Cerebral salt wasting following traumatic brain injury
#MMPMID28458890
Taylor P
; Dehbozorgi S
; Tabasum A
; Scholz A
; Bhatt H
; Stewart P
; Kumar P
; Draman MS
; Watt A
; Rees A
; Hayhurst C
; Davies S
Endocrinol Diabetes Metab Case Rep
2017[]; 2017
(?): ? PMID28458890
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SUMMARY: Hyponatraemia is the most commonly encountered electrolyte disturbance
in neurological high dependency and intensive care units. Cerebral salt wasting
(CSW) is the most elusive and challenging of the causes of hyponatraemia, and it
is vital to distinguish it from the more familiar syndrome of inappropriate
antidiuretic hormone (SIADH). Managing CSW requires correction of the
intravascular volume depletion and hyponatraemia, as well as mitigation of
on-going substantial sodium losses. Herein we describe a challenging case of CSW
requiring large doses of hypertonic saline and the subsequent substantial benefit
with the addition of fludrocortisone. LEARNING POINTS: The diagnosis of CSW
requires a high index of suspicion. Distinguishing it from SIADH is essential to
enable prompt treatment in order to prevent severe hyponatraemia.The hallmarks of
substantial CSW are hyponatraemia, reduced volume status and inappropriately high
renal sodium loss.Substantial volumes of hypertonic saline may be required for a
prolonged period of time to correct volume and sodium deficits.Fludrocortisone
has a role in the management of CSW. It likely reduces the doses of hypertonic
saline required and can maintain serum sodium levels of hypertonic saline.
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