Register for email alerts and news feeds:
This journal | BMJ Group
rss
Archives of Disease in Childhood 2001;85:246-251; doi:10.1136/adc.85.3.246
Copyright © 2001 BMJ Publishing Group Ltd & Royal College of Paediatrics and Child Health.
Arch Dis Child 2001;85:246-251 ( September )

Article

Personal practice

Management of hyponatraemia in patients with acute cerebral insults A Albanesea, P Hindmarshb, R Stanhopeb

a Department of Paediatric Endocrinology, St George's Hospital, Level 5, Lanesborough Wing, Blackshaw Road, London SW17 0QT, UK, b Great Ormond Street NHS Trust, London, UK

Correspondence to: Dr Albanese assuntaalbanese{at}hotmail.com

Accepted 23 May 2001

Hyponatraemia is a common finding in patients with acute cerebral insults. The main differential diagnosis is between syndrome of inappropriate ADH secretion and cerebral salt wasting. Our aim is to review the topic of hyponatraemia in patients with acute cerebral insults and suggest a clinical approach to diagnosis and management.


Key messages

  • Careful adjustment of dose of desmopressin, cortisol, and some anticonvulsants, as all three interact
  • Provided that fluid replacement is maintained. DI is not life threatening
  • Excessive administration of desmopressin can result in hyponatraemia with fatal fluid overload and may require dialysis
  • The only biochemical difference between CSW and SIADH is the extracellular volume, decreased in the former and increased in the latter
  • In euvolaemic and hyponatraemic patients with cerebral insults: give sodium supplement and maintenance fluid intake first. If no improvement or deterioration, assess volume state with central venous pressure monitoring
  • Limit the rate of correction of plasma sodium to less than 12 mmol/l/day




Keywords: hyponatraemia; SIADH; cerebral salt wasting; diabetes insipidus

© 2001 by Archives of Disease in Childhood
Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?

This article has been cited by other articles:

  • Guerrero, R, Pumar, A, Soto, A, Pomares, M A, Palma, S, Mangas, M A, Leal, A, Villamil, F (2007). Early hyponatraemia after pituitary surgery: cerebral salt-wasting syndrome. Eur J Endocrinol 156: 611-616 [Abstract] [Full Text]  

This Article

Services
Citing Articles
Google Scholar
PubMed
Topic Collections
Bookmark with

Register for free content

The full back archive is now available for all BMJ Journals. Institutional subscribers may access the entire archive as part of their subscription. Personal subscribers will also have access to all content when logged in. Non-subscribers who register have free access to all articles published before 2006 right back to volume 1 issue 1. Register here to access the free archive of all BMJ Journals.

Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.

Latest from ADC

 

ADC is co-owned by the RCPCH and is the official journal of the European Academy of Paediatrics

BMJ Careers - Latest Paediatrics and Paediatric Surgery Jobs

Paediatrics and Paediatric Surgery Jobs

Show me all >>