scholarly journals Concurrent central diabetes insipidus and cerebral salt wasting disease in a post-operative case of craniopharyngioma: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Patel Zeeshan Jameel ◽  
Sham Lohiya ◽  
Keta Vagha ◽  
Tauheed Ahmed ◽  
Divya Pujari ◽  
...  
Keyword(s):  
Diabetes Insipidus ◽  
Central Diabetes Insipidus ◽  
Electrolyte Disorders ◽  
Wasting Disease ◽  
Cerebral Salt Wasting ◽  
Salt Wasting ◽  
Diuretic Hormone ◽  
Diagnosis And Management ◽  
Post Surgery ◽  
Inappropriate Secretion

Abstract Background Water and electrolyte disorders commonly encountered in children post-surgery involving hypothalamus and posterior pituitary, are central diabetes insipidus, syndrome of inappropriate secretion of anti-diuretic hormone and cerebral salt wasting disease. Delayed diagnosis and inadequate management of such cases may lead to worsened neurological outcomes with a high mortality rate. Case presentation Here we report the case of a 7-year-old girl who underwent surgical resection of a craniopharyngioma, following which she initially developed central diabetes insipidus. However, later on in the course of her illness she developed symptomatic hyponatremia with natriuresis which was diagnosed to be due to cerebral salt wasting disease. This combination of central diabetes insipidus and cerebral salt wasting syndrome is a rare occurrence and poses a diagnostic challenge. Diagnosis and management can be even more difficult when these conditions precede or coexist with each other. Conclusion In such cases development of hyponatremia should always prompt consideration of unusual causes like cerebral salt wasting disease in addition to the classically described syndrome of inappropriate secretion of anti-diuretic hormone. Hence, a thorough knowledge of these disorders along with intensive monitoring of fluid and sodium status is critical for timely diagnosis and management of these patients.

scholarly journals Gradient washout and secondary nephrogenic diabetes insipidus after brain injury in an infant: a case report

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Nathan Chang ◽  
Karley Mariano ◽  
Lakshmi Ganesan ◽  
Holly Cooper ◽  
Kevin Kuo
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Brain Injury ◽  
Diabetes Insipidus ◽  
Nephrogenic Diabetes Insipidus ◽  
Pediatric Intensive Care ◽  
Central Diabetes Insipidus ◽  
Osmotic Gradient ◽  
Cerebral Salt Wasting ◽  
Salt Wasting

Abstract Background Disorders of water and sodium balance can occur after brain injury. Prolonged polyuria resulting from central diabetes insipidus and cerebral salt wasting complicated by gradient washout and a type of secondary nephrogenic diabetes insipidus, however, has not been described previously, to the best of our knowledge. We report an unusual case of an infant with glioblastoma who, after tumor resection, was treated for concurrent central diabetes insipidus and cerebral salt wasting complicated by secondary nephrogenic diabetes insipidus. Case presentation A 5-month-old Hispanic girl was found to have a large, hemorrhagic, suprasellar glioblastoma causing obstructive hydrocephalus. Prior to mass resection, she developed central diabetes insipidus. Postoperatively, she continued to have central diabetes insipidus and concurrent cerebral salt wasting soon after. She was managed with a vasopressin infusion, sodium supplementation, fludrocortisone, and urine output replacements. Despite resolution of her other major medical issues, she remained in the pediatric intensive care unit for continual and aggressive management of water and sodium derangements. Starting on postoperative day 18, her polyuria began increasing dramatically and did not abate with increasing vasopressin. Nephrology was consulted. Her blood urea nitrogen was undetectable during this time, and it was thought that she may have developed a depletion of inner medullary urea and osmotic gradient: a “gradient washout.” Supplemental dietary protein was added to her enteral nutrition, and her fluid intake was decreased. Within 4 days, her blood urea nitrogen increased, and her vasopressin and fluid replacement requirements significantly decreased. She was transitioned soon thereafter to subcutaneous desmopressin and transferred out of the pediatric intensive care unit. Conclusions Gradient washout has not been widely reported in humans, although it has been observed in the mammalian kidneys after prolonged polyuria. Although not a problem with aquaporin protein expression or production, gradient washout causes a different type of secondary nephrogenic diabetes insipidus because the absence of a medullary gradient impairs water reabsorption. We report a case of an infant who developed complex water and sodium imbalances after brain injury. Prolonged polyuria resulting from both water and solute diuresis with low enteral protein intake was thought to cause a urea gradient washout and secondary nephrogenic diabetes insipidus. The restriction of fluid replacements and supplementation of enteral protein appeared adequate to restore the renal osmotic gradient and efficacy of vasopressin.

Combined Central Diabetes Insipidus and Cerebral Salt Wasting Syndrome in Children

2009 ◽  
Vol 40 (2) ◽  
pp. 84-87 ◽  
Author(s):  
Jainn-Jim Lin ◽  
Kuang-Lin Lin ◽  
Shao-Hsuan Hsia ◽  
Chang-Teng Wu ◽  
Huei-Shyong Wang
Keyword(s):  
Diabetes Insipidus ◽  
Central Diabetes Insipidus ◽  
Cerebral Salt Wasting Syndrome ◽  
Cerebral Salt Wasting ◽  
Salt Wasting ◽  
Wasting Syndrome ◽  
Salt Wasting Syndrome

scholarly journals Central Neurogenic Diabetes Insipidus, Syndrome of Inappropriate Secretion of Antidiuretic Hormone, and Cerebral Salt-Wasting Syndrome in Traumatic Brain Injury

2012 ◽  
Vol 32 (2) ◽  
pp. e1-e7 ◽  
Author(s):  
Cynthia (Cindi) A. John ◽  
Michael W. Day
Keyword(s):  
Traumatic Brain Injury ◽  
Diabetes Insipidus ◽  
Antidiuretic Hormone ◽  
Cerebral Salt Wasting Syndrome ◽  
Cerebral Salt Wasting ◽  
Salt Wasting ◽  
Wasting Syndrome ◽  
Inappropriate Secretion ◽  
Salt Wasting Syndrome ◽  
Neurogenic Diabetes Insipidus

Central neurogenic diabetes insipidus, syndrome of inappropriate secretion of antidiuretic hormone, and cerebral salt-wasting syndrome are secondary events that affect patients with traumatic brain injury. All 3 syndromes affect both sodium and water balance; however, they have differences in pathophysiology, diagnosis, and treatment. Differentiating between hypernatremia (central neurogenic diabetes insipidus) and the 2 hyponatremia syndromes (syndrome of inappropriate secretion of antidiuretic hormone, and cerebral salt-wasting syndrome) is critical for preventing worsening neurological outcomes in patients with head injuries.

scholarly journals Hyponatremia in the neurosurgical patient: diagnosis and management

2004 ◽  
Vol 16 (4) ◽  
pp. 1-10 ◽  
Author(s):  
Chad D. Cole ◽  
Oren N. Gottfried ◽  
James K. Liu ◽  
William T. Couldwell
Keyword(s):  
Aneurysmal Subarachnoid Hemorrhage ◽  
Pituitary Tumors ◽  
Accurate Diagnosis ◽  
Fluid Restriction ◽  
Cerebral Salt Wasting ◽  
Salt Wasting ◽  
Diagnosis And Management ◽  
Inappropriate Secretion ◽  
Patient Diagnosis ◽  
Neurosurgical Patient

Hyponatremia is frequently encountered in patients who have undergone neurosurgery for intracranial processes. Making an accurate diagnosis between the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and cerebral salt wasting (CSW) in patients in whom hyponatremia develops is important because treatment differs greatly between the conditions. The SIADH is a volume-expanded condition, whereas CSW is a volume-contracted state that involves renal loss of sodium. Treatment for patients with SIADH is fluid restriction and treatment for patients with CSW is generally salt and water replacement. In this review, the authors discuss the differential diagnosis of hyponatremia, distinguish SIADH from CSW, and highlight the diagnosis and management of hyponatremia, which is commonly encountered in patients who have undergone neurosurgery, specifically those with traumatic brain injury, aneurysmal subarachnoid hemorrhage, recent transsphenoidal surgery for pituitary tumors, and postoperative cranial vault reconstruction for craniosynostosis.

Sign in / Sign up

Export Citation Format

Share Document