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CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2016; 03(03): 205-210
DOI: 10.4103/2348-0548.190065
Review Article
Thieme Medical and Scientific Publishers Private Ltd.

Cerebral salt wasting syndrome

Harshal Dholke
Department of Neuroanaesthesia and Critical Care, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
,
Ann Campos
Department of Neuroanaesthesia and Critical Care, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
,
C. Naresh K. Reddy
Department of Neuroanaesthesia and Critical Care, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
,
Manas K. Panigrahi
1   Department of Neurosurgery, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
› Author Affiliations
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Publication History

Publication Date:
05 May 2018 (online)

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Abstract

Traumatic brain injury (TBI) is on the rise, especially in today’s fast-paced world. TBI requires not only neurosurgical expertise but also neurointensivist involvement for a better outcome. Disturbances of sodium balance are common in patients with brain injury, as the central nervous system plays a major role in sodium regulation. Hyponatraemia, defined as serum sodium <135 meq/L is commonly seen and is especially deleterious as it can contribute to cerebral oedema in these patients. Syndrome of inappropriate antidiuretic hormone secretion (SIADH), is the most well-known cause of hyponatraemia in this subset of patients. Cerebral Salt Wasting Syndrome (CSWS), leading to renal sodium loss is an important cause of hyponatraemia in patients with TBI. Although incompletely studied, decreased renal sympathetic responses and cerebral natriuretic factors play a role in the pathogenesis of CSWS. Maintaining a positive sodium balance and adequate hydration can help in the treatment. It is important to differentiate between SIADH and CSWS when trying to ascertain a case for patients with acute brain injury, as the treatment of the two are diametrically opposite.

Keywords

Brain natriuretic peptide - cerebral salt wasting - conivaptan - fludrocortisone - hypertonic saline - hyponatraemia
 

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