Advertisement

Intensive Care Medicine

, Volume 34, Issue 1, pp 125–131 | Cite as

Hyponatremia in neurological patients: cerebral salt wasting versus inappropriate antidiuretic hormone secretion

  • Serge BrimioulleEmail author
  • Carlos Orellana-Jimenez
  • Adel Aminian
  • Jean-Louis Vincent
Original

Abstract

Objective

To assess whether hyponatremia in acute neurological patients is associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) or with the cerebral salt-wasting syndrome (CSWS).

Design

Clinical, controlled, prospective study.

Setting

Department of intensive care of a tertiary care academic hospital.

Patients

Forty acute neurological patients with hyponatremia suggesting SIADH or CSWS (20) or with normonatremia (20).

Interventions

None.

Measurements and main results

Measurement of clinical and biological variables. Measurement of blood, plasma, and red blood cell volumes to discriminate SIADH and CSWS. Renal, adrenal and thyroid functions were normal in all patients. Average blood, plasma, and red blood cell volumes were 54, 37 and 17 ml/kg in control patients and 54, 37 and 18 ml/kg in hyponatremic patients, respectively.

Conclusions

The adequate blood volumes in hyponatremic patients confirm the diagnosis of SIADH and do not support the concept of CSWS.

Keywords

Antidiuretic hormone Natriuretic factor Natriuretic peptide Subarachnoid hemorrhage Brain trauma Intracranial disease 

Supplementary material

134_2007_905_MOESM1_ESM.doc (30 kb)
Electronic Supplementary Material (DOC 179K)

References

  1. 1.
    Peters JP, Welt LG, Sims EAH, Orloff J, Needham J (1950) A salt-wasting syndrome associated with cerebral disease. Trans Assoc Am Physicians 63:57–64PubMedGoogle Scholar
  2. 2.
    Cort JH (1954) Cerebral salt wasting. Lancet 1:752–754CrossRefGoogle Scholar
  3. 3.
    Schwartz WB, Bennett W, Curelop S, Bartter FC (1957) A syndrome of renal sodium loss and hyponatremia probably resulting from inappropriate secretion of antidiuretic hormone. Am J Med 23:529–542PubMedCrossRefGoogle Scholar
  4. 4.
    Bartter FC, Schwartz WB (1967) Syndrome of inappropriate secretion of antidiuretic hormone. Am J Med 42:790–806PubMedCrossRefGoogle Scholar
  5. 5.
    Nelson PB, Seif SM, Maroon JC, Robinson AG (1981) Hyponatremia in intracranial disease: perhaps not the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). J Neurosurg 55:938–941PubMedCrossRefGoogle Scholar
  6. 6.
    Wijdicks EFM, Vermeulen M, ten Haaf JA, Hijdra A, Bakker WH, van Gijn J (1985) Volume depletion and natriuresis in patients with a ruptured intracranial aneurysm. Ann Neurol 18:211–216PubMedCrossRefGoogle Scholar
  7. 7.
    Sivakumar V, Rajshekhar V, Chandy MJ (1994) Management of neurosurgical patients with hyponatremia and natriuresis. Neurosurgery 34:269–274PubMedCrossRefGoogle Scholar
  8. 8.
    Betjes MGH (2002) Hyponatremia in acute brain disease: the cerebral salt wasting syndrome. Eur J Intern Med 13:9–14PubMedCrossRefGoogle Scholar
  9. 9.
    Verbalis JG (1994) Pathogenesis of hyponatremia in an experimental model of the syndrome of inappropriate secretion of antidiuretic hormone. Am J Physiol 267:R1617–1625PubMedGoogle Scholar
  10. 10.
    Harrigan MR (1996) Cerebral salt wasting syndrome: a review. Neurosurgery 38:152–160PubMedCrossRefGoogle Scholar
  11. 11.
    Maesaka JK, Gupta S, Fishbane S (1999) Cerebral salt-wasting syndrome: does it exist? Nephron 82:100–109PubMedCrossRefGoogle Scholar
  12. 12.
    Oh MS, Carroll HJ (1999) Cerebral salt-wasting syndrome: we need better proof of its existence. Nephron 82:110–114PubMedCrossRefGoogle Scholar
  13. 13.
    Ellison DH, Berl T (2007) The syndrome of inappropriate antidiuresis. N Engl J Med 356:2064–2072PubMedCrossRefGoogle Scholar
  14. 14.
    International Committee for Standardization in Haematology (1980) Recommended methods for measurement of red-cell and plasma volume. J Nucl Med 21:793–800Google Scholar
  15. 15.
    Decaux G, Unger J, Brimioulle S, Mockel J (1982) Hyponatremia in the syndrome of inappropriate ADH secretion: rapid correction with urea, NaCl and water restriction. JAMA 247:471–474PubMedCrossRefGoogle Scholar
  16. 16.
    DeFronzo RA, Arieff AI (1995) Disorders of sodium metabolism. Hyponatremia. In: Arieff AI, DeFronzo RA (eds) Fluid, electrolyte and acid–base disorders. Churchill Livingstone, New York, pp 255–303Google Scholar
  17. 17.
    Shippy CR, Appel PL, Shoemaker WC (1984) Reliability of clinical monitoring to assess blood volume in critically ill patients. Crit Care Med 12:107–112PubMedCrossRefGoogle Scholar
  18. 18.
    Jones JG, Wardrop CAJ (2000) Measurement of blood volume in surgical and intensive care practice. Br J Anaesth 84:226–235PubMedGoogle Scholar
  19. 19.
    Pearson TC, Guthrie DL, Simpson J, Chinn S, Barosi G, Ferrant A, Lewis SM, Najean Y (1995) Interpretation of measured red cell mass and plasma volume in adults: expert panel on radionuclides of the International Council for Standardization in Haematology. Brit J Haematol 89:748–756CrossRefGoogle Scholar
  20. 20.
    Davy KP, Seals DR (1994) Total blood volume in healthy young and older men. J Appl Plysiol 76:2059–2062Google Scholar
  21. 21.
    Zorbas YG, Yarullin VL, Denogratov SD, Luzhkov YS, Kuznetsov NA (2002) Fluid volume compartments and biochemical measurements for disclosing fluid depletion during acute and rigorous bed rest in normal subjects. Intern Urol Nephrol 34:467–476CrossRefGoogle Scholar
  22. 22.
    Decaux G, Dumont I, Waterlot Y, Hanson B (1985) Mechanisms of hypouricemia in the syndrome of inappropriate secretion of antidiuretic hormone. Nephron 39:164–168PubMedGoogle Scholar
  23. 23.
    Decaux G, Prospert F, Cauchie P, Soupart A (1990) Dissociation between uric acid and urea clearances in the syndrome of inappropriate secretion of antidiuretic hormone related to salt excretion. Clin Sci 78:451–455PubMedGoogle Scholar
  24. 24.
    Singh S, Bohn D, Carlotti APCP, Cusimano M, Rutka JT, Halperin ML (2002) Cerebral salt wasting: truths, fallacies, theories, and challenges. Crit Care Med 30:2575–2579PubMedCrossRefGoogle Scholar
  25. 25.
    Al-Mufti H, Arieff AI (1984) Hyponatremia due to cerebral salt-wasting syndrome. Combined cerebral and distal tubular lesion. Am J Med 77:740–746PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Serge Brimioulle
    • 1
    Email author
  • Carlos Orellana-Jimenez
    • 1
  • Adel Aminian
    • 1
  • Jean-Louis Vincent
    • 1
  1. 1.Department of Intensive CareErasme University Hospital, Free University of BrusselsBrusselsBelgium

Personalised recommendations