title: Renal salt-wasting syndrome in children with intracranial disorders.
abstract: Hypotonic hyponatremia, a serious and recognized complication of any intracranial disorder, results from extra-cellular fluid volume depletion, inappropriate anti-diuresis or renal salt-wasting. The putative mechanisms by which intracranial disorders might lead to renal salt-wasting are either a disrupted neural input to the kidney or the elaboration of a circulating natriuretic factor. The key to diagnosis of renal salt-wasting lies in the assessment of extra-cellular volume status: the central venous pressure is currently considered the yardstick for measuring fluid volume status in subjects with intracranial disorders and hyponatremia. Approximately 110 cases have been reported so far in subjects ≤18 years of age (male: 63%; female: 37%): intracranial surgery, meningo-encephalitis (most frequently tuberculous) or head injury were the most common underlying disorders. Volume and sodium repletion are the goals of treatment, and this can be performed using some combination of isotonic saline, hypertonic saline, and mineralocorticoids (fludrocortisone). It is worthy of a mention, however, that some authorities contend that cerebral salt wasting syndrome does not exist, since this diagnosis requires evidence of a reduced arterial blood volume, a concept but not a measurable variable.
authors.affiliation: Department of Pediatrics, San Leopoldo Mandic Hospital, Largo Mandic 1, 23807 Merate-Lecco, Italy. a.bettinelli@ospedale.lecco.it
authors.forename: Alberto
authors.initials: A
authors.lastname: Bettinelli
authors.forename: Laura
authors.initials: L
authors.lastname: Longoni
authors.forename: Fabiana
authors.initials: F
authors.lastname: Tammaro
authors.forename: Pietro B
authors.initials: PB
authors.lastname: Faré
authors.forename: Luca
authors.initials: L
authors.lastname: Garzoni
authors.forename: Mario G
authors.initials: MG
authors.lastname: Bianchetti
mesh_terms: D000293:Adolescent; D001927:Brain Diseases / Q000150:complications* / Q000503:physiopathology; D002648:Child; D006259:Craniocerebral Trauma / Q000150:complications; D019468:Disease Management; D005260:Female; D006801:Humans; D007010:Hyponatremia / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy; D007177:Inappropriate ADH Syndrome / Q000503:physiopathology; D007674:Kidney Diseases / Q000150:complications / Q000503:physiopathology; D007677:Kidney Function Tests; D008297:Male