Cerebral Salt Wasting Syndrome: Diagnosis By Urine Sodium Excretion
Abstract Background Cerebral salt wasting syndrome (CSWS) was initially described over 60 years ago in hyponatremic patients with a cerebral lesion. However, the diagnostic criteria for CSWS have not been fully established. Thus, when hyponatremia is observed in patients with CSWS, they may be misdi...
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| description | Abstract Background Cerebral salt wasting syndrome (CSWS) was initially described over 60 years ago in hyponatremic patients with a cerebral lesion. However, the diagnostic criteria for CSWS have not been fully established. Thus, when hyponatremia is observed in patients with CSWS, they may be misdiagnosed as having the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Thus, it is critical to differentiate between these two conditions because their treatments are diametrically opposed. Methods We carried out a retrospective study of 45 patients with CSWS and compared them to 60 normonatremic control patients, and 28 patients with SIADH. All patients had their 24 hour urine volumes and Na excretion measured. Results Patients with either CSWS or SIADH had an elevated 24 hour urine osmolality (above 350 mOsm/kg). In patients with CSWS, urinary Na excretion was 394 ± 369 mmol/24 hour, and urinary volume was 2603 ± 996 ml/24 hour; both values significantly greater than in controls (p |
| doi_str_mv | 10.1016/j.amjms.2017.05.007 |
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However, the diagnostic criteria for CSWS have not been fully established. Thus, when hyponatremia is observed in patients with CSWS, they may be misdiagnosed as having the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Thus, it is critical to differentiate between these two conditions because their treatments are diametrically opposed. Methods We carried out a retrospective study of 45 patients with CSWS and compared them to 60 normonatremic control patients, and 28 patients with SIADH. All patients had their 24 hour urine volumes and Na excretion measured. Results Patients with either CSWS or SIADH had an elevated 24 hour urine osmolality (above 350 mOsm/kg). In patients with CSWS, urinary Na excretion was 394 ± 369 mmol/24 hour, and urinary volume was 2603 ± 996 ml/24 hour; both values significantly greater than in controls (p<0.01). By contrast, in patients with SIADH, the urine Na excretion was only 51± 25 mmol/24 hour and urine volume was 729 ± 488 ml/24 hour; values significantly lower than in patients with CSWS (p<0.01). Conclusions CSWS was diagnosed in patients with cerebral lesion who had: 1) symptomatic hyponatremia; 2) urine Na excretion 2 SD above controls; and 3) increased urine volume. Patients with SIADH also had symptomatic hyponatremia but, in contrast to CSWS patients, they had decreased Na excretion and urine volume. Thus urine Na excretion and volume are very important for diagnosing the cause of hyponatremia in patients with cerebral lesions.</description><identifier>ISSN: 0002-9629</identifier><identifier>EISSN: 1538-2990</identifier><identifier>DOI: 10.1016/j.amjms.2017.05.007</identifier><identifier>PMID: 29078838</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Brain Diseases - diagnosis ; Brain Diseases - urine ; Cerebral salt wasting ; Female ; Humans ; Hyponatremia - diagnosis ; Hyponatremia - urine ; Hyponatremic encephalopathy ; Internal Medicine ; Male ; Middle Aged ; Retrospective Studies ; Sodium - urine ; Syndrome ; Syndrome of inappropriate secretion of antidiuretic hormone ; Traumatic brain injury ; Urine sodium</subject><ispartof>The American journal of the medical sciences, 2017-10, Vol.354 (4), p.350-354</ispartof><rights>2017 Southern Society for Clinical Investigation</rights><rights>Copyright © 2017 by the Southern Society for Clinical Investigation. Unauthorized reproduction of this article is prohibited.</rights><rights>Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4594-406befa16482d61a7ff38143a3e14d99c9085871d99239dbe530af4dba425a043</citedby><cites>FETCH-LOGICAL-c4594-406befa16482d61a7ff38143a3e14d99c9085871d99239dbe530af4dba425a043</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29078838$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Arieff, Allen I., MD</creatorcontrib><creatorcontrib>Gabbai, Ramin, MD</creatorcontrib><creatorcontrib>Goldfine, Ira D., MD</creatorcontrib><title>Cerebral Salt Wasting Syndrome: Diagnosis By Urine Sodium Excretion</title><title>The American journal of the medical sciences</title><addtitle>Am J Med Sci</addtitle><description>Abstract Background Cerebral salt wasting syndrome (CSWS) was initially described over 60 years ago in hyponatremic patients with a cerebral lesion. However, the diagnostic criteria for CSWS have not been fully established. Thus, when hyponatremia is observed in patients with CSWS, they may be misdiagnosed as having the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Thus, it is critical to differentiate between these two conditions because their treatments are diametrically opposed. Methods We carried out a retrospective study of 45 patients with CSWS and compared them to 60 normonatremic control patients, and 28 patients with SIADH. All patients had their 24 hour urine volumes and Na excretion measured. Results Patients with either CSWS or SIADH had an elevated 24 hour urine osmolality (above 350 mOsm/kg). In patients with CSWS, urinary Na excretion was 394 ± 369 mmol/24 hour, and urinary volume was 2603 ± 996 ml/24 hour; both values significantly greater than in controls (p<0.01). By contrast, in patients with SIADH, the urine Na excretion was only 51± 25 mmol/24 hour and urine volume was 729 ± 488 ml/24 hour; values significantly lower than in patients with CSWS (p<0.01). Conclusions CSWS was diagnosed in patients with cerebral lesion who had: 1) symptomatic hyponatremia; 2) urine Na excretion 2 SD above controls; and 3) increased urine volume. Patients with SIADH also had symptomatic hyponatremia but, in contrast to CSWS patients, they had decreased Na excretion and urine volume. Thus urine Na excretion and volume are very important for diagnosing the cause of hyponatremia in patients with cerebral lesions.</description><subject>Brain Diseases - diagnosis</subject><subject>Brain Diseases - urine</subject><subject>Cerebral salt wasting</subject><subject>Female</subject><subject>Humans</subject><subject>Hyponatremia - diagnosis</subject><subject>Hyponatremia - urine</subject><subject>Hyponatremic encephalopathy</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Retrospective Studies</subject><subject>Sodium - urine</subject><subject>Syndrome</subject><subject>Syndrome of inappropriate secretion of antidiuretic hormone</subject><subject>Traumatic brain injury</subject><subject>Urine sodium</subject><issn>0002-9629</issn><issn>1538-2990</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU1v1DAQhi0EokvhFyChHLkkzNjOh5FAgqV8SJU4LBVHy3EmrbdJXOyEsv8ep1s4cMEXf-h9ZqxnGHuOUCBg9WpfmHE_xoID1gWUBUD9gG2wFE3OlYKHbAMAPFcVVyfsSYx7AOQNisfshCuom0Y0G7bdUqA2mCHbmWHOvps4u-ky2x2mLviRXmcfnLmcfHQxe3_ILoKbKNv5zi1jdvbLBpqdn56yR70ZIj2730_Zxcezb9vP-fnXT1-2785zK0slcwlVS73BSja8q9DUfS8alMIIQtkpZRU0ZVNjOnKhupZKAaaXXWskLw1IccpeHuveBP9joTjr0UVLw2Am8kvUqMpaKkQOKSqOURt8jIF6fRPcaMJBI-jVnt7rO3t6taeh1Mleol7cN1jakbq_zB9dKSCPgVs_zBTi9bDcUtBXlNxdpRJpSYn5WhPXS373krA3R4ySnZ8uEdE6mix1LpCddefdf_719h_eDm5y1gzXdKC490uYkniNOnINerfOfR071gJ4jUr8BmI9pDY</recordid><startdate>201710</startdate><enddate>201710</enddate><creator>Arieff, Allen I., MD</creator><creator>Gabbai, Ramin, MD</creator><creator>Goldfine, Ira D., MD</creator><general>Elsevier Inc</general><general>Copyright by the Southern Society for Clinical Investigation. Unauthorized reproduction of this article is prohibited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201710</creationdate><title>Cerebral Salt Wasting Syndrome: Diagnosis By Urine Sodium Excretion</title><author>Arieff, Allen I., MD ; Gabbai, Ramin, MD ; Goldfine, Ira D., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4594-406befa16482d61a7ff38143a3e14d99c9085871d99239dbe530af4dba425a043</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Brain Diseases - diagnosis</topic><topic>Brain Diseases - urine</topic><topic>Cerebral salt wasting</topic><topic>Female</topic><topic>Humans</topic><topic>Hyponatremia - diagnosis</topic><topic>Hyponatremia - urine</topic><topic>Hyponatremic encephalopathy</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Retrospective Studies</topic><topic>Sodium - urine</topic><topic>Syndrome</topic><topic>Syndrome of inappropriate secretion of antidiuretic hormone</topic><topic>Traumatic brain injury</topic><topic>Urine sodium</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Arieff, Allen I., MD</creatorcontrib><creatorcontrib>Gabbai, Ramin, MD</creatorcontrib><creatorcontrib>Goldfine, Ira D., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of the medical sciences</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Arieff, Allen I., MD</au><au>Gabbai, Ramin, MD</au><au>Goldfine, Ira D., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cerebral Salt Wasting Syndrome: Diagnosis By Urine Sodium Excretion</atitle><jtitle>The American journal of the medical sciences</jtitle><addtitle>Am J Med Sci</addtitle><date>2017-10</date><risdate>2017</risdate><volume>354</volume><issue>4</issue><spage>350</spage><epage>354</epage><pages>350-354</pages><issn>0002-9629</issn><eissn>1538-2990</eissn><abstract>Abstract Background Cerebral salt wasting syndrome (CSWS) was initially described over 60 years ago in hyponatremic patients with a cerebral lesion. However, the diagnostic criteria for CSWS have not been fully established. Thus, when hyponatremia is observed in patients with CSWS, they may be misdiagnosed as having the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Thus, it is critical to differentiate between these two conditions because their treatments are diametrically opposed. Methods We carried out a retrospective study of 45 patients with CSWS and compared them to 60 normonatremic control patients, and 28 patients with SIADH. All patients had their 24 hour urine volumes and Na excretion measured. Results Patients with either CSWS or SIADH had an elevated 24 hour urine osmolality (above 350 mOsm/kg). In patients with CSWS, urinary Na excretion was 394 ± 369 mmol/24 hour, and urinary volume was 2603 ± 996 ml/24 hour; both values significantly greater than in controls (p<0.01). By contrast, in patients with SIADH, the urine Na excretion was only 51± 25 mmol/24 hour and urine volume was 729 ± 488 ml/24 hour; values significantly lower than in patients with CSWS (p<0.01). Conclusions CSWS was diagnosed in patients with cerebral lesion who had: 1) symptomatic hyponatremia; 2) urine Na excretion 2 SD above controls; and 3) increased urine volume. Patients with SIADH also had symptomatic hyponatremia but, in contrast to CSWS patients, they had decreased Na excretion and urine volume. Thus urine Na excretion and volume are very important for diagnosing the cause of hyponatremia in patients with cerebral lesions.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>29078838</pmid><doi>10.1016/j.amjms.2017.05.007</doi><tpages>5</tpages></addata></record> |
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| subjects | Brain Diseases - diagnosis Brain Diseases - urine Cerebral salt wasting Female Humans Hyponatremia - diagnosis Hyponatremia - urine Hyponatremic encephalopathy Internal Medicine Male Middle Aged Retrospective Studies Sodium - urine Syndrome Syndrome of inappropriate secretion of antidiuretic hormone Traumatic brain injury Urine sodium |
| title | Cerebral Salt Wasting Syndrome: Diagnosis By Urine Sodium Excretion |
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