The association between hyponatremia and intracranial pathology has been well described. When accompanied by natriuresis, hyponatremia has most commonly been attributed to inappropriate secretion of antidiuretic hormone. However, there is growing evidence to suggest that many of these patients may actually have cerebrally mediated salt losses, a disorder referred to as the cerebral salt wasting syndrome (CSWS). While this syndrome has been reasonably well described in adults, data regarding CSWS in pediatric-aged patients remains sparse. Since fluid management of these disorders is different, it is important that the clinician be able to rapidly differentiate between them. We report three cases of CSWS in acutely brain-injured children and comment on the role that early quantitation of urine volume and urine sodium concentration had in rapidly establishing the correct diagnosis.

Kappy MS, Ganong CA: Cerebral salt wasting in children: The role of atrial natriuretic hormone. Adv Pediatr 1996;43:271–308.
Bussmann C, Bust T, Rating D: Hyponatremia in children with acute CNS disease: SIADH or cerebral salt wasting? Childs Nerv Syst 2001;17:58–63.
Oh MS, Carroll HJ: Cerebral salt-wasting syndrome: We need better proof of its existence. Nephron 1999;82:110–114.
Nelson PB, Seif SM, Maroon JC, Robinson AG: Hyponatremia in intracranial disease: Perhaps not the syndrome of inappropriate antidiuretic hormone (SIADH). J Neurosurg 1981;55:938–941.
Bianchetti MG, Thyssen HR, Laux-End R, Schaad UB: Evidence for fluid volume depletion in hyponatraemic patients with bacterial meningitis. Acta Paediatr 1996;85:1163–1166.
Fox JL, Falik JL, Shaloub RJ: Neurosurgical hyponatremia: The role of inappropriate antidiuresis. J Neurosurg 1971;34:506–514.
Schwartz WB, Bennett W, Curelop S: A syndrome of renal sodium loss and hyponatremia probably resulting from inappropriate secretion of antidiuretic hormone. Am Med J 1957;23:529–542.
Wijdicks EFM, Vermeulen M, Hijdra A, van Gijn J: Hyponatremia and cerebral infarction in patients with a ruptured intracranial aneurysm: Is fluid restriction harmful? Ann Neurol 1985;17:137–140.
Wijdicks EFM, Vermeulen M, ten Haaf JA, Hijdra A, Bakker WH, van Gijn J: Volume depletion and natriuresis in patients with a ruptured intracranial aneurysm. Ann Neurol 1985;18:211–216.
Sivakamur V, Rajshekhar V, Chandy MJ: Management of neurosurgical patients with hyponatremia and natriuresis. Neurosurgery 1994;34:269–274.
Damaraju SC, Rajshekhar V, Chandy MJ: Validation study of a central venous pressure-based protocol for the management of neurosurgical patients with hyponatremia and natriuresis. Neurosurgery 1997;40:312–317.
Palmer BF: Hyponatraemia in a neurosurgical patient: Syndrome of inappropriate antidiuretic hormone secretion versus cerebral salt wasting. Nephrol Dial Transplant 2000;15:262–268.
Albanese A, Hindmarsh P, Stanhope R: Management of hyponatremia in patients with acute cerebral insults. Arch Dis Child 2001;85:246–251.
Mocan H, Eduran E, Aslan Y, Gedik Y, Okten A, Deser O, Gor A: Two disturbances of water and electrolyte metabolism in patients with tuberculous meningitis: Cerebral salt wasting (CSW) and the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Pediatr Today 1995;3:8–15.
Rudman D, Racette D, Rudman IW, Mattson DE, Erve PR: Hyponatremia in tube-fed elderly men. J Chronic Dis 1986;39:73–80.
Harrigan MR: Cerebral salt wasting syndrome. Crit Care Clin 2001;17:125–138.
Kappy MS, Ganong CA: Cerebral salt wasting in children: The need for recognition and treatment. Am J Dis Child 1993;147:167–169.
Donati-Genet PC, Dubuis J-M, Girardin E, Rimensberger PC: Acute symptomatic hyponatremia and cerebral salt wasting after head injury: An important clinical entity. J Pediatr Surg 2001;36:1094–1097.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.