Cerebral Salt Wasting Syndrome(Cerebral Salt Wasting Syndrome，CSWS)
l Commonly seen after neurosurgery
l The mechanism of onset is currently unclear, possibly due to increased secretion of (Atrial Natriuretic Factor，ANF).
l Mainly manifested as hypovolemia, hyponatremia, low plasma osmolality, high sodium excretion, and sodium negative balance, with increased plasma or cerebrospinal fluid ANF.
l Diagnostic criteria:CSWSCurrently, there are no unified diagnostic criteria, generally believed that the following conditions assist in the diagnosis of CSWS.
l Hyponatremia with polyuria;
l Increased urinary sodium, increased urine output with normal urine specific gravity;
l Hypovolemia, decreased central venous pressure (often <6mmHg), weight loss, often with signs of dehydration, dry skin and mucous membranes, poor elasticity, sunken eyes, rapid heart rate, orthostatic hypotension, elevated hematocrit and blood urea nitrogen;
l Improvement of the condition after fluid and sodium replenishment.
l Treatment methods
l Volume supplementation, increasing plasma osmolality, and correcting sodium negative balance are key to treating CSWS.
l Determine oral salt supplementation, intravenous normal saline, hypertonic saline (3% NaCl), or combined application based on the severity of dehydration.
l Treatment of the primary disease is very important for CSWS, especially for CSWS associated with hydrocephalus and increased intracranial pressure, cerebrospinal fluid drainage or reduction of intracranial pressure can quickly cure the condition.
Additionally, mineralocorticoid drugs such as fludrocortisone can also be used. In a randomized controlled trial for patients with aneurysmal subarachnoid hemorrhage, the fludrocortisone group was administered 0.1mg per dose, three times a day, and after 8 days, the water and sodium excretion and the incidence of hyponatremia were significantly reduced in this group. The experimental group had a 6.6% incidence of hyponatremia, while the control group had a 33.3% incidence of hyponatremia.