Cerebral Salt-Wasting Syndrome Treatment & Management

Updated: May 13, 2020
  • Author: Sudha Garimella, MBBS; Chief Editor: Sasigarn A Bowden, MD  more...
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Treatment

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. [3] 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.

A retrospective, single-center study by Sigmon et al found an increased risk of hyperchloremia and acute kidney injury in patients with neurologic injury who undergo hypertonic sodium therapy with a large chloride load. The 142 patients in the study received high volumes of intravenous hypertonic sodium chloride, with acute kidney injury and hyperchloremia developing in 13% and 38% of them, respectively. [18]

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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.

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