Cerebral Salt Wasting Syndrome (CSWS) and Potentially Fatal Neurosurgical Hyponatremia

Abstract

Background: Hyponatremia is considered as a common electrolyte imbalance in hospitalized patients. Cerebral salt wasting syndrome (CSWS) is an abnormality in the renal sodium transport in patients with intracranial disease, in the face of preserved thyroid and adrenal function. However, treatment of CSW and syndrome of inappropriate antidiuretic hormone (SIADH) varies, making an accurate diagnosis significant. In order to differentiate CSWS from syndrome of inappropriate antidiuretic hormone (SIADH), this study aimed to detect CSWS related hyponatremia (benign and reversible condition) in its early stages. Methods: This retrospective cross-sectional study was conducted at the Department of Neurosurgery, Ziauddin Medical University Hospital, Karachi, Pakistan from August 2016 to August 2019. All patients who had a cerebral lesion along with hyponatremia and natriuresis were included. Patients with SIADH, though considered in the differential diagnosis, were not included in the study. Data was analyzed by using SPSS (Statistical Package for the Social Sciences) and p<0.05 was considered statistically significant. Results: A total of 39 patients in a period of three years were found with CSWS-related hyponatremia, predominantly males 28(71.8%), who were operated for cranial tumors 15(38.46%). All 39(100%) had an increased uric acid level. After treatment 31(79.5%) developed post-florinef hypokalemia, while, potassium remained unaffected in 8(20.5%). Hypokalemia was noted in majority of the patients 31(79.5%) treated with fludrocortisones. Conclusion: Cerebral salt wasting syndrome was found high among males with cranial tumors. Hyponatremia in CSWS patients was found challenging if untreated might lead to mortality. However, treatment with intravenous normal saline and fludrocortisone was successful in this course. Keywords: Hyponatremia; Natriuresis; Hypovolemia; Syndrome.