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Hyponatremia in neurological patients: cerebral salt wasting versus inappropriate antidiuretic hormone secretion

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Abstract

Objective

To assess whether hyponatremia in acute neurological patients is associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) or with the cerebral salt-wasting syndrome (CSWS).

Design

Clinical, controlled, prospective study.

Setting

Department of intensive care of a tertiary care academic hospital.

Patients

Forty acute neurological patients with hyponatremia suggesting SIADH or CSWS (20) or with normonatremia (20).

Interventions

None.

Measurements and main results

Measurement of clinical and biological variables. Measurement of blood, plasma, and red blood cell volumes to discriminate SIADH and CSWS. Renal, adrenal and thyroid functions were normal in all patients. Average blood, plasma, and red blood cell volumes were 54, 37 and 17 ml/kg in control patients and 54, 37 and 18 ml/kg in hyponatremic patients, respectively.

Conclusions

The adequate blood volumes in hyponatremic patients confirm the diagnosis of SIADH and do not support the concept of CSWS.

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Correspondence to Serge Brimioulle.

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Brimioulle, S., Orellana-Jimenez, C., Aminian, A. et al. Hyponatremia in neurological patients: cerebral salt wasting versus inappropriate antidiuretic hormone secretion. Intensive Care Med 34, 125–131 (2008). https://doi.org/10.1007/s00134-007-0905-7

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  • DOI: https://doi.org/10.1007/s00134-007-0905-7

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