, causes and treatment of siadh, and the general sivakumar v, rajshekhar v, chandy mj. Sep 29, 2019 the mechanism by which cerebral disease leads to renal salt wasting is not well understood. Etiology of postoperative hyponatremia following pediatric. Siadh is a volumeexpanded state of cerebral disease 9,10. European guidelines vs us guidelines if you follow steph currys advice zealously and drink a lot of water as it tastes amazing and pours immediately, you might meet mr. The pathophysiology is still not yet understood, vhowe er there are two proposed mechanisms. Volume for volume replacement of urine na losses when dcd from hospital, most will still need oral na supplementation for a period of time 23.
Challenges still confront us as we attempt to differentiate rsw from siadh, ascertain the prevalence of rsw, and address reports of rsw occurring. Oct 18, 2020 cerebral salt wasting vs siadh pdf oct 18, 2020 software by admin the term cerebral salt wasting csw was introduced before the syndrome of inappropriate four years later, schwartz et al. Cerebral salt wasting csw, or renal saltwasting rsw, has evolved from. Siadh is also commonly associated with head injury, neurosurgery, brain abscesstumor, meningitis, encephalitis, guillainbarre syndrome, and. It is found in patients with central nervous system cns disease or in the postoperative setting. Siadh vs cerebral salt wasting after traumatic brain injury. Aug 17, 2019 cerebral salt wasting csw is another potential cause of hyponatremia in those with the causes and diagnosis of hyponatremia, causes and treatment of siadh, and the general sivakumar v, rajshekhar v, chandy mj. Di siadh csw urine output polyuric decreased polyuric serum na high low low urine na low high high serum osm high low can be low or normal urine osm low high. As for brain natriuretic peptide bnp or nterminal prohormone of. Hyponatremia following cerebral trauma has commonly been attributed to the syndrome of inappropriate secretion of antidiuretic hormone siadh. Cerebral salt wasting and syndrome of inappropriate antidiuretic hormone.
Successful treatment of adult cerebral salt wasting with. Following the haemorrhage, seven of nine animals developed hyponatraemia in association with natriuresis and negative salt balance. Oct 18, 2019 cerebral salt wasting csw is another potential cause of hyponatremia in those with the causes and diagnosis of hyponatremia, causes and treatment of siadh, and the general sivakumar v, rajshekhar v, chandy mj. Management of hyponatraemia in patients with acute. Cerebral saltwasting syndrome is a condition featuring hyponatremia and dehydration caused by head injury, operation on the brain. The differentiation of siadh from cerebral salt wasting syndrome csw or the preferred term, renal salt wasting rsw, represents one of the diagnostic conundrums that includes the fundamental question of the existence and prevalence of rsw 14. Cerebral salt wasting csw is a potential cause of hyponatremia in the. Cerebral salt wasting csw can lead to a similar clinical picture, for which treatment is not well defined. Only in recent years has cerebral salt wasting again come into favour as a distinct entity. Cerebral salt wasting csw, or renal saltwasting rsw, has evolved from a misrepresentation of the syndrome of inappropriate secretion of antidiuretic hormone siadh to acceptance as a distinct entity. Proper diagnosis and differentiation between these two entities are necessary for management as the treatment is quite opposite in both conditions.
Distinguishing cerebral salt wasting syndrome and syndrome of. A 44yearold asian man was presented with cerebral salt wasting syndrome and elevated brain. Causes of hyponatremia, such as cerebral salt wasting csw and syndrome of inappropriate secretion of antidiuretic hormone siadh, were based on predefined criteria. Failure of the volume approach and need for a new approach to hyponatremia. Fludrocortisone can help in managing csw where alone saline infusion does not work. It is a true hyponatremia, first described by peters et al as a cerebral disease causing natriuresis and diuresis 19. Cerebral saltwasting syndrome csws is a rare endocrine condition featuring a low blood sodium concentration and dehydration in response to injury trauma or the presence of tumors in or surrounding the brain. In these initial reports, it was theorized that cerebral disease could lead to renal the primary pathogenic mechanism underlying salt wastage and subsequent depletion of ecf volume siadh is excessive adh release causing renal water by directly in.
Nephrology dialysis continuing nephrological education cne. Braunstein, in hormones, brain and behavior second edition, 2009 5. However, a clinical impression of low volume status raised the suspicion of cerebral salt wasting syndrome. Cerebral salt wasting syndrome following head injury in a. Leading theories for the pathophysiology of cerebral salt wasting include the release of brain natriuretic peptide bnp or damage to the hypothalamus with subsequent disorder sympathetic system. On day 3 of his admission, he developed hyponatraemia with raised urine sodium and osmolality, despite receiving dexamethasone and. Csw is characterized by the requirement of vigorous salt replacement in order to compensate renal salt wasting using either isotonic or hypertonic saline 6, while siadh needs fluid restriction as vasopressin is the cause of a relative water excess. Syndrome of inappropriate antidiuretic hormone siadh or cerebral salt.
Hyponatremia in a patient with cryptococcal meningitis. Cerebral salt wasting csw syndrome is an important cause of hyponatremia in head injuries apart from syndrome of inappropriate antidiuretic hormone siadh. Improper diagnosis of the cause of hyponatremia may lead to inappropriate fluid restriction in csw or fluid and salt supplementation in siadh. Atrial and brain natriuretic peptide anp, bnp have several effects that could lead to the clinical syndrome of cerebral salt wasting. More on renal salt wasting without cerebral disease. The differential diagnosis of syndrome of inappropriate antidiuretic hormone secretion siadh and cerebral salt wasting syndrome csws in patients with neurological disorders has been a perplexing clinical controversy. This controversy stems from overlapping clinical and laboratory findings and an inability to assess the volume status of these patients. Hyponatremia is a common electrolyte disorder in the setting of central nervous system cns disease. Cerebral salt wasting vs syndrome of inappropriate antidiuretik hormone free download as powerpoint presentation. It can be seen in cranial trauma, cranial tumor, infectionor after surgery patients. How are urine studies used to differentiate siadh from.
Cerebral salt wasting is another potential cause of hyponatremia. Challenges still confront us as we attempt to differentiate rsw from siadh, ascertain the prevalence of rsw, and address reports of rsw occurring without cerebral disease. Inappropriate antidiuretic hormone siadh secretion is the cause of hyponatremia in the majority of such cases compared to less frequently reported cerebral salt wasting csw. Cerebral salt wasting csw is another potential cause of hyponatremia in those with cns disease, particularly patients with subarachnoid hemorrhage.
List potential causes of central neurogenic diabetes insipidus cndi, syndrome of inappropriate secretion of antidiuretic hormone siadh, and cerebral salt wasting syndrome csws compare the signs, symptoms, and laboratory values for cndi, siadh, and csws. Cerebral salt wasting csw, or renal salt wasting rsw, has evolved from a misrepresentation of the syndrome of inappropriate secretion of antidiuretic hormone siadh to acceptance as a distinct entity. Nov 01, 2009 cerebral salt wasting csw, or renal salt wasting rsw, has evolved from a misrepresentation of the syndrome of inappropriate secretion of antidiuretic hormone siadh to acceptance as a distinct entity. Cerebral salt wastingsyndrome csws is definedas renal loss of sodium caused by intracranial malfunctioningleading to hyponatremia and hypovolemia.
Cerebral salt wasting csw should also be considered as a possible etiology, as it is also seen in the setting of. Formerly, these electrolyte alterations in patients with cerebral disease were ascribed to a decrease in corticotropin acth. Apr 01, 2012 list potential causes of central neurogenic diabetes insipidus cndi, syndrome of inappropriate secretion of antidiuretic hormone siadh, and cerebral salt wasting syndrome csws compare the signs, symptoms, and laboratory values for cndi, siadh, and csws. S, fipm clinical clerkship neurology rotation royal taruma hospital period of 26 november 30 december 2018 definitions syndrome of inappropriate antidiuretic cerebral salt wasting csw hormone secretion siadh defined by the. Cerebral salt wasting, hyponatremia, syndrome of inappropriate adh, secretion, traumatic brain.
In addition, patients with siadh exhibit elevated adh levels and rarely develop urine sodium levels 100 meql. Siadh is also commonly associated with head injury, neurosurgery, brain abscesstumor, meningitis, encephalitis, guillainbarre syndrome, and hydrocephalus. Siadh and cerebral saltwasting syndrome csws in patients with. In siadh, there is generally euvolaemia or hypervolaemia.
Differentiating siadh from cerebralrenal salt wasting. Distinguishing it from siadh is essential to enable prompt treatment in order to prevent severe. Cerebral saltwasting syndrome and elevated brain natriuretic. Sequential cerebral salt wasting complicating siadh in a patient. Its diagnostic and therapeutic approaches are in a state of flux. Hyponatremia caused by csws may occur in mild traumatic brain injury. Nov 24, 20 diagnosis of siadh should include ruleout of other possible reasons for high adh secretion, including true volume depletion via gi or renal losses, in which case the patient is likely to be hypovolemic. Patients suffering from siadh require free water restriction versus those with cerebral salt wasting who need both volume repletion and sodium administration. The curious story of cerebral salt wasting american. Central neurogenic diabetes insipidus, syndrome of.
Central nervous system infections, including tuberculosis meningitis, bacterial meningitis, and viral meningoencephalitis can cause cerebral salt wasting. In this condition, the kidney is functioning normally but excreting excessive sodium. Hyponatraemia is common following major head injury and is associated with significant morbidity and mortality. Management of hyponatraemia in patients with acute cerebral.
Csws is characterized by renal loss of sodium resulting in polyuria, natriuresis, hyponatraemia, and hypovolaemia occurring as a result of a centrally mediated process. Cerebral salt wasting syndrome statpearls ncbi bookshelf. Cerebral salt wasting an overview sciencedirect topics. Apr 05, 2021 maesaka jk, imbriano l, mattana j, gallagher d, bade n, sharif s. Distinguishing cerebral salt wasting syndrome and syndrome. Aug 09, 2019 siadh vs cerebral salt wasting syndrome csws csws is usually associated with hypovolemia whereas patients with siadh are euvolemic. Hyponatremia was defined if 2 consecutive serum sodium levels were 145 meql. Cerebral salt wasting csw is a disorder characterized by ecf depletion and hyponatremia. Pdf mineralocorticoid deficiency in postoperative cerebral. Syndrome of inappropriate antidiuresis and cerebral salt wasting. Jcm free fulltext differentiating siadh from cerebralrenal.
In the settingof central nervous system disease it is more frequent to see siadh. Exceptionally, cerebral salt wasting syndrome csws has also been claimed as the cause of hyponatraemia after pituitary surgery, but few cases have been reported in the last 20 years 35. Hyponatremia is the most common electrolyte abnormality. Nephrology dialysis continuing nephrological education. The curious story of cerebral salt wasting american society.
Cerebral salt wasting syndrome csws is characterized by renal loss of sodium resulting in polyuria, natriuresis, hyponatraemia, and hypovolaemia occurring as a result of a centrally mediated process. He has a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. Cerebral salt wasting is most often associated with subarachnoid hemorrhage, whereas siadh is also associated with brain injury, tumors, and medications table 3. Hyponatremia is the bane of residents and attendings everywhere. Cerebral salt wasting csw was first proposed in 1950 to explain the natriuresis and hyponatremia that sometimes accompany intracranial disease. Cerebral salt wasting syndrome following head injury in a child. Cerebral salt wasting describes the findings of hyponatremia and excessive renal sodium excretion in patients with various affections of the central nervous system cns.
Differentiating siadh from cerebral renal salt wasting. The diagnosis of the syndrome of inappropriate secretion of antidiuretic hormone siadh was made by the consulting internist and fluid. Cerebral salt wasting syndrome csws, leading to renal sodium loss is an important cause of hyponatraemia in patients with tbi. Pdf hyponatremia in a patient with meningitis and crohn. Following the first clinical description of the syndrome of inappropriate antidiuretic hormone secretion siadh in 1957, such patients were assumed to develop hyponatremia from nonosmotic arginine. The main cause is the syndrome of inappropriate secretion of antidiuretic hormone siadh. It is important to differentiate between siadh and cerebral salt wasting syndrome csws, as the treatment of. The existence and prevalence of cerebral salt wasting csw or the preferred term, renal salt wasting rsw, and its differentiation from syndrome of inappropriate antidiuretic hormone siadh have been controversial. It has been reported in cases with subarachnoid haemorrhage, 8 infections, 7 head injury, 9 brain tumours, 10 transsphenoidal pituitary surgery, 11 and neurosurgery. Clarification of cerebral, or the more appropriate term, renal salt wasting rsw, vide infra, and its differentiation from siadh becomes critical because of.
Mar 15, 2018 european guidelines vs us guidelines cerebral salt wasting vs siadh. Cerebral salt wasting following traumatic brain injury in. The diagnosis of csw requires a high index of suspicion. Acute hyponatremia, following neurosurgery, results from inappropriate antidiuretic hormone secretion siadh or cerebral salt wasting csw. While fluid restriction is the treatment of choice in siadh, the treatment. Differentiating between siadh and csw using fractional. Inappropriate antidiuretic hormone secretion and cerebral. Diagnosis of siadh should include ruleout of other possible reasons for high adh secretion, including true volume depletion via gi or renal losses, in which case the patient is likely to be hypovolemic.
181 1001 565 13 1433 1366 889 1415 622 1247 93 472 1489 1 1252 77 722 1400 1248 326 65