BACKGROUND: The reported prevalence of cerebral salt wasting has increased in the past three decades. A cerebral lesion and a large natriuresis without a known stimulus to excrete so much sodium (Na ) constitute its essential two elements. OBJECTIVES: To review the topic of cerebral salt wasting. There is a diagnostic problem because it is difficult to confirm that a stimulus for the renal excretion of Na is absent. DESIGN: Review article. INTERVENTION: None. MAIN RESULTS: Three fallacies concerning cerebral salt wasting are stressed: first, cerebral salt wasting is a common disorder; second, hyponatremia should be one of its diagnostic features; and third, most patients have a negative balance for Na when the diagnosis of cerebral salt wasting is made. Three causes for the large natriuresis were considered: first, a severe degree of extracellular fluid volume expansion could down-regulate transporters involved in renal Na resorption; second, an adrenergic surge could cause a pressure natriuresis; and third, natriuretic agents might become more potent when the effective extracellular fluid volume is high. CONCLUSIONS: Cerebral salt wasting is probably much less common than the literature suggests. With optimal treatment in the intensive care unit, hyponatremia should not develop.
BACKGROUND: The reported prevalence of cerebral salt wasting has increased in the past three decades. A cerebral lesion and a large natriuresis without a known stimulus to excrete so much sodium (Na ) constitute its essential two elements. OBJECTIVES: To review the topic of cerebral salt wasting. There is a diagnostic problem because it is difficult to confirm that a stimulus for the renal excretion of Na is absent. DESIGN: Review article. INTERVENTION: None. MAIN RESULTS: Three fallacies concerning cerebral salt wasting are stressed: first, cerebral salt wasting is a common disorder; second, hyponatremia should be one of its diagnostic features; and third, most patients have a negative balance for Na when the diagnosis of cerebral salt wasting is made. Three causes for the large natriuresis were considered: first, a severe degree of extracellular fluid volume expansion could down-regulate transporters involved in renal Na resorption; second, an adrenergic surge could cause a pressure natriuresis; and third, natriuretic agents might become more potent when the effective extracellular fluid volume is high. CONCLUSIONS:Cerebral salt wasting is probably much less common than the literature suggests. With optimal treatment in the intensive care unit, hyponatremia should not develop.
Authors: Serge Brimioulle; Carlos Orellana-Jimenez; Adel Aminian; Jean-Louis Vincent Journal: Intensive Care Med Date: 2007-10-19 Impact factor: 17.440
Authors: Josh Hanson; Amir Hossain; Prakaykaew Charunwatthana; Mahtab Uddin Hassan; Timothy M E Davis; Sophia W K Lam; S A Paul Chubb; Richard J Maude; Emran Bin Yunus; Gofranul Haque; Nicholas J White; Nicholas P J Day; Arjen M Dondorp Journal: Am J Trop Med Hyg Date: 2009-01 Impact factor: 2.345