Cerebral salt-wasting syndrome

Cerebral salt-wasting syndrome (CSWS) is a rare endocrine condition characterized by hyponatremia and dehydration due to excessive renal sodium and water loss. It is often associated with diseases that affect the brain such as subarachnoid hemorrhage, traumatic brain injury, and central nervous system infections.

Etiology

The exact cause of CSWS is not well understood. It is thought to be due to an increase in the secretion of natriuretic peptides from the brain, which leads to increased renal sodium and water excretion. This is often triggered by diseases that affect the brain such as subarachnoid hemorrhage, traumatic brain injury, and central nervous system infections.

Clinical Presentation

Patients with CSWS often present with symptoms of hyponatremia and dehydration. These may include nausea, vomiting, headache, confusion, seizures, and in severe cases, coma. On examination, patients may have low blood pressure, rapid heart rate, and signs of dehydration such as dry mucous membranes and decreased skin turgor.

Diagnosis

The diagnosis of CSWS is often challenging as it can be confused with the syndrome of inappropriate antidiuretic hormone secretion (SIADH), which also presents with hyponatremia. However, unlike SIADH, patients with CSWS have evidence of volume depletion. Laboratory tests often show low serum sodium, high urine sodium, and high urine osmolality. A simultaneous measurement of urine and serum osmolality can help differentiate CSWS from SIADH.

Treatment

The mainstay of treatment for CSWS is sodium and fluid replacement. This can be achieved through oral or intravenous administration of sodium chloride and water. In some cases, fludrocortisone, a mineralocorticoid that increases renal sodium reabsorption, may be used. It is important to monitor the patient's serum sodium and volume status closely during treatment.

Prognosis

The prognosis of CSWS depends on the underlying cause. If the underlying brain disease is treated effectively, the CSWS often resolves. However, if left untreated, CSWS can lead to severe hyponatremia and dehydration, which can be life-threatening.

See Also

• Hyponatremia
• Syndrome of inappropriate antidiuretic hormone secretion
• Subarachnoid hemorrhage
• Traumatic brain injury
• Central nervous system infections

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