The isotonic fluid provides the fluid for the hypovolemic patient as well as helps to restore the body's sodium stores. Typically, the patient is started on isotonic saline for mild to moderate cases of hyponatremia of cerebral salt wasting. Secondly, the patient must be volume repleted while treating the hyponatremia. This treatment is covered in the StatPearls article on acute subarachnoid hemorrhage. The treatment of cerebral salt wasting (CSW) and syndrome of inappropriate secretion of antidiuretic of hormone (SIADH) is very different, so it is critical to have the correct diagnosis prior to initiating treatment.Īs cerebral salt wasting typically occurs after aneurysmal subarachnoid hemorrhage, the first treatment strategies are targeted at treating the underlying subarachnoid hemorrhage and aneurysm or another CNS insult. Many times cerebral salt wasting becomes a diagnosis of exclusion after labs reveal serum hyponatremia with increased urine sodium levels. Other potential causes of hyponatremia should also be sought including polydipsia, renal disease, use of diuretics, heart failure, hypothyroidism, heart failure, malignancies, hormone deficiency, and pseudohyponatremia. However, with SIADH, the patient is euvolemic to hypervolemic from the retained free water as compared to the hypovolemic picture of cerebral salt wasting. Syndrome of inappropriate secretion of antidiuretic of hormone (SIADH) will have a similar laboratory picture as cerebral salt wasting with hyponatremia and increased urine sodium. The patient must also have signs or symptoms of hypovolemia such as hypotension, decreased central venous pressure, lack of skin turgor, or elevated hematocrit. Urine osmolality is elevated above 100 mosmol/kg. Urine sodium is typically elevated above 40 meq/L. Urine studies are commonly checked for urine sodium and osmolality. Evaluation for cerebral salt wasting begins with a basic metabolic panel (BMP) to identify the hyponatremia (serum sodium less than 135 meq/L). It is critically important to distinguish cerebral salt wasting (CSW) from the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) as the treatments are opposite.
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