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Cerebral Salt Wasting Versus SIADH: What Difference?

Rochester General Hospital, Rochester, University of Rochester School of Medicine and Dentistry, Rochester, New York

Correspondence: Richard H. Sterns, 1425 Portland Avenue, Rochester, NY 14621. Phone: 585-922-4242; Fax: 585-922-4440; E-mail: Richard.Sterns{at}viahealth.org

The term cerebral salt wasting (CSW) was introduced before the syndrome of inappropriate antidiuretic hormone secretion was described in 1957. Subsequently, CSW virtually vanished, only to reappear a quarter century later in the neurosurgical literature. A valid diagnosis of CSW requires evidence of inappropriate urinary salt losses and reduced "effective arterial blood volume." With no gold standard, the reported measures of volume depletion do not stand scrutiny. We cannot tell the difference between CSW and the syndrome of inappropriate antidiuretic hormone secretion. Furthermore, the distinction does not make a difference; regardless of volume status, hyponatremia complicating intracranial disease should be treated with hypertonic saline.

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673