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Arch Dis Child 2001;85:246-251 ( September )

Article

Personal practice

Management of hyponatraemia in patients with acute cerebral insults A Albanesea, P Hindmarshb, R Stanhopeb

a Department of Paediatric Endocrinology, St George's Hospital, Level 5, Lanesborough Wing, Blackshaw Road, London SW17 0QT, UK, b Great Ormond Street NHS Trust, London, UK

Correspondence to: Dr Albanese assuntaalbanese{at}hotmail.com

Accepted 23 May 2001

Hyponatraemia is a common finding in patients with acute cerebral insults. The main differential diagnosis is between syndrome of inappropriate ADH secretion and cerebral salt wasting. Our aim is to review the topic of hyponatraemia in patients with acute cerebral insults and suggest a clinical approach to diagnosis and management.


Key messages

  • Careful adjustment of dose of desmopressin, cortisol, and some anticonvulsants, as all three interact
  • Provided that fluid replacement is maintained. DI is not life threatening
  • Excessive administration of desmopressin can result in hyponatraemia with fatal fluid overload and may require dialysis
  • The only biochemical difference between CSW and SIADH is the extracellular volume, decreased in the former and increased in the latter
  • In euvolaemic and hyponatraemic patients with cerebral insults: give sodium supplement and maintenance fluid intake first. If no improvement or deterioration, assess volume state with central venous pressure monitoring
  • Limit the rate of correction of plasma sodium to less than 12 mmol/l/day




Keywords: hyponatraemia; SIADH; cerebral salt wasting; diabetes insipidus

© 2001 by Archives of Disease in Childhood


This article has been cited by other articles:


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R Guerrero, A Pumar, A Soto, M A Pomares, S Palma, M A Mangas, A Leal, and F Villamil
Early hyponatraemia after pituitary surgery: cerebral salt-wasting syndrome
Eur. J. Endocrinol., June 1, 2007; 156(6): 611 - 616.
[Abstract] [Full Text] [PDF]


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