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.

Author: Kelar Yozshuzshura
Country: Switzerland
Language: English (Spanish)
Genre: Education
Published (Last): 19 March 2016
Pages: 389
PDF File Size: 11.12 Mb
ePub File Size: 19.6 Mb
ISBN: 666-2-36010-746-2
Downloads: 86148
Price: Free* [*Free Regsitration Required]
Uploader: Mooguzahn

Related articles Cerebral salt wasting fludrocortisone natriuretic peptide tuberculous meningoencephalitis. Abstract Hyponatremia is the most common electrolyte abnormality. Evidence from a meta-analysis. The influence of hypertonic saline infusions upon the fractional reabsorption of urate and other ions in normal and hypertensive man.

After several days of pitressin administration, a large increase in urine sodium and chloride excretion was noted. Changing CSW to RSW is an important modification in nomenclature that will expand our consideration of a large number of RSW patients without evidence of clinical cerebral disease and to avoid mismanagement and possibly reduce morbidity and mortality.

Abnormal renal urate transport in patients with intracranial disease. On an average of 7 days following the event, nine patients developed hyponatraemia that met the criteria for a diagnosis of SIADH. The recent recommendations to treat most or all patients with hyponatremia introduce an urgency to resolve this diagnostic and therapeutic dilemma.

SIADH versus Cerebral Salt Wasting

Shaded areas represent normal ranges. By contrast, uric acid levels in patients with hyponatraemia occurring in the setting of decreased ECF volume are either normal or slightly increased.

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. Medicine Baltimore ; A syndrome of renal sodium loss and hyponatremia probably resulting from inappropriate secretion of antidiuretic hormone. 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.

Hyponatremia and natriuresis following subarachnoid hemorrhage in a monkey model. Failure to distinguish properly between these disorders such that therapy indicated wastibg one disorder is inappropriately employed for the other can potentially result in an adverse outcome.


Initial laboratory examination was unremarkable.

SIADH versus Cerebral Salt Wasting

This syndrome is characterized by hyponatraemia with an inappropriately concentrated urine, increased urine sodium concentration, and evidence of normal or slightly increased intravascular volume. This hypothesis was later proven by demonstrating inappropriately high ADH levels that did not respond to the usual volume and osmolar stimuli [ 19 ].

A likely site for depressed renal sodium absorption in CSW is the proximal nephron. Add comment Close comment form modal.

In two patients with SIADH and increased blood volumes, saline infusion failed to dilute their urine or correct their hyponatremia [ 11 ]. Distinguishing between CSW and SIADH in clinical practice can be difficult given the similarity in laboratory values and the overlap in associated intracranial diseases. To better understand how these disorders differ from other causes of hyponatraemia, a brief overview on the general approach to the hyponatraemic patient will be provided.

In addition the volume expansion leads to decreased proximal sodium reabsorption and urinary sodium excretion is increased and equal to dietary sodium intake.

The cerebral salt wasting syndrome. If a hypo-osmolar state is confirmed the next step is to determine whether the kidney’s ability to dilute the urine is intact. In fact hypo-uricaemia and increased fractional urate excretion may be a common feature of intracranial disease in general [ 2122 ].

Differentiating SIADH from RSW has been extremely difficult to accomplish, in part because of significant overlapping clinical findings between both syndromes. Learn how your comment data is processed. Neurological manifestations and morbidity of hyponatremia: Is fluid restriction harmful?

Unexpectedly high Frequency of reset osmostat and cerebral-renal salt wasting in non-edematous hyponatremia: In this regard, hypokalaemia has not been a feature of CSW and in the current case the serum potassium was actually slightly increased.

Cerebral salt wasting versus SIADH: what difference?

Published online Dec 8. There is sidh agreement that we cannot assess ECV with any degree of accuracy by usual clinical criteria, yet the approach to hyponatremia starts with an assessment of volume.

Mild hyponatremia and risk of fracture in the ambulatory elderly. SIADH evolved as a clinical entity by the demonstration of a clinical correlate to the seminal work by Leaf et al.


Cerebral salt wasting versus SIADH: what difference?

Correlation with brain water and electrolytes. Journal List J Clin Med v. In patients with SIADH, serum urate is not elevated but is actually depressed as these patients are volume expanded, although it is clinically difficult to detect saalt degree of volume expansion. The administration of pitressin to a normal human subject results in an abrupt increase in urine osmolality U osm.

In these initial reports, it was theorized that cerebral disease could lead to renal salt wastage and subsequent depletion wwsting ECF volume by directly influencing nervous input into the kidneys.

Sivakumar [ 23 ]. Find articles by Naveen Bade. Receive exclusive offers and updates from Oxford Academic. Evidence in hyponatremia related to inappropriate secretion of ADH that V1 receptor stimulation contributes to the increase in renal uric acid clearance.

A fall in body weight induced by water restriction leads to a decrease in urinary sodium excretion despite the presence of a persistently concentrated urine. A salt-wasting syndrome associated with cerebral disease.

Unfortunately, the present volume approach to hyponatremia, which has been in existence for decades, has been inadequate and misleading, in part because of misconceptions that are unsubstantiated by supportive data.

To persist in this outmoded approach will lead to misdiagnosis and mistreatment of patients with hyponatremia that will lead to increased morbidity and mortality of a group of patients with what appears to be more serious co-morbid conditions. Based on a large database, we would like to introduce a new, updated algorithm which centers on the determination of FEurate outlined in Figure 3.

Table 3 Summary of extracellular volume expansion with isotonic, hypotonic and hypertonic saline on fractional excretion sidh sodium [FEsodium] and urate [FEurate] at control and experimental Exp. In general, because the normal kidney is able to excrete 20—30 l of water per day, it is difficult to become wxsting with an intact diluting mechanism. In summary, a substantial number of neurosurgical patients who develop hyponatraemia and otherwise meet the clinical criteria for a diagnosis of SIADH have a volume status inconsistent with that diagnosis.

In summary, this year-old man developed significant hyponatraemia in association with a recent subarachnoid haemorrhage.