Williams Cydni N, Riva-Cambrin Jay, Bratton Susan L
Department of Pediatrics, Oregon Health and Sciences University, Portland, Oregon; and.
Departments of 2 Neurosurgery and.
J Neurosurg Pediatr. 2016 Mar;17(3):303-9. doi: 10.3171/2015.7.PEDS15277. Epub 2015 Nov 27.
OBJECT Cerebral salt wasting (CSW) and the syndrome of inappropriate antidiuretic hormone secretion (SIADH) cause postoperative hyponatremia in neurosurgery patients, can be difficult to distinguish clinically, and are associated with increased morbidity. The authors aimed to determine risk factors associated with CSW and SIADH among children undergoing surgery for intracranial tumors. METHODS This retrospective cohort study included children 0-19 years of age who underwent a first intracranial tumor surgery with postoperative hyponatremia (sodium ≤ 130 mEq/L). CSW was differentiated from SIADH by urine output and fluid balance, exclusive of other causes of hyponatremia. The CSW and SIADH groups were compared with basic bivariate analysis and recursive partitioning. RESULTS Of 39 hyponatremic patients, 17 (44%) had CSW and 10 (26%) had SIADH. Patients with CSW had significantly greater natriuresis compared with those with SIADH (median urine sodium 211 vs 28 mEq/L, p = 0.01). Age ≤ 7 years and female sex were significant risk factors for CSW (p = 0.03 and 0.04, respectively). Both patient groups had hyponatremia onset within the first postoperative week. Children with CSW had trends toward increased sodium variability and symptomatic hyponatremia compared with those with SIADH. Most received treatment, but inappropriate treatment was noted to worsen hyponatremia. CONCLUSIONS The authors found that CSW was more common following intracranial tumor surgery and was associated with younger age and female sex. Careful assessment of fluid balance and urine output can separate patients with CSW from those who have SIADH, and high urine sodium concentrations (> 100 mEq/L) support a CSW diagnosis. Patients with CSW and SIADH had similar clinical courses, but responded to different interventions, making appropriate diagnosis and treatment imperative to prevent morbidity.
目的 脑性盐耗综合征（CSW）和抗利尿激素分泌不当综合征（SIADH）可导致神经外科患者术后低钠血症，临床上难以区分，且与发病率增加相关。作者旨在确定颅内肿瘤手术患儿中与CSW和SIADH相关的危险因素。方法 这项回顾性队列研究纳入了0至19岁首次接受颅内肿瘤手术且术后出现低钠血症（血钠≤130 mEq/L）的患儿。通过尿量和液体平衡将CSW与SIADH区分开来，排除其他低钠血症原因。采用基本双变量分析和递归划分对CSW组和SIADH组进行比较。结果 在39例低钠血症患者中，17例（44%）患有CSW，10例（26%）患有SIADH。与SIADH患者相比，CSW患者的尿钠排泄显著增加（尿钠中位数211 vs 28 mEq/L，p = 0.01）。年龄≤7岁和女性是CSW的显著危险因素（分别为p = 0.03和0.04）。两组患者均在术后第一周内出现低钠血症。与SIADH患儿相比，CSW患儿的血钠变异性增加和症状性低钠血症有增加趋势。大多数患者接受了治疗，但发现不恰当的治疗会使低钠血症恶化。结论 作者发现CSW在颅内肿瘤手术后更为常见，且与年龄较小和女性有关。仔细评估液体平衡和尿量可将CSW患者与SIADH患者区分开来，高尿钠浓度（>100 mEq/L）支持CSW诊断。CSW和SIADH患者的临床病程相似，但对不同干预措施的反应不同，因此进行恰当的诊断和治疗对于预防发病至关重要。
