HDCN Abstract:  ASN Annual Meeting -- Philadelphia  

Arieff A, Gabbai R

Cerebral salt wasting syndrome: Role of volume contraction and potassium wasting.

ASN Annual Meeting -- Philadelphia
J Am Soc Nephrol (Nov) 16:532A 2005

Cerebral salt wasting syndrome (CSWS) has been described as a clinical syndrome in patients with hyponatremia (plasma Na < 128 mmol/L), a cerebral lesion and urine Na concentration > than plasma Na. The main differential diagnosis has been SIADH.

Over 4 yrs we prospectively studied 26 patients (12M, 14F: 56 22 yrs) who presented with symptomatic hyponatremia and urine monovalent cation (Na+K) concentration > 150 mmol/L. Patients had plasma Na 1188 mmol/L, normal renal function (Cr Cl =11031 ml/min), hypertonic urine (671156 mOsm/kg) and became hypotensive (systolic BP < 100 mm Hg) with fluid restriction. Presenting features included: dementia; recurrent seizures; and recurrent falls with orthopedic injury. The 24 hr urine monovalent cation loss was 356195 mmol (216 gm)/day of which 27% was K (102101 mmol/day) and the rest Na (261148 mmol/day).

Twelve patients, initially believed to have SIADH, were fluid restricted, which led to hypotension. When diagnosed, all initially required treatment with IV 3% NaCl. Eight died of underlying illness (7 malignant brain tumors) but 18/26 recovered. Survivors were eventually maintained with oral NaCl (6-14 gm/day). All 18 are active and maintained on oral NaCl tablets for over 3 years.

Conclusions: a) CSWS can be defined as a patient with symptomatic hyponatremia who is volume contracted and has lost sufficient (Na+K) in the urine to lower plasma Na below 128 mmol/L; b) Urinary loss of K is a major component in the pathogenesis of hyponatremia associated with CSWS; c) CSWS can be differentiated from SIADH by fluid restriction, which leads to hypotension; d) most patients with CSWS require emergency therapy with IV 3% NaCl, but can then be effectively managed with oral NaCl.

© Copyright 2005-2006, American Society of Nephrology. Reproduced with permission.
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