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. 2001 Sep;85(3):246–251. doi: 10.1136/adc.85.3.246

Management of hyponatraemia in patients with acute cerebral insults

A Albanese 1, P Hindmarsh 1, R Stanhope 1
PMCID: PMC1718897  PMID: 11517113

Abstract

Hyponatraemia is a common finding in patients with acute cerebral insults. The main differential diagnosis is between syndrome of inappropriate ADH secretion and cerebral salt wasting. Our aim is to review the topic of hyponatraemia in patients with acute cerebral insults and suggest a clinical approach to diagnosis and management.


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Selected References

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  1. Atkin S. L., Coady A. M., White M. C., Mathew B. Hyponatraemia secondary to cerebral salt wasting syndrome following routine pituitary surgery. Eur J Endocrinol. 1996 Aug;135(2):245–247. doi: 10.1530/eje.0.1350245. [DOI] [PubMed] [Google Scholar]
  2. Baylis P. H., Cheetham T. Diabetes insipidus. Arch Dis Child. 1998 Jul;79(1):84–89. doi: 10.1136/adc.79.1.84. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Damaraju S. C., Rajshekhar V., Chandy M. J. Validation study of a central venous pressure-based protocol for the management of neurosurgical patients with hyponatremia and natriuresis. Neurosurgery. 1997 Feb;40(2):312–317. doi: 10.1097/00006123-199702000-00015. [DOI] [PubMed] [Google Scholar]
  4. Diringer M., Ladenson P. W., Borel C., Hart G. K., Kirsch J. R., Hanley D. F. Sodium and water regulation in a patient with cerebral salt wasting. Arch Neurol. 1989 Aug;46(8):928–930. doi: 10.1001/archneur.1989.00520440124031. [DOI] [PubMed] [Google Scholar]
  5. Diringer M., Ladenson P. W., Borel C., Hart G. K., Kirsch J. R., Hanley D. F. Sodium and water regulation in a patient with cerebral salt wasting. Arch Neurol. 1989 Aug;46(8):928–930. doi: 10.1001/archneur.1989.00520440124031. [DOI] [PubMed] [Google Scholar]
  6. Diringer M., Ladenson P. W., Stern B. J., Schleimer J., Hanley D. F. Plasma atrial natriuretic factor and subarachnoid hemorrhage. Stroke. 1988 Sep;19(9):1119–1124. doi: 10.1161/01.str.19.9.1119. [DOI] [PubMed] [Google Scholar]
  7. Dunger D. B., Seckl J. R., Grant D. B., Yeoman L., Lightman S. L. A short water deprivation test incorporating urinary arginine vasopressin estimations for the investigation of posterior pituitary function in children. Acta Endocrinol (Copenh) 1988 Jan;117(1):13–18. doi: 10.1530/acta.0.1170013. [DOI] [PubMed] [Google Scholar]
  8. Espiner E. A. Physiology of natriuretic peptides. J Intern Med. 1994 Jun;235(6):527–541. doi: 10.1111/j.1365-2796.1994.tb01261.x. [DOI] [PubMed] [Google Scholar]
  9. Grundy R., Larcher V., Gosden R. G., Hewitt M., Leiper A., Spoudeas H. A., Walker D., Wallace W. H. Fertility preservation for children treated for cancer (2): ethics of consent for gamete storage and experimentation. Arch Dis Child. 2001 Apr;84(4):360–362. doi: 10.1136/adc.84.4.360. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Hansell P., Göransson A., Leppäluoto J., Arjamaa O., Vakkuri O., Ulfendahl H. R. CNS-induced natriuresis is not mediated by the atrial natriuretic factor. Acta Physiol Scand. 1987 Feb;129(2):221–227. doi: 10.1111/j.1748-1716.1987.tb08062.x. [DOI] [PubMed] [Google Scholar]
  11. Hill P., Taylor E. An auditable protocol for treating attention deficit/hyperactivity disorder. Arch Dis Child. 2001 May;84(5):404–409. doi: 10.1136/adc.84.5.404. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Ishikawa S. E., Saito T., Kaneko K., Okada K., Kuzuya T. Hyponatremia responsive to fludrocortisone acetate in elderly patients after head injury. Ann Intern Med. 1987 Feb;106(2):187–191. doi: 10.7326/0003-4819-106-2-187. [DOI] [PubMed] [Google Scholar]
  13. Isotani E., Suzuki R., Tomita K., Hokari M., Monma S., Marumo F., Hirakawa K. Alterations in plasma concentrations of natriuretic peptides and antidiuretic hormone after subarachnoid hemorrhage. Stroke. 1994 Nov;25(11):2198–2203. doi: 10.1161/01.str.25.11.2198. [DOI] [PubMed] [Google Scholar]
  14. Kanagasundaram S. A., Lane L. J., Cavalletto B. P., Keneally J. P., Cooper M. G. Efficacy and safety of nitrous oxide in alleviating pain and anxiety during painful procedures. Arch Dis Child. 2001 Jun;84(6):492–495. doi: 10.1136/adc.84.6.492. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Kappy M. S., Ganong C. A. Cerebral salt wasting in children: the role of atrial natriuretic hormone. Adv Pediatr. 1996;43:271–308. [PubMed] [Google Scholar]
  16. Kirchlechner V., Koller D. Y., Seidl R., Waldhauser F. Treatment of nephrogenic diabetes insipidus with hydrochlorothiazide and amiloride. Arch Dis Child. 1999 Jun;80(6):548–552. doi: 10.1136/adc.80.6.548. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Maesaka J. K., Gupta S., Fishbane S. Cerebral salt-wasting syndrome: does it exist? Nephron. 1999 Jun;82(2):100–109. doi: 10.1159/000045384. [DOI] [PubMed] [Google Scholar]
  18. Menniti-Ippolito F., Sagliocca L., Da Cas R., Saggiomo G., Di Nardo R., Traversa G. Niflumic acid and cutaneous reactions in children. Arch Dis Child. 2001 May;84(5):430–431. doi: 10.1136/adc.84.5.430. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Mewasingh L., Aylett S., Kirkham F., Stanhope R. Hyponatraemia associated with lamotrigine in cranial diabetes insipidus. Lancet. 2000 Aug 19;356(9230):656–656. doi: 10.1016/S0140-6736(00)02613-1. [DOI] [PubMed] [Google Scholar]
  20. Morinaga K., Hayashi S., Matsumoto Y., Omiya N., Mikami J., Sato H., Inoue Y., Okawara S. [Therapeutic effect of mineralocorticoid in patients with hyponatremia of central origin]. No To Shinkei. 1994 Jun;46(6):545–548. [PubMed] [Google Scholar]
  21. Nelson P. B., Seif S. M., Maroon J. C., Robinson A. G. Hyponatremia in intracranial disease: perhaps not the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). J Neurosurg. 1981 Dec;55(6):938–941. doi: 10.3171/jns.1981.55.6.0938. [DOI] [PubMed] [Google Scholar]
  22. PETERS J. P., WELT L. G., SIMS E. A. H., ORLOFF J., NEEDHAM J. A salt-wasting syndrome associated with cerebral disease. Trans Assoc Am Physicians. 1950;63:57–64. [PubMed] [Google Scholar]
  23. Sakarcan A., Bocchini J., Jr The role of fludrocortisone in a child with cerebral salt wasting. Pediatr Nephrol. 1998 Nov;12(9):769–771. doi: 10.1007/s004670050543. [DOI] [PubMed] [Google Scholar]
  24. Sivakumar V., Rajshekhar V., Chandy M. J. Management of neurosurgical patients with hyponatremia and natriuresis. Neurosurgery. 1994 Feb;34(2):269–274. doi: 10.1227/00006123-199402000-00010. [DOI] [PubMed] [Google Scholar]
  25. Unsworth D. J. Adrenaline syringes are vastly over prescribed. Arch Dis Child. 2001 May;84(5):410–411. doi: 10.1136/adc.84.5.410. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Van Amelsvoort T., Bakshi R., Devaux C. B., Schwabe S. Hyponatremia associated with carbamazepine and oxcarbazepine therapy: a review. Epilepsia. 1994 Jan-Feb;35(1):181–188. doi: 10.1111/j.1528-1157.1994.tb02930.x. [DOI] [PubMed] [Google Scholar]
  27. Wijdicks E. F., Vermeulen M., ten Haaf J. A., Hijdra A., Bakker W. H., van Gijn J. Volume depletion and natriuresis in patients with a ruptured intracranial aneurysm. Ann Neurol. 1985 Aug;18(2):211–216. doi: 10.1002/ana.410180208. [DOI] [PubMed] [Google Scholar]
  28. Wijdicks E. F., Vermeulen M., van Brummelen P., den Boer N. C., van Gijn J. Digoxin-like immunoreactive substance in patients with aneurysmal subarachnoid haemorrhage. Br Med J (Clin Res Ed) 1987 Mar 21;294(6574):729–732. doi: 10.1136/bmj.294.6574.729. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Yamada K., Goto A., Nagoshi H., Hui C., Omata M. Role of brain ouabainlike compound in central nervous system-mediated natriuresis in rats. Hypertension. 1994 Jun;23(6 Pt 2):1027–1031. doi: 10.1161/01.hyp.23.6.1027. [DOI] [PubMed] [Google Scholar]
  30. Yamamoto N., Kuwayama A., Miyamoto N., Seo H., Matsui N. Elevation of plasma atrial natriuretic peptide in a neurosurgical patient with the syndrome of inappropriate secretion of antidiuretic hormone--case report. Neurol Med Chir (Tokyo) 1989 Mar;29(3):255–258. doi: 10.2176/nmc.29.255. [DOI] [PubMed] [Google Scholar]
  31. Zafonte R. D., Mann N. R. Cerebral salt wasting syndrome in brain injury patients: a potential cause of hyponatremia. Arch Phys Med Rehabil. 1997 May;78(5):540–542. doi: 10.1016/s0003-9993(97)90173-8. [DOI] [PubMed] [Google Scholar]

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