Prolonged coexistent central diabetes insipidus and cerebral salt wasting syndrome following neurosurgery

Background: Disorders of sodium balance are common in critically ill neurologic patients. However, the coexisting of cerebral salt wasting syndrome (CSW) and central diabetes insipidus (CDI) in such patients is rare. Early recognition of such conditions is challenging, thus making the prognosis ominous. Case Presentation: A 50-year-old male patient presented with acute posterior cerebrovascular infarction complicated by several attacks of disturbed sodium homeostasis. The first attack manifested as hypernatremia (up to 161 mmol/L) and polyuria with high urine sodium (188 mmol/L) could only be explained by CSW on top of CDI. Especially the patient was not receiving any hyperosmolar or sodium-containing fluids. Serum sodium was corrected by desmopressin acetate. Later, the patient developed 2 attacks of hyponatremia (down to 119 mmol/L) diagnosed as CSW that was treated with fludrocortisone. Finally, he developed hypernatremia (up to 165 mmol/L) diagnosed as CDI and was treated with desmopressin acetate. Conclusion: Sodium hemostasis disorders require full consideration of serum electrolytes, intravascular volume state, and urine electrolytes in view of the clinical condition. Early diagnosis and administration of the proper treatment are the cornerstones of successful management.

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Diagnosis and Management of Combined Central Diabetes Insipidus and Cerebral Salt Wasting Syndrome After Traumatic Brain Injury

World Neurosurgery ◽

10.1016/j.wneu.2015.10.011 ◽

2016 ◽

Vol 88 ◽

pp. 483-487 ◽

Cited By ~ 7

Author(s):

Xuehai Wu ◽

Xiaolan Zhou ◽

Liang Gao ◽

Xing Wu ◽

Li Fei ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Diabetes Insipidus ◽

Central Diabetes Insipidus ◽

Cerebral Salt Wasting Syndrome ◽

Cerebral Salt Wasting ◽

Salt Wasting ◽

Diagnosis And Management ◽

Wasting Syndrome ◽

Salt Wasting Syndrome

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A challenging case of cerebral salt wasting syndrome superimposed on central diabetes insipidus following pituitary tumour apoplexy

Endocrine Abstracts ◽

10.1530/endoabs.62.p61 ◽

2019 ◽

Author(s):

Kirsten Mitchell ◽

Carly Lamb ◽

Yared Demssie

Keyword(s):

Diabetes Insipidus ◽

Pituitary Tumour ◽

Central Diabetes Insipidus ◽

Cerebral Salt Wasting Syndrome ◽

Cerebral Salt Wasting ◽

Salt Wasting ◽

Wasting Syndrome ◽

Salt Wasting Syndrome

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Pengelolaan Diabetes Insipidus dengan Cerebral Salt Wasting Syndrome dan Tension Pneumocephalus pada Pasien Pascabedah Eksisi Tumor Pineal

Jurnal Neuroanestesi Indonesia ◽

10.24244/jni.v10i3.337 ◽

2021 ◽

Vol 10 (3) ◽

pp. 182-192

Author(s):

Dhania A. Santosa ◽

◽

Nancy Margareta Rehatta

Keyword(s):

Brain Injury ◽

Diabetes Insipidus ◽

Pineal Tumor ◽

Secondary Brain Injury ◽

Cerebral Salt Wasting Syndrome ◽

Cerebral Salt Wasting ◽

Salt Wasting ◽

Tension Pneumocephalus ◽

Wasting Syndrome ◽

Salt Wasting Syndrome

Electrolyte imbalance is an often incident in patients underwent neurosurgery and it potentially induces secondary brain injury, leading to a worse outcome, despite successful surgery. Diabetes insipidus is a frequent hypernatremic condition, commonly caused by abnormalities in the hypophysis; but rarely happens due to pineal tumor. A 21-year-old male with preoperative diabetes insipidus experienced episodes of diabetes insipidus complicated by cerebral salt wasting syndrome and tension pneumocephalus after a successful pineal tumor removal surgery. Closed observation on volume status, plasma glucose and electrolyte, along with optimal dose of desmopressin were keys of successful postoperative management in this patient in order to avoid the patient from secondary brain injury. An intensivist plays a key role, mainly in the understanding of intracranial pathophysiology and its implications to fluid and electrolyte balance.

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