Top

Intensive Care Medicine

Published in:

01-01-2008 | Original

Hyponatremia in neurological patients: cerebral salt wasting versus inappropriate antidiuretic hormone secretion

Authors: Serge Brimioulle, Carlos Orellana-Jimenez, Adel Aminian, Jean-Louis Vincent

Published in: Intensive Care Medicine | Issue 1/2008

Abstract

Objective

To assess whether hyponatremia in acute neurological patients is associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) or with the cerebral salt-wasting syndrome (CSWS).

Design

Clinical, controlled, prospective study.

Setting

Department of intensive care of a tertiary care academic hospital.

Patients

Forty acute neurological patients with hyponatremia suggesting SIADH or CSWS (20) or with normonatremia (20).

Interventions

None.

Measurements and main results

Measurement of clinical and biological variables. Measurement of blood, plasma, and red blood cell volumes to discriminate SIADH and CSWS. Renal, adrenal and thyroid functions were normal in all patients. Average blood, plasma, and red blood cell volumes were 54, 37 and 17 ml/kg in control patients and 54, 37 and 18 ml/kg in hyponatremic patients, respectively.

Conclusions

The adequate blood volumes in hyponatremic patients confirm the diagnosis of SIADH and do not support the concept of CSWS.

Available only for authorised users

Peters JP, Welt LG, Sims EAH, Orloff J, Needham J (1950) A salt-wasting syndrome associated with cerebral disease. Trans Assoc Am Physicians 63:57–64PubMed

Cort JH (1954) Cerebral salt wasting. Lancet 1:752–754CrossRef

Schwartz WB, Bennett W, Curelop S, Bartter FC (1957) A syndrome of renal sodium loss and hyponatremia probably resulting from inappropriate secretion of antidiuretic hormone. Am J Med 23:529–542PubMedCrossRef

Bartter FC, Schwartz WB (1967) Syndrome of inappropriate secretion of antidiuretic hormone. Am J Med 42:790–806PubMedCrossRef

Nelson PB, Seif SM, Maroon JC, Robinson AG (1981) Hyponatremia in intracranial disease: perhaps not the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). J Neurosurg 55:938–941PubMedCrossRef

Wijdicks EFM, Vermeulen M, ten Haaf JA, Hijdra A, Bakker WH, van Gijn J (1985) Volume depletion and natriuresis in patients with a ruptured intracranial aneurysm. Ann Neurol 18:211–216PubMedCrossRef

Sivakumar V, Rajshekhar V, Chandy MJ (1994) Management of neurosurgical patients with hyponatremia and natriuresis. Neurosurgery 34:269–274PubMedCrossRef

Betjes MGH (2002) Hyponatremia in acute brain disease: the cerebral salt wasting syndrome. Eur J Intern Med 13:9–14PubMedCrossRef

Verbalis JG (1994) Pathogenesis of hyponatremia in an experimental model of the syndrome of inappropriate secretion of antidiuretic hormone. Am J Physiol 267:R1617–1625PubMed

10.

Harrigan MR (1996) Cerebral salt wasting syndrome: a review. Neurosurgery 38:152–160PubMedCrossRef

11.

Maesaka JK, Gupta S, Fishbane S (1999) Cerebral salt-wasting syndrome: does it exist? Nephron 82:100–109PubMedCrossRef

12.

Oh MS, Carroll HJ (1999) Cerebral salt-wasting syndrome: we need better proof of its existence. Nephron 82:110–114PubMedCrossRef

13.

Ellison DH, Berl T (2007) The syndrome of inappropriate antidiuresis. N Engl J Med 356:2064–2072PubMedCrossRef

14.

International Committee for Standardization in Haematology (1980) Recommended methods for measurement of red-cell and plasma volume. J Nucl Med 21:793–800

15.

Decaux G, Unger J, Brimioulle S, Mockel J (1982) Hyponatremia in the syndrome of inappropriate ADH secretion: rapid correction with urea, NaCl and water restriction. JAMA 247:471–474PubMedCrossRef

16.

DeFronzo RA, Arieff AI (1995) Disorders of sodium metabolism. Hyponatremia. In: Arieff AI, DeFronzo RA (eds) Fluid, electrolyte and acid–base disorders. Churchill Livingstone, New York, pp 255–303

17.

Shippy CR, Appel PL, Shoemaker WC (1984) Reliability of clinical monitoring to assess blood volume in critically ill patients. Crit Care Med 12:107–112PubMedCrossRef

18.

Jones JG, Wardrop CAJ (2000) Measurement of blood volume in surgical and intensive care practice. Br J Anaesth 84:226–235PubMed

19.

Pearson TC, Guthrie DL, Simpson J, Chinn S, Barosi G, Ferrant A, Lewis SM, Najean Y (1995) Interpretation of measured red cell mass and plasma volume in adults: expert panel on radionuclides of the International Council for Standardization in Haematology. Brit J Haematol 89:748–756CrossRef

20.

Davy KP, Seals DR (1994) Total blood volume in healthy young and older men. J Appl Plysiol 76:2059–2062

21.

Zorbas YG, Yarullin VL, Denogratov SD, Luzhkov YS, Kuznetsov NA (2002) Fluid volume compartments and biochemical measurements for disclosing fluid depletion during acute and rigorous bed rest in normal subjects. Intern Urol Nephrol 34:467–476CrossRef

22.

Decaux G, Dumont I, Waterlot Y, Hanson B (1985) Mechanisms of hypouricemia in the syndrome of inappropriate secretion of antidiuretic hormone. Nephron 39:164–168PubMed

23.

Decaux G, Prospert F, Cauchie P, Soupart A (1990) Dissociation between uric acid and urea clearances in the syndrome of inappropriate secretion of antidiuretic hormone related to salt excretion. Clin Sci 78:451–455PubMed

24.

Singh S, Bohn D, Carlotti APCP, Cusimano M, Rutka JT, Halperin ML (2002) Cerebral salt wasting: truths, fallacies, theories, and challenges. Crit Care Med 30:2575–2579PubMedCrossRef

25.

Al-Mufti H, Arieff AI (1984) Hyponatremia due to cerebral salt-wasting syndrome. Combined cerebral and distal tubular lesion. Am J Med 77:740–746PubMedCrossRef

Title: Hyponatremia in neurological patients: cerebral salt wasting versus inappropriate antidiuretic hormone secretion
Authors: Serge Brimioulle
Carlos Orellana-Jimenez
Adel Aminian
Jean-Louis Vincent
Publication date: 01-01-2008
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 1/2008
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-007-0905-7

At a glance: The STEP trials

Springer Medicine

Hyponatremia in neurological patients: cerebral salt wasting versus inappropriate antidiuretic hormone secretion

Abstract

Objective

Design

Setting

Patients

Interventions

Measurements and main results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Design

Setting

Patients

Interventions

Measurements and main results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2008

Why does airway pressure rise sometimes near the end of inflation during pressure support?

Liberal vs. conservative vasopressor use to maintain mean arterial blood pressure during resuscitation of septic shock: an observational study

The effect of epinephrine by nebulization on measures of airway obstruction in patients with acute severe croup

High-frequency percussive ventilation attenuates lung injury in a rabbit model of gastric juice aspiration

Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008

Burnout in a surgical ICU team