Momi Jasminder, Tang Christopher M, Abcar Antoine C, Kujubu Dean A, Sim John J
Perm J. 2010 Summer;14(2):62-5. doi: 10.7812/TPP/08-066.
Hyponatremia is a common electrolyte imbalance in hospitalized patients. It is associated with significant morbidity and mortality, especially if the underlying cause is incorrectly diagnosed and not treated appropriately. Often, the hospitalist is faced with a clinical dilemma when a patient presents with hyponatremia of an unclear etiology and with uncertain volume status. Syndrome of inappropriate antidiuretic hormone (SIADH) is frequently diagnosed in this clinical setting, but cerebral salt wasting (CSW) is an important diagnosis to consider.
We wanted to describe the diagnosis, treatment, and history of CSW to provide clinicians with a better understanding of the differential diagnosis for hyponatremia.
CSW is a process of extracellular volume depletion due to a tubular defect in sodium transport. Two postulated mechanisms for CSW are the excess secretion of natriuretic peptides and the loss of sympathetic stimulation to the kidney. Making the distinction between CSW and SIADH is important because the treatment for the two conditions is very different.
低钠血症是住院患者常见的电解质紊乱。它与显著的发病率和死亡率相关，尤其是在潜在病因未得到正确诊断和适当治疗的情况下。通常，当患者出现病因不明且容量状态不确定的低钠血症时，住院医师会面临临床困境。在这种临床情况下，抗利尿激素分泌不当综合征（SIADH）常被诊断出来，但脑性盐耗综合征（CSW）也是一个需要考虑的重要诊断。
我们希望描述CSW的诊断、治疗及病史，以便临床医生更好地理解低钠血症的鉴别诊断。
CSW是由于钠转运的肾小管缺陷导致细胞外液容量减少的过程。CSW的两种假说机制是利钠肽分泌过多和肾脏交感神经刺激丧失。区分CSW和SIADH很重要，因为这两种情况的治疗方法截然不同。
