title: Diagnosis and management of cerebral salt wasting (CSW) in children: the role of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP).
abstract: OBJECTIVE
  The aim of this study is to report our experience with diagnosis and management of cerebral salt wasting (CSW) in children and to evaluate the role of atrial natriuretic peptide/brain natriuretic peptide (ANP/BNP) in pediatric patients.
  
  
  METHODS
  We present nine children suffering from prevalent cerebral disease--seven of whom underwent anesthesia and surgical procedures--with features of CSW, seen within a 22-month period. The symptoms, patient characteristics (including hormone status), monitoring, treatment protocol, and outcome are described.
  
  
  RESULTS
  Natriuresis (urine Na+ concentrations 131 to >250 mmol/l) and polyuria (5.5+/-1.5 ml/kg/h) with increased Na+ turnover (maximum Na+ loss: median 1.50 mmol Na+/kg/h, range 0.47 to >3.50) vanished within 2 weeks in 6/9 patients (increase in serum Na+ from 127+/-2 mmol/l to 136+/-1). K+ excretion was also high (maximum K+ loss: median 0.18 mmol K+/kg/h, range 0.09-0.53). ANP/BNP as suspected causes of salt wasting were elevated only in 1/6 and 2/7 patients, respectively. Plasma renin activities and aldosterone levels were either suppressed or in the low normal range.
  
  
  CONCLUSIONS
  Natriuresis and polyuria are the main diagnostic criteria for CSW. The fluid balance in CSW is negative, in contrast to a positive fluid balance in SIADH. The length of the disease is self-limited and generally ceases within 2 weeks, while Na+, K+, and fluid turnover should be monitored carefully. Only a minority of our children showed elevated ANP/BNP levels. A dose/effect relationship for natriuretic peptide levels and increased Na+ turnover could not be established.
authors.affiliation: Department of General Pediatrics, Children's Hospital, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Schwanenweg 20, 24105, Kiel, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: von Bismarck
authors.forename: Tobias
authors.initials: T
authors.lastname: Ankermann
authors.forename: Paul
authors.initials: P
authors.lastname: Eggert
authors.forename: Alexander
authors.initials: A
authors.lastname: Claviez
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fritsch
authors.forename: Martin F
authors.initials: MF
authors.lastname: Krause
mesh_terms: D000293:Adolescent; D009320:Atrial Natriuretic Factor / Q000378:metabolism*; D001927:Brain Diseases / Q000175:diagnosis* / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000378:metabolism*; D011863:Radioimmunoassay / Q000379:methods; D012492:Salts / Q000008:administration & dosage / Q000378:metabolism*; D013997:Time Factors; D014667:Vasopressins / Q000378:metabolism
chemical_list: D012492:Salts; D014667:Vasopressins; D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor