title: Cerebral salt wasting after traumatic brain injury: a review of the literature.
abstract: Electrolyte imbalances are common among patients with traumatic brain injury (TBI). Cerebral salt wasting (CSW) is an electrolyte imbalance characterized by hyponatremia and hypovolemia. Differentiating the syndrome of inappropriate antidiuretic hormone and CSW remains difficult and the pathophysiological mechanisms underlying CSW are unclear. Our intent was to review the literature on CSW within the TBI population, in order to report the incidence and timing of CSW after TBI, examine outcomes, and summarize the biochemical changes in patients who developed CSW. We searched MEDLINE through 2014, hand-reviewed citations, and searched abstracts from the American Association for the Surgery of Trauma (2003-2014). Publications were included if they were conducted within a TBI population, presented original data, and diagnosed CSW. Publications were excluded if they were review articles, discussed hyponatremia but did not differentiate the etiology causing hyponatremia, or presented cases with chronic disease. Fifteen of the 47 publications reviewed met the selection criteria; nine (60%) were case reports, five (33%) were prospective and 1 (7%) was a retrospective study. Incidence of CSW varied between 0.8 - 34.6%. The populations studied were heterogeneous and the criteria used to define hyponatremia and CSW varied. Though believed to play a role in the development of CSW, increased levels of natriuretic peptides in patients diagnosed with CSW were not consistently reported. These findings reinforce the elusiveness of the CSW diagnosis and the need for strict and consistent diagnostic criteria.
authors.affiliation: Department of Trauma Research, Swedish Medical Center, 501 E. Hampden Ave, Englewood, CO, 80113, USA. Jan_leonard@icloud.com.|Department of Trauma Research, St. Anthony Hospital, 11600 W. 2nd Place, Lakewood, CO, 80228, USA. Jan_leonard@icloud.com.|Department of Trauma Research, The Medical Center of Plano, 3901 West 15th St, Plano, TX, 75075, USA. Jan_leonard@icloud.com.
authors.forename: Jan
authors.initials: J
authors.lastname: Leonard
authors.affiliation: Department of Trauma Research, Swedish Medical Center, 501 E. Hampden Ave, Englewood, CO, 80113, USA. docraynjoy@aol.com.|Craig Hospital, 3425 S. Clarkson St, Englewood, CO, 80113, USA. docraynjoy@aol.com.
authors.forename: Raymond E
authors.initials: RE
authors.lastname: Garrett
authors.affiliation: Department of Trauma Research, Swedish Medical Center, 501 E. Hampden Ave, Englewood, CO, 80113, USA. ksalottolo@ampiopharma.com.|Department of Trauma Research, St. Anthony Hospital, 11600 W. 2nd Place, Lakewood, CO, 80228, USA. ksalottolo@ampiopharma.com.|Department of Trauma Research, The Medical Center of Plano, 3901 West 15th St, Plano, TX, 75075, USA. ksalottolo@ampiopharma.com.
authors.forename: Kristin
authors.initials: K
authors.lastname: Salottolo
authors.affiliation: Trauma Services Department, Swedish Medical Center, 501 E. Hampden Ave, Englewood, CO, 80113, USA. sue.slone@healthonecares.com.
authors.forename: Denetta S
authors.initials: DS
authors.lastname: Slone
authors.affiliation: Trauma Services Department, St. Anthony Hospital, 11600 W. 2nd Place, Lakewood, CO, 80228, USA. CharlesMains@centura.org.
authors.forename: Charles W
authors.initials: CW
authors.lastname: Mains
authors.affiliation: Trauma Services Department, The Medical Center of Plano, 3901 West 15th St, Plano, TX, 75075, USA. Matt.Carrick@acutesurgical.com.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Carrick
authors.affiliation: Department of Trauma Research, Swedish Medical Center, 501 E. Hampden Ave, Englewood, CO, 80113, USA. dbaror@ampiopharma.com.|Department of Trauma Research, St. Anthony Hospital, 11600 W. 2nd Place, Lakewood, CO, 80228, USA. dbaror@ampiopharma.com.|Department of Trauma Research, The Medical Center of Plano, 3901 West 15th St, Plano, TX, 75075, USA. dbaror@ampiopharma.com.
authors.forename: David
authors.initials: D
authors.lastname: Bar-Or
mesh_terms: D001930:Brain Injuries / Q000150:complications* / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007010:Hyponatremia / Q000209:etiology* / Q000503:physiopathology; D020896:Hypovolemia / Q000209:etiology* / Q000503:physiopathology; D015601:Injury Severity Score; D008297:Male; D011379:Prognosis; D018570:Risk Assessment; D015996:Survival Rate; D014883:Water-Electrolyte Imbalance / Q000209:etiology / Q000401:mortality / Q000503:physiopathology