Cerebral salt wasting in a child with cervicothoracic hematoma

Area of Science:

• Pediatric Neurology
• Nephrology
• Trauma Medicine

Background:

• Syndrome of inappropriate antidiuretic hormone secretion (SIADH) and cerebral salt wasting (CSW) are common causes of hyponatremia in CNS disorders.
• CSW is rarely reported in children, presenting diagnostic and therapeutic challenges.
• Distinguishing between SIADH and CSW is critical due to differing management strategies.

Observation:

• A pediatric case of cervicothoracic hematoma secondary to trauma presented with hyponatremia.
• Cerebral salt wasting (CSW) was diagnosed based on high urinary sodium excretion, hyponatremia, and low serum osmolarity.
• Absence of brain edema did not rule out CSW.

Findings:

• The patient exhibited high urinary sodium excretion and hyponatremia, consistent with CSW.
• Serum sodium levels improved with saline hydration, confirming the CSW diagnosis.
• This case highlights CSW as a potential cause of hyponatremia in pediatric trauma.

Implications:

• Cerebral salt wasting (CSW) should be considered in pediatric patients with cervicothoracic hematoma and hyponatremia, even without brain edema.
• Accurate diagnosis of CSW is essential for appropriate management, contrasting with SIADH treatment.
• Early identification and fluid expansion therapy can prevent complications in pediatric CSW cases.