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Cerebral salt wasting: truths, fallacies, theories, and challenges
Sheila Singh1, Desmond Bohn, Ana P C P Carlotti
1Department of Pediatric Neurosurgery, Hospital for Sick Children, Toronto, Canada.
Critical Care Medicine
|November 21, 2002
Summary
Cerebral salt wasting is likely less common than reported. Hyponatremia should not be a diagnostic feature or develop with proper intensive care unit treatment.
Area of Science:
- Nephrology
- Neurology
- Internal Medicine
Background:
- The reported prevalence of cerebral salt wasting has increased significantly over the last 30 years.
- Cerebral salt wasting is characterized by a cerebral lesion and significant sodium (Na) loss without a clear stimulus.
- A key diagnostic challenge is confirming the absence of a stimulus for renal sodium excretion.
Purpose of the Study:
- To critically review the diagnosis and understanding of cerebral salt wasting.
- To address diagnostic challenges and common misconceptions regarding cerebral salt wasting.
Main Methods:
- This study is a review article.
- No specific interventions were performed.
Main Results:
- Three common misconceptions about cerebral salt wasting are highlighted: its supposed commonality, the necessity of hyponatremia for diagnosis, and a negative sodium balance at diagnosis.
- Potential causes for excessive natriuresis include extracellular fluid volume expansion, adrenergic surge leading to pressure natriuresis, and potentiation of natriuretic agents.
Conclusions:
- Cerebral salt wasting is likely much rarer than suggested by current literature.
- With optimal intensive care unit management, hyponatremia should be preventable in patients with cerebral salt wasting.