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Cerebral Salt-Wasting Syndrome Treatment & Management

  • Author: Sudha Garimella, MBBS; Chief Editor: Stephen Kemp, MD, PhD  more...
Updated: Sep 04, 2015

Approach Considerations

Evaluation and treatment of cerebral salt-wasting syndrome, or renal salt wasting, typically occurs in the inpatient setting because most patients are seriously ill with acute CNS disease.

Management centers on correction of intravascular volume depletion and hyponatremia, as well as on replacement of ongoing urinary sodium loss, usually with intravenous (IV) hypertonic saline solutions.[11] Some clinicians have reported a favorable response to mineralocorticoid therapy in cerebral salt-wasting syndrome. Once the patient is stabilized, enteral salt supplementation can be considered.

Ongoing monitoring of body weight, fluid balance, and serum sodium concentration is essential during the hospital course.


Long-Term Monitoring

Patients whose neurologic insult has improved and who demonstrate normal intravascular volume and serum sodium concentrations on enteral salt supplements, fludrocortisone, or both can be closely observed on an outpatient basis until cerebral salt-wasting syndrome resolves.

Contributor Information and Disclosures

Sudha Garimella, MBBS Clinical Assistant Professor of Pediatrics, University of Buffalo, State University of New York School of Medicine and Biomedical Sciences

Sudha Garimella, MBBS is a member of the following medical societies: American Society of Pediatric Nephrology

Disclosure: Nothing to disclose.


James E Springate, MD Professor of Pediatrics, University of Buffalo, State University of New York School of Medicine and Biomedical Sciences; Attending Physician, Department of Pediatrics, Division of Nephrology, Women and Children's Hospital of Buffalo

James E Springate, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Pediatric Research, International Pediatric Transplant Association, American Physiological Society, American Society of Pediatric Nephrology

Disclosure: Nothing to disclose.

Chief Editor

Stephen Kemp, MD, PhD Former Professor, Department of Pediatrics, Section of Pediatric Endocrinology, University of Arkansas for Medical Sciences College of Medicine, Arkansas Children's Hospital

Stephen Kemp, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association of Clinical Endocrinologists, American Pediatric Society, Endocrine Society, Phi Beta Kappa, Southern Medical Association, Southern Society for Pediatric Research

Disclosure: Nothing to disclose.


Erawati V Bawle, MD, FAAP, FACMG Division of Genetic and Metabolic Disorders, Children's Hospital of Michigan; Professor (Clinician-Educator), Department of Pediatrics, Wayne State University School of Medicine

Erawati V Bawle, MD, FAAP, FACMG is a member of the following medical societies: American Academy of Pediatrics, American College of Medical Genetics, American Medical Association, and American Society of Human Genetics

Disclosure: Nothing to disclose.

Barry B Bercu, MD Professor, Departments of Pediatrics, Molecular Pharmacology and Physiology, University of South Florida College of Medicine, All Children's Hospital

Barry B Bercu, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Clinical Endocrinologists, American Federation for Clinical Research, American Medical Association, American Pediatric Society, Association of Clinical Scientists, Endocrine Society, Florida Medical Association, Lawson-Wilkins Pediatric Endocrine Society, Pituitary Society, Society for Pediatric Research, Society for the Study of Reproduction, and Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

  1. Peters JP, Welt LG, Sims EA, et al. A salt-wasting syndrome associated with cerebral disease. Trans Assoc Am Physicians. 1950. 63:57-64. [Medline].

  2. Bettinelli A, Longoni L, Tammaro F, Fare PB, Garzoni L, Bianchetti MG. Renal salt-wasting syndrome in children with intracranial disorders. Pediatr Nephrol. 2012 May. 27(5):733-9. [Medline].

  3. Moritz ML. Syndrome of inappropriate antidiuresis and cerebral salt wasting syndrome: are they different and does it matter?. Pediatr Nephrol. 2012 May. 27(5):689-93. [Medline].

  4. Maesaka JK, Miyawaki N, Palaia T, Fishbane S, Durham JH. Renal salt wasting without cerebral disease: diagnostic value of urate determinations in hyponatremia. Kidney Int. 2007 Apr. 71(8):822-6. [Medline].

  5. Maesaka JK, Imbriano LJ, Ali NM, Ilamathi E. Is it cerebral or renal salt wasting?. Kidney Int. 2009 Nov. 76(9):934-8. [Medline].

  6. Bitew S, Imbriano L, Miyawaki N, Fishbane S, Maesaka JK. More on renal salt wasting without cerebral disease: response to saline infusion. Clin J Am Soc Nephrol. 2009 Feb. 4(2):309-15. [Medline]. [Full Text].

  7. Kao L, Al-Lawati Z, Vavao J, Steinberg GK, Katznelson L. Prevalence and clinical demographics of cerebral salt wasting in patients with aneurysmal subarachnoid hemorrhage. Pituitary. 2009. 12(4):347-51. [Medline].

  8. Kojima J, Katayama Y, Moro N, et al. Cerebral salt wasting in subarachnoid hemorrhage rats: model, mechanism, and tool. Life Sci. 2005 Apr 1. 76(20):2361-70. [Medline].

  9. Rivkees SA. Differentiating appropriate antidiuretic hormone secretion, inappropriate antidiuretic hormone secretion and cerebral salt wasting: the common, uncommon, and misnamed. Curr Opin Pediatr. 2008 Aug. 20(4):448-52. [Medline].

  10. Sherlock M, O'Sullivan E, Agha A, et al. Incidence and pathophysiology of severe hyponatraemia in neurosurgical patients. Postgrad Med J. 2009 Apr. 85(1002):171-5. [Medline].

  11. [Guideline] Rahman M, Friedman WA. Hyponatremia in neurosurgical patients: clinical guidelines development. Neurosurgery. 2009 Nov. 65(5):925-35; discussion 935-6. [Medline].

  12. Brimioulle S, Orellana-Jimenez C, Aminian A, Vincent JL. Hyponatremia in neurological patients: cerebral salt wasting versus inappropriate antidiuretic hormone secretion. Intensive Care Med. 2008 Jan. 34(1):125-31. [Medline].

  13. Cerda-Esteve M, Cuadrado-Godia E, Chillaron JJ, et al. Cerebral salt wasting syndrome: review. Eur J Intern Med. 2008 Jun. 19(4):249-54. [Medline].

  14. Costa KN, Nakamura HM, da Cruz LR, et al. Hyponatremia and brain injury: absence of alterations of serum brain natriuretic peptide and vasopressin. Arq Neuropsiquiatr. 2009 Dec. 67(4):1037-44. [Medline].

  15. Diringer MN, Zazulia AR. Hyponatremia in neurologic patients: consequences and approaches to treatment. The Neurologist. 2006. 12:117-126. [Medline].

  16. Fenske W, Stork S, Koschker AC, et al. Value of fractional uric acid excretion in differential diagnosis of hyponatremic patients on diuretics. J Clin Endocrinol Metab. 2008 Aug. 93(8):2991-7. [Medline].

  17. Frey FJ. [Hyponatraemia in patients with neurosurgical disorders: SIADH or cerebral salt wasting syndrome?]. Ther Umsch. 2009 Nov. 66(11):769-72. [Medline].

  18. Harrigan MR. Cerebral salt wasting syndrome: a review. Neurosurgery. 1996 Jan. 38(1):152-60. [Medline].

  19. Kappy MS, Ganong CA. Cerebral salt wasting in children. Adv Pediatr. 1996. 43:271-308. [Medline].

  20. Levine JP, Stelnicki E, Weiner HL, et al. Hyponatremia in the postoperative craniofacial pediatric patient population: a connection to cerebral salt wasting syndrome and management of the disorder. Plast Reconstr Surg. 2001 Nov. 108(6):1501-8. [Medline].

  21. Lin JJ, Lin KL, Hsia SH, Wu CT, Wang HS. Combined central diabetes insipidus and cerebral salt wasting syndrome in children. Pediatr Neurol. 2009 Feb. 40(2):84-7. [Medline].

  22. Maesaka J, Imbriano L, et al. Cerebral-renal salt wasting. Hyponatremia. New York: EE Simon, Springer; 2013. 65-85.

  23. McGirt MJ, Blessing R, Nimjee SM, et al. Correlation of serum brain natriuretic peptide with hyponatremia and delayed ischemic neurological deficits after subarachnoid hemorrhage. Neurosurgery. 2004. 54:1369-1374. [Medline].

  24. [Guideline] Mentes JC. Hydration management. Iowa City (IA): University of Iowa Gerontological Nursing Interventions Research Center, Research Dissemination Core; 2004 Feb. [Full Text].

  25. Singh S, Bohn D, Carlotti AP, et al. Cerebral salt wasting: truths, fallacies, theories, and challenges. Crit Care Med. 2002 Nov. 30(11):2575-9. [Medline].

  26. Soni SS, Adikey GK, Raman AS. Fractional excretion of uric acid as a therapeutic monitor in cerebral salt wasting syndrome. Saudi J Kidney Dis Transpl. 2008 Jan. 19(1):106-8. [Medline].

  27. Taplin CE, Cowell CT, Silink M, Ambler GR. Fludrocortisone therapy in cerebral salt wasting. Pediatrics. 2006 Dec. 118(6):e1904-8. [Medline].

  28. Janus D, Wojcik M, Dolezal-Oltarzewska K, Kalicka-Kasperczyk A, Poplawska K, Starzyk JB. Cerebral salt wasting in a postoperative period. Neuro Endocrinol Lett. 2014. 35 (4):252-6. [Medline].

Possible mechanisms for cerebral salt-wasting syndrome. The injured brain may release natriuretic proteins that act directly on the kidney. In addition, cerebral injury may increase sympathetic nervous system activity, elevating renal perfusion pressure and releasing dopamine.
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