scholarly journals Hyponatremia in Acute Stroke Patients: Pathophysiology, Clinical Significance, and Management Options

2019 ◽  
Vol 82 (1-3) ◽  
pp. 32-40 ◽  
Author(s):  
George Liamis ◽  
Fotios Barkas ◽  
Efstathia Megapanou ◽  
Eliza Christopoulou ◽  
Andromachi Makri ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Sodium Level ◽  
Hormone Secretion ◽  
Fluid Restriction ◽  
Hypertonic Solution ◽  
Stroke Patients ◽  
Volume Depletion ◽  
Management Options ◽  
Cerebral Salt Wasting ◽  
Inappropriate Antidiuretic Hormone Secretion

Background: Hyponatremia is frequent in acute stroke patients, and it is associated with worse outcomes and increased mortality. Summary: Nonstroke-related causes of hyponatremia include patients’ comorbidities and concomitant medications, such as diabetes mellitus, chronic kidney disease, heart failure, and thiazides. During hospitalization, “inappropriate” administration of hypotonic solutions, poor solute intake, infections, and other drugs, such as mannitol, could also lower sodium levels in patients with acute stroke. On the other hand, secondary adrenal insufficiency due to pituitary ischemia or hemorrhage, syndrome of inappropriate antidiuretic hormone secretion, and cerebral salt wasting are additional stroke-related causes of hyponatremia. Although it is yet unclear whether the appropriate restoration of sodium level improves outcomes in patients with acute stroke, the restoration of the volume depletion remains the cornerstone of treatment in hypovolemic hyponatremia. In case of hyper- and euvolemic hyponatremia, apart from the correction of the underlying cause (e.g., withdrawal of an offending drug), fluid restriction, administration of hypertonic solution, loop diuretics, and vasopressin-receptor antagonists (vaptans) are among the therapeutic options. Key Messages: Hyponatremia is frequent in patients with acute stroke. The plethora of underlying etiologies warrants a careful differential diagnosis which should take into consideration comorbidities, concurrent medication, findings from the clinical examination, and laboratory measurements, which in turn will guide management decisions. However, it is yet unclear whether the appropriate restoration of sodium level improves outcomes in patients with acute stroke.

scholarly journals Cerebral salt wasting in a patient with myeloproliferative neoplasm

2019 ◽  
Author(s):  
Lea Orlik ◽  
Reto Venzin ◽  
Thomas Fehr ◽  
Karin Hohloch
Keyword(s):  
Hormone Secretion ◽  
Myeloproliferative Neoplasm ◽  
Visual Disturbance ◽  
Mental Condition ◽  
Microcirculatory Disturbance ◽  
Volume Depletion ◽  
Severe Hyponatremia ◽  
Cerebral Salt Wasting ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Salt Wasting

Abstract Background: Cerebral salt wasting (CSW) is a rare metabolic disorder with severe hyponatremia and volume depletion usually caused by brain injury like trauma, cerebral lesion, tumor or a cerebral hematoma. The renal function is normal with excretion of very high amounts of sodium in the urine. Diagnosis is made by excluding other reasons for hyponatremia, mainly the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Case report: A 60-year-old patient was admitted to the emergency room with pain in the upper abdomen and visual disturbance two weeks after knee replacement. The patient was confused with severe hematoma at the site of the knee endoprosthesis. Laboratory values showed massive thrombocytosis, leukocytosis, anemia, severe hyponatremia and no evidence of infection. CT scan of the abdomen was inconspicuous. Head MRI showed no ischemia or bleeding, but a mild microangiopathy. A myeloproliferative neoplasm (MPN) was suspected and confirmed by bone marrow biopsy. Cerebral salt wasting syndrome was identified as the cause of severe hyponatremia most likely provoked by cerebral microcirculatory disturbance. The hematoma at the operation site was interpreted as a result of a secondary von Willebrand syndrome (vWS) due to the myeloproliferative neoplasm with massive thrombocytosis. After starting cytoreductive therapy with hydroxycarbamide, thrombocytosis and blood sodium slowly improved along with normalization of his mental condition. Conclusion: To the best of our knowledge this is the first description of a patient with CSW most likely caused by a microcirculatory disturbance due to a massive thrombocytosis in the context of a myeloproliferative neoplasm.

scholarly journals Cerebral salt wasting in a patient with myeloproliferative neoplasm

2019 ◽  
Author(s):  
Lea Orlik ◽  
Reto Venzin ◽  
Thomas Fehr ◽  
Karin Hohloch
Keyword(s):  
Hormone Secretion ◽  
Myeloproliferative Neoplasm ◽  
Volume Depletion ◽  
Severe Hyponatremia ◽  
Cerebral Salt Wasting ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Salt Wasting ◽  
Cerebral Hematoma ◽  
Very High ◽  
Rare Metabolic Disorder

Abstract Background Cerebral salt wasting (CSW) is a rare metabolic disorder with severe hyponatremia and volume depletion usually caused by brain injury like trauma, cerebral lesion, tumor or a cerebral hematoma. The renal function is normal with excretion of very high amounts of sodium in the urine. Diagnosis is made by excluding other reasons for hyponatremia, mainly the syndrome of inappropriate antidiuretic hormone secretion (SIADH).

scholarly journals Cerebral salt wasting in a patient with myeloproliferative neoplasm

2019 ◽  
Author(s):  
Lea Orlik ◽  
Reto Venzin ◽  
Thomas Fehr ◽  
Karin Hohloch
Keyword(s):  
Hormone Secretion ◽  
Myeloproliferative Neoplasm ◽  
Volume Depletion ◽  
Severe Hyponatremia ◽  
Cerebral Salt Wasting ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Salt Wasting ◽  
Cerebral Hematoma ◽  
Very High ◽  
Rare Metabolic Disorder

Abstract Background Cerebral salt wasting (CSW) is a rare metabolic disorder with severe hyponatremia and volume depletion usually caused by brain injury like trauma, cerebral lesion, tumor or a cerebral hematoma. The renal function is normal with excretion of very high amounts of sodium in the urine. Diagnosis is made by excluding other reasons for hyponatremia, mainly the syndrome of inappropriate antidiuretic hormone secretion (SIADH).

scholarly journals Cerebral salt wasting in a patient with myeloproliferative neoplasm

2019 ◽  
Author(s):  
Lea Orlik ◽  
Reto Venzin ◽  
Thomas Fehr ◽  
Karin Hohloch
Keyword(s):  
Hormone Secretion ◽  
Myeloproliferative Neoplasm ◽  
Visual Disturbance ◽  
Mental Condition ◽  
Microcirculatory Disturbance ◽  
Volume Depletion ◽  
Severe Hyponatremia ◽  
Cerebral Salt Wasting ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Salt Wasting

Abstract Background: Cerebral salt wasting (CSW) is a rare metabolic disorder with severe hyponatremia and volume depletion usually caused by brain injury like trauma, cerebral lesion, tumor or a cerebral hematoma. The renal function is normal with excretion of very high amounts of sodium in the urine. Diagnosis is made by excluding other reasons for hyponatremia, mainly the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Case report: A 60-year-old patient was admitted to the emergency room with pain in the upper abdomen and visual disturbance two weeks after knee replacement. The patient was confused with severe hematoma at the site of the knee endoprosthesis. Laboratory values showed massive thrombocytosis, leukocytosis, anemia, severe hyponatremia and no evidence of infection. CT scan of the abdomen was inconspicuous. Head MRI showed no ischemia or bleeding, but a mild microangiopathy. A myeloproliferative neoplasm (MPN) was suspected and confirmed by bone marrow biopsy. Cerebral salt wasting syndrome was identified as the cause of severe hyponatremia most likely provoked by cerebral microcirculatory disturbance. The hematoma at the operation site was interpreted as a result of a secondary von Willebrand syndrome (vWS) due to the myeloproliferative neoplasm with massive thrombocytosis. After starting cytoreductive therapy with hydroxycarbamide, thrombocytosis and blood sodium slowly improved along with normalization of his mental condition. Conclusion: To the best of our knowledge this is the first description of a patient with CSW most likely caused by a microcirculatory disturbance due to a massive thrombocytosis in the context of a myeloproliferative neoplasm.

scholarly journals Cerebral salt wasting in a case of tubercular meningitis in a child

2017 ◽  
Vol 4 (6) ◽  
pp. 2217
Author(s):  
Kapil Bainade ◽  
V. Kotrashetti ◽  
Vijay Sonwane ◽  
Rizwan Ahmed ◽  
Prashant Abusaria
Keyword(s):  
Serum Sodium ◽  
Hormone Secretion ◽  
Final Diagnosis ◽  
Total Leukocyte Count ◽  
Fluid Restriction ◽  
Communicating Hydrocephalus ◽  
Cerebral Salt Wasting ◽  
Meningeal Enhancement ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Salt Wasting

A 12-year-old female child presented with fever, headache, vomiting since 20 days and convulsions for 1 day. She was unimmunised and BCG scar was absent. Clinical examination showed signs of meningeal irritation, Kernigs sign and Brudzinkins sign with signs of raised intracranial tension. Fundus examination was suggestive of stage 2 papilledema. Her laboratory reports were normal on admission. LP was with hold in view of raised ICT. CT brain was done. S/O meningeal enhancement, mild communicating hydrocephalus with periventricular ooze, extra axial hyper densities in bilateral sylvian fissures along the tentorium (Basal Exudates) On day 3 of admission she had low serum sodium, serum osmolality High urinary sodium. While on lumbar puncture (LP) and cerebrospinal fluid (CSF) examination, CSF protein, and total leukocyte count (predominant lymphocytes) were all increased. On his 5th day of admission, her serum sodium was low and he had a normal urine output. Fluid restriction was tried in order to rule out syndrome of inappropriate antidiuretic hormone secretion (SIADH) but the patient did not respond to it. Keeping in view the above findings, a final diagnosis of tuberculous meningitis leading to cerebral salt wasting syndrome was made. The patient was started on anti-tuberculous therapy (ATT), IV Steroids, anticonvulsants, 3% NaCl and supportive treatment, to which she responded favourably and was later discharged. 

Pre-eclampsia complicated by severe hyponatraemia

2020 ◽  
Vol 13 (12) ◽  
pp. e237827
Author(s):  
Annalisa Montebello ◽  
John Thake ◽  
Sandro Vella ◽  
Josanne Vassallo
Keyword(s):  
Caesarean Section ◽  
Sodium Level ◽  
Hormone Secretion ◽  
Fetal Distress ◽  
Emergency Caesarean Section ◽  
Fluid Restriction ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
Severe Hyponatraemia ◽  
Fetal Tachycardia

A 41-year-old woman was diagnosed with pre-eclampsia at 35 weeks gestation. She was treated with antihypertensives but, unfortunately, her condition became complicated by severe hyponatraemia. Her sodium levels rapidly dropped to 125 mmol/L. The cause for the hyponatraemia was the syndrome of inappropriate antidiuretic hormone secretion. She was initially managed with fluid restriction, but an emergency caesarean section was necessary in view of fetal distress. Her sodium levels returned to normal within 48 hours of delivery.Pre-eclampsia is rarely associated with hyponatraemia. A low maternal sodium level further increases the mother’s risk for seizures during this state. Additionally, the fetal sodium rapidly equilibrates to the mother’s and may result in fetal tachycardia, jaundice and polyhdraminios. All these factors may necessitate an emergency fetal delivery.

scholarly journals SIADH in COVID 19 infection, an association or cause : A case report

2020 ◽  
Vol 8 (2) ◽  
pp. 126-128
Author(s):  
Karishma Shamarukh ◽  
Sharmin Rahman ◽  
Umme Kulsum Chy ◽  
Amina Sultana ◽  
Mohammad Omar Faruq
Keyword(s):  
Case Report ◽  
Antidiuretic Hormone ◽  
Hypertonic Saline ◽  
Sodium Level ◽  
Hormone Secretion ◽  
Fluid Restriction ◽  
Laboratory Parameters ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
Low Sodium

One of the leading cause of hyponatremia is syndrome of inappropriate antidiuretic hormone secretion (SIADH). Various etiologies of hyponatraemia have been observed till today but its association with Covid leading to SIADH is rare. Therefore, we present a case where SIADH was associated with Covid-19 pneumonia. This was a case of a 66 years old male with multiple co-morbidities presenting with symptoms of Covid infection including generalized weakness. After confirming Covid 19 infection management was started accordingly but patient’s weakness seemed to increase. He was found to have low sodium level of 105 mmol /L and investigations confirmed that he was having SIADH. He was treated with hypertonic saline, fluid restriction and his symptoms and laboratory parameters gradually improved. Bangladesh Crit Care J September 2020; 8(2): 126-128

scholarly journals Tolvaptan Use to Treat SIADH in a Child

2018 ◽  
Vol 23 (6) ◽  
pp. 494-498
Author(s):  
Adem Yasin Koksoy ◽  
Meltem Kurtul ◽  
Aslı Kantar Ozsahin ◽  
Fatma Semsa Cayci ◽  
Meltem Tayfun ◽  
...  
Keyword(s):  
Hypertonic Saline ◽  
Treatment Option ◽  
Pediatric Patients ◽  
Hormone Secretion ◽  
Saline Infusion ◽  
Fluid Restriction ◽  
Effective Treatment Option ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Electrolyte Abnormalities ◽  
Hypertonic Saline Infusion

Hyponatremia is one of the most common electrolyte abnormalities encountered in the clinical setting in hospitalized patients. The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the leading cause of hyponatremia in most of these cases. While fluid restriction, hypertonic saline infusion, diuretics, and the treatment of underlying conditions constitute the first line of treatment of SIADH, in refractory cases, and especially for pediatric patients, there seems not to be any other choice for treatment. Tolvaptan, although its use in pediatric patients is still very limited, might be an attractive treatment option for correction of hyponatremia due to SIADH. Here we present a pediatric case of SIADH that was resistant to treatment with fluid restriction and hypertonic saline infusion and was treated successfully with tolvaptan. Tolvaptan could be a good, safe, and effective treatment option in pediatric SIADH cases that are resistant to treatment. However, the dosage should be titrated carefully.

Sign in / Sign up

Export Citation Format

Share Document