scholarly journals Differential diagnosis between syndrome of inappropriate antidiuretic hormone secretion and cerebral/renal salt wasting syndrome in children over 1 year: proposal for a simple algorithm

2021 ◽  
Author(s):  
Flaminia Bardanzellu ◽  
Maria Antonietta Marcialis ◽  
Roberta Frassetto ◽  
Alice Melis ◽  
Vassilios Fanos
Keyword(s):  
Differential Diagnosis ◽  
Antidiuretic Hormone ◽  
Hormone Secretion ◽  
Extracellular Volume ◽  
Simple Algorithm ◽  
Diagnostic Algorithm ◽  
Clinical Approach ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Salt Wasting ◽  
Renal Salt Wasting

AbstractHyponatremia, especially if acute and severe, can be a life-threatening condition. Several conditions can trigger hyponatremia. In this review, we will discuss two conditions that can determine euvolemic hyponatremia: the cerebral/renal salt wasting (CRSW) syndrome and the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), including the two subtypes: reset osmostat (RO) and nephrogenic syndrome of inappropriate antidiuresis (NSIAD) and their differential diagnoses. Despite the passage of over 70 years since its first description, to date, the true etiopathogenesis of CRSW syndrome, a rare cause of hypovolemic/euvolemic hyponatremia, is almost unknown. SIADH, including RO and NSIAD, is sometimes difficult to differentiate from CRSW syndrome; in its differential diagnosis, the clinical approach based on the evaluation of the extracellular volume (ECV) was proven insufficient. We therefore suggest a simple diagnostic algorithm based on the assessment of the degree of hyponatremia, urinary osmolality, and the assessment of the fraction of urate excretion (FEUa) in conditions of hyponatremia and after serum sodium correction, to be applied in children over 1 year of life.

scholarly journals Cisplatin-Induced Renal Salt Wasting Requiring over 12 Liters of 3% Saline Replacement

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Phuong-Chi Pham ◽  
Pavani Reddy ◽  
Shaker Qaqish ◽  
Ashvin Kamath ◽  
Johana Rodriguez ◽  
...  
Keyword(s):  
Fanconi Syndrome ◽  
Cell Cancer ◽  
Hormone Secretion ◽  
Free Water ◽  
Severe Case ◽  
Acute Onset ◽  
Water Restriction ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Salt Wasting ◽  
Renal Salt Wasting

Cisplatin is known to induce Fanconi syndrome and renal salt wasting (RSW). RSW typically only requires transient normal saline (NS) support. We report a severe RSW case that required 12 liters of 3% saline. A 57-year-old woman with limited stage small cell cancer was admitted for cisplatin (80 mg/m2) and etoposide (100 mg/m2) therapy. Patient’s serum sodium (SNa) decreased from 138 to 133 and 125 mEq/L within 24 and 48 hours of cisplatin therapy, respectively. A diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH) was initially made. Despite free water restriction, patient’s SNa continued to decrease in association with acute onset of headaches, nausea, and dizziness. Three percent saline (3%S) infusion with rates up to 1400 mL/day was required to correct and maintain SNa at 135 mEq/L. Studies to evaluate Fanconi syndrome revealed hypophosphatemia and glucosuria in the absence of serum hyperglycemia. The natriuresis slowed down by 2.5 weeks, but 3%S support was continued for a total volume of 12 liters over 3.5 weeks. Attempts of questionable benefits to slow down glomerular filtration included the administration of ibuprofen and benazepril. To our knowledge, this is the most severe case of RSW ever reported with cisplatin.

scholarly journals Demonstration of natriuretic activity in urine of neurosurgical patients with renal salt wasting

F1000Research ◽  
2013 ◽  
Vol 2 ◽  
pp. 126 ◽  
Author(s):  
Steven J Youmans ◽  
Miriam R Fein ◽  
Elizabeth Wirkowski ◽  
John K Maesaka
Keyword(s):  
Ammonium Sulfate ◽  
Hormone Secretion ◽  
Transcellular Transport ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Salt Wasting ◽  
Renal Salt Wasting ◽  
Natriuretic Factor ◽  
Potential Biomarker ◽  
Neurosurgical Patients

We have utilized the persistent elevation of fractional excretion (FE) of urate, > 10%, to differentiate cerebral/renal salt wasting (RSW) from the syndrome of inappropriate antidiuretic hormone secretion (SIADH), in which a normalization of FEurate occurs after correction of hyponatremia.  Previous studies suggest as well  that an elevated FEurate with normonatremia, without pre-existing hyponatremia, is also consistent with RSW, including studies demonstrating induction of RSW in rats infused with plasma from normonatremic neurosurgical and Alzheimer’s disease patients.  The present studies were designed to test whether precipitates from the urine of normonatremic neurosurgical patients, with either normal or elevated FEurate, and patients with SIADH, display natriuretic activity.  Methods: Ammonium sulfate precipitates from the urine of 6 RSW and 5 non-RSW Control patients were dialyzed (10 kDa cutoff) to remove the ammonium sulfate, lyophilized, and the reconstituted precipitate was tested for its effect on transcellular transport of 22Na across LLC-PK1 cells grown to confluency in transwells.Results: Precipitates from 5 of the 6 patients with elevated FEurate and normonatremia significantly inhibited the in vitro transcellular transport of 22Na above a concentration of 3 μg protein/ml, by 10-25%, versus to vehicle alone, and by 15-40% at concentrations of 5-20 μg/ml as compared to precipitates from 4 of the 5 non-RSW patients with either normal FEurate and normonatremia (2 patients) or with SIADH (2 patients).Conclusion: These studies provide further evidence that an elevated FEurate with normonatremia is highly consistent with RSW.  Evidence in the urine of natriuretic activity suggests significant renal excretion of the natriuretic factor. The potentially large source of the natriuretic factor that this could afford, coupled with small analytical sample sizes required by the in-vitro bioassay used here, should facilitate future experimental analysis and allow the natriuretic factor to be investigated as a potential biomarker for RSW.

PITUITARY ADENOMA ASSOCIATED WITH INAPPROPRIATE ANTIDIURETIC HORMONE SECRETION

1974 ◽  
Vol 76 (1) ◽  
pp. 59-66 ◽  
Author(s):  
Kamal C. Greiss ◽  
Arnold M. Moses ◽  
Dorothy T. Krieger
Keyword(s):  
Pituitary Adenoma ◽  
Antidiuretic Hormone ◽  
Hormone Secretion ◽  
Ethanol Ingestion ◽  
Water Load ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Salt Wasting ◽  
Antidiuretic Hormone Secretion ◽  
Chromophobe Adenoma ◽  
Suprasellar Extension

ABSTRACT A 50 year old male with a chromophobe adenoma with suprasellar extension manifested hyponatraemia, plasma hypoosmolality, renal salt wasting and inability to excrete dilute urine after a standard water load. The patient exhibited no evidence of thyroid or adrenal insufficiency. The inability to excrete a water load was not corrected by prior cortisone administration but was partially corrected after ethanol ingestion. A measurable inappropriate amount of arginine vasopressin was excreted in the presence of sustained hydration. It is suggested that inappropriate production of antidiuretic hormone either by the adenoma, or secondary to hypothalamic involvement by the suprasellar extension of the tumour was responsible for the observed findings.

scholarly journals Syndrome of inappropriate antidiuretic hormone secretion and cerebral salt wasting as the common causes of hyponatremia in tertiary care hospital

2020 ◽  
Vol 7 (4) ◽  
pp. 577
Author(s):  
Yogesh Pralhad Bade ◽  
Harishchandra Rameshchandra Chaudhari
Keyword(s):  
Antidiuretic Hormone ◽  
Tertiary Care ◽  
Hormone Secretion ◽  
Cerebral Salt Wasting ◽  
Common Cause ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Salt Wasting ◽  
Antidiuretic Hormone Secretion ◽  
Common Causes ◽  
The Common

Background: Hyponatremia is a typical condition of electrolyte disturbance that may be euvolemic, hypovolemic or hypervolemic. Proper interpretation through laboratory tests helps to differentiate the types and causes of hyponatremia. This study was conducted to evaluate the syndrome of inappropriate antidiuretic hormone secretion (SIADH) and cerebral salt wasting (CSW) as the common causes of hyponatremia in tertiary care hospital.Methods: A prospective interventional study was conducted, including hyponatremia cases, admitted in NTU/ICU/CCU and other medical wards at Ruby Hall Clinic from August 2011 to December 2013.Results: Of 150 patients enrolled in this study, 33.33% patients were euvolemic, 34% patients were hypervolemic and 32.66% patients were hypovolemic. For the euvolemic patients, SIADH (68%) was the most common cause; whereas, CSW (34.39%) was the common cause for hypovolemic type of hyponatremia. Stroke was found to be the most common cause of SIADH (55.88%), Intra-cerebral bleeding was observed to be the most common causative factor between SIADH and CSW associated hyponatremia.Conclusions: Hyponatremia in central nervous system disorder patients frequently occurred due to SIADH and CSW. Most common cause of SIADH was stroke and for CSW it was intra cerebral bleed.

Sign in / Sign up

Export Citation Format

Share Document