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The term cerebral salt wasting (CSW) was introduced before the syndrome of inappropriate Four years later, Schwartz et al. published their landmark paper on SIADH. . Damaraju SC, Rajshekhar V, Chandy MJ: Validation study of a central. 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. While fluid restriction is the treatment of choice in SIADH, the treatment .. Differential diagnosis of cerebral salt wasting (CSW) vs syndrome of.

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SIADH is a volume-expanded state.

How to cite this URL: Serial values of investigations done in the patient Click here to view. Since this segment normally reabsorbs the bulk of filtered sodium, a small decrease in the efficiency of this segment would result in the delivery of large amounts of sodium to the wastkng nephron and ultimately into the final urine. ANP and BNP have also been shown capable of directly decreasing autonomic outflow through effects at the level of the brain stem [ 1718 ].

The administration of saline should not affect the FEurate to any significant degree Table 3and drugs such as atorvastatin and cerebgal which are known to increase urate excretion have not been shown to have a meaningful effect on the results [ 4445 ]. She was diagnosed as having CSWS on the basis of hypovolemia, polyuria, natriuresis, and the relatively high level of fractional excretion of uric acid.

Part of this new found appreciation for the diagnosis of CSW can be traced to reports in which measurement of blood and plasma volume were found to be decreased in patients who met the traditional laboratory criteria for SIADH. He was treated with librium for his tremulousness, dilantin for seizure prophylaxis, and thiamine, folate and multivitamins.

SIADH versus Cerebral Salt Wasting

It is clear from these studies that RSW is much more common than SIADH, yet it is still perceived as a rare clinical entity, which has been propagated for many years without either negating these compelling studies nor by providing evidence to the contrary by suitable methods.


This same constellation of findings was subsequently confirmed in additional patients with widely varying forms of cerebral disease [ 910 ]. In this regard, hypokalaemia has not been a feature of CSW and in the current case the serum potassium was actually slightly increased.

The concept of a CSW syndrome was first introduced by Peters and colleagues in in a report describing three patients with neurological disorders who presented with hyponatraemia, clinical evidence of volume depletion, and renal sodium wasting without an obvious disturbance in the pituitary—adrenal axis [ 8 ].

For a more detailed discussion on this topic, the reader is referred to two recent reviews [ 12 ]. The establishment of normal renal sodium handling despite a decreased serum sodium concentration is a characteristic feature of SIADH. How to cite this article: On hospital day 10 the patient was noted to be confused and hypotensive.

Pathophysiology of cerebral salt wasting. Management of neurosurgical patient with hyponatremia and natriuresis.

Introduction Hyponatraemia is a common electrolyte disorder in the setting of central nervous system disease and is often attributed to the syndrome of inappropriate secretion of antidiuretic hormone SIADH.

Vasopressin function in the syndrome of inappropriate antidiuresis. The volume stimulus is more potent than the osmolar stimulus so a volume depleted patient continues to secrete ADH despite becoming progressively hyponatremic as long as the patient continues to take in free water [ 10 ].

The uric acid was 3. Maintenance of an adequate intravascular volume is important in the management of subarachnoid haemorrhage in order to minimize cerebral ischaemia induced by vasospasm. Maesaka JK, Fishbane S.

Cerebral salt wasting versus SIADH: what difference?

In summary, this year-old man developed significant hyponatraemia in association with a recent subarachnoid haemorrhage. For example, infusion of either of these peptides into normal human subjects results in a natriuretic response that is unrelated to changes in blood pressure [ 17 ].


Find articles by Naveen Bade. Changing CSW to RSW is an important modification in nomenclature that will expand our wastinh of a large number of RSW patients without evidence of clinical cerebral disease and to avoid mismanagement and possibly reduce morbidity and mortality. In order to avoid worsening hyponatraemia in this setting the osmolality of the fluid dasting must exceed the osmolality of the urine.

Role of the central nervous system in metabolism of electrolytes and water. His past medical history was significant for chronic alcoholism complicated by alcohol withdrawal seizures and delirium tremens. In addition there is evidence of a suppressed renin—angiotensin—aldosterone axis. Osmo-regulation and baro-regulation of plasma vasopressin in essential hypertension. If so, fluid restriction would tend to aggravate an already decreased plasma volume.

These data provide further evidence for the ineffectiveness of the volume approach to evaluating patients with hyponatremia and support the common notion that we cannot assess the volume status of patients with any degree of accuracy.

Increased release of cardiac BNP could be part of a generalized stress response to the underlying illness while increased intracranial pressure may provide a signal for brain BNP release. At this time severe dietary sodium restriction will lead to excretion of urine that is essentially sodium free whereas administration of a large isotonic sodium load is followed by rapid and almost quantitative urinary excretion of the infused solute [ 7 ].

This article has been cited by other articles in PMC. Why does it matter? In one additional report of 21 neurosurgical patients with hyponatraemia associated with increased urine sodium concentration and an inappropriately concentrated urine, volume status was assessed by measurement of total blood volume and central venous pressure and determining the response to volume supplementation [ 14 ].

After several days of pitressin administration, a large increase in urine sodium and chloride excretion was noted.