title: [Case of cerebral salt wasting syndrome with difficulty in controling excessive urine volume].
abstract: Symptoms of hyponatremia and diuresis due to cerebral salt wasting syndrome (CSWS) are often observed after aneurysmal subarachnoid hemorrhage (SAH). Inadequately treated CSWS is known to work as a trigger of symptomatic vasospasm in SAH patients. Therefore, it is indispensable to detect and treat CSWS as early as possible in ICU. A 36-year-old man with SAH was admitted to our ICU. His urine volume increased excessively 3 days after ICU admission, and it reached a peak (39,250 ml x day(-1)) on the 6th day in ICU. Since infusion volume was controlled with regard to daily urinary output, hyponatremia was not noticeable and excessive urine volume stood out conspicuously. Though vasopressin and desmopressin were administered, the symptoms of natriuresis and hyponatremia were aggravated, associated with hyper secretion of natriuretic peptides (ANP 160 pg x dl(-1), BNP 172 pg x dl(-1)). Recent studies revealed that hyponatremia and hypovolemia following SAH might be caused by exaggerated secretion of natriuretic peptides. Experimental studies showed that the administration of vasopressin and desmopressin cause excessive secretion of natriuretic peptides under the circumstance of volume expansion in rats. We infer that the administration of vasopressin and desmopressin to our patient deterionated natriuresis in CSWS as in the previous experimental findings.
authors: Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto.
authors: Sakiko
authors: S
authors: Fujiki
authors: Kunihiko
authors: K
authors: Kooguch
authors: Michihiko
authors: M
authors: Fukui
authors: Takeshi
authors: T
authors: Osawa
authors: Satoru
authors: S
authors: Beppu
authors: Shizuka
authors: S
authors: Inoue
authors: Tomoki
authors: T
authors: Yamada
mesh_terms: D000328:Adult; D000818:Animals; D009320:Atrial Natriuretic Factor / Q000378:metabolism; D001927:Brain Diseases / Q000209:etiology* / Q000652:urine; D000075202:Contraindications; D006801:Humans; D007010:Hyponatremia / Q000209:etiology* / Q000652:urine; D020896:Hypovolemia / Q000209:etiology* / Q000652:urine; D008297:Male; D009318:Natriuresis; D051381:Rats; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D013577:Syndrome; D014555:Urination Disorders / Q000209:etiology* / Q000652:urine; D014667:Vasopressins
chemical_list: D014667:Vasopressins; D009320:Atrial Natriuretic Factor