Pediatr Nephrol. 2012 May;27(5):689-93. doi: 10.1007/s00467-012-2112-1. Epub 2012 Feb 23.
The syndrome of inappropriate antidiudresis (SIAD) and cerebral salt wasting (CSW) are similar conditions with the main difference being the absence or presence of volume depletion. The two conditions may be indistinguishable at presentation, as volume status is difficult to assess, which can lead to under-diagnosis of CSW in patients with central nervous system (CNS) disease. Carefully conducted studies in patients with CNS disease have indicated that CSW may be more common than SIAD. CSW may be differentiated from SIAD based on the persistence of hypouricemia and increased fractional excretion of urate following the correction of hyponatremia. Hyponatremia should be prevented if possible and treated promptly when discovered in patients with CNS disease as even mild hyponatremia could lead to neurological deterioration. Fluid restriction should not be used for the prevention or treatment of hyponatremia in hospitalized patients with CNS disease as it could lead to volume depletion especially if CSW is present. 0.9% sodium chloride may not be sufficiently hypertonic for the prevention of hyponatremia in hospitalized patients with CNS disease and a more hypertonic fluid may be required. The preferred therapy for the treatment of hyponatremia in patients with CNS disease is 3% sodium chloride.
抗利尿激素分泌不当综合征（SIAD）和脑性盐耗综合征（CSW）是两种相似的病症，主要区别在于是否存在容量不足。这两种病症在发病时可能难以区分，因为很难评估容量状态，这可能导致中枢神经系统（CNS）疾病患者的 CSW 漏诊。对 CNS 疾病患者进行的仔细研究表明，CSW 可能比 SIAD 更为常见。根据低钠血症纠正后低尿酸血症和尿酸排泄分数增加的持续存在，可以将 CSW 与 SIAD 区分开来。如果可能，应预防 CNS 疾病患者的低钠血症，如果发现低钠血症，应迅速治疗，因为即使是轻度低钠血症也可能导致神经功能恶化。在 CNS 疾病住院患者中，不应使用液体限制来预防或治疗低钠血症，因为这可能导致容量不足，尤其是在存在 CSW 的情况下。0.9%氯化钠可能不足以预防 CNS 疾病住院患者的低钠血症，可能需要更浓的液体。3%氯化钠是治疗 CNS 疾病患者低钠血症的首选疗法。
