Combined central diabetes insipidus and cerebral salt wasting syndrome in children.
Central diabetes insipidus, a common consequence of acute central nervous system injury, causes hypernatremia; cerebral salt wasting syndrome can cause hyponatremia. The two conditions occurring simultaneous are rarely described in pediatric patients. Pediatric cases of combined diabetes insipidus and cerebral salt wasting after acute central nervous system injury between January 2000 and December 2007 were retrospectively reviewed, and clinical characteristics were systemically assessed. Sixteen patients, aged 3 months to 18 years, met study criteria: 11 girls and 5 boys. The most common etiologies were severe central nervous system infection (n = 7, 44%) and hypoxic-ischemic event (n = 4, 25%). In 15 patients, diabetes insipidus was diagnosed during the first 3 days after acute central nervous system injury. Onset of cerebral salt wasting syndrome occurred 2-8 days after the onset of diabetes insipidus. In terms of outcome, 13 patients died (81%) and 3 survived under vegetative status (19%). Central diabetes insipidus and cerebral salt wasting syndrome may occur after acute central nervous system injury. A combination of both may impede accurate diagnosis. Proper differential diagnoses are critical, because the treatment strategy for each entity is different.
Lin
Jainn-Jim
JJ
Division of Pediatric Neurology, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Lin
Kuang-Lin
KL
Hsia
Shao-Hsuan
SH
Wu
Chang-Teng
CT
Wang
Huei-Shyong
HS
D000293:Adolescent; D001928:Brain Diseases, Metabolic / Q000150:complications* / Q000401:mortality; D002494:Central Nervous System Infections / Q000150:complications; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000150:complications; D020790:Diabetes Insipidus, Neurogenic / Q000150:complications* / Q000401:mortality; D004569:Electroencephalography; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000150:complications; D007223:Infant; D020300:Intracranial Hemorrhages / Q000150:complications; D007511:Ischemia / Q000150:complications; D008297:Male; D013577:Syndrome; D014883:Water-Electrolyte Imbalance / Q000150:complications* / Q000401:mortality