title: Fludrocortisone therapy in cerebral salt wasting.
abstract: Cerebral salt wasting is an increasingly recognized condition in pediatrics and is characterized by inappropriate natriuresis and volume contraction in the presence of cerebral pathology. Diagnosis can be difficult and therapy challenging. A few single case reports of the successful use of fludrocortisone exist. We report 4 patients with cerebral salt wasting, all of whom presented with hyponatremia in the presence of known intracerebral pathology. All had clinically significant hyponatremia, and 3 had hyponatremic seizures. Two of the patients also satisfied clinical criteria for diabetes insipidus. They all were treated with regimens using increased sodium and fluid administration but experienced ongoing salt wasting. Fludrocortisone was instituted in all 4 patients and in 3 resulted in rapid improvement in net sodium balance, enabling the weaning of hypertonic fluids and stabilization of serum electrolytes. In 3 patients, fludrocortisone treatment was complicated by hypokalemia, and in 1 patient by hypertension, which necessitated a dose reduction or brief cessation of therapy. Duration of therapy was 4 to 125 days. Cerebral salt wasting presents considerable management challenges; however, fludrocortisone therapy can be an effective adjunct to treatment.
authors.affiliation: The Children's Hospital at Westmead, Institute of Endocrinology and Diabetes, Locked Bag 4001, Westmead 2145, New South Wales, Australia.
authors.forename: Craig E
authors.initials: CE
authors.lastname: Taplin
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Cowell
authors.forename: Martin
authors.initials: M
authors.lastname: Silink
authors.forename: Geoffrey R
authors.initials: GR
authors.lastname: Ambler
mesh_terms: D001927:Brain Diseases / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism*; D002648:Child; D005260:Female; D005438:Fludrocortisone / Q000627:therapeutic use*; D006801:Humans; D007010:Hyponatremia / Q000150:complications* / Q000188:drug therapy*; D007223:Infant
chemical_list: D005438:Fludrocortisone