Artikel
Cerebral salt wasting in children with neurosurgical disease
CSW bei Kindern mit neurochirurgischen Erkrankungen
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Autoren
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M. J. Fritsch
- Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
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P. von Bismarck
- Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
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T. Ankermann
- Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
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P. Eggert
- Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
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A. Claviez
- Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
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M. F. Krause
- Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| Veröffentlicht: | 4. Mai 2005 |
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Gliederung
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Objective
Cerebral salt wasting (CSW) is a medical complication in children with acute or chronic brain diseases and occurs at all ages beyond the neonatal period. Usually, stressful stimuli such as surgical procedures, general anesthesia or acute complications of chronic brain disease are known to cause CSW.
Methods
We present a case series of 9 patients with brain disease, negative sodium balance and polyuria seen in our institution within a 22 months period and describe the symptoms, patient characteristics (including hormone status), monitoring, treatment protocol and course of the disease.
Results
For induction of CSW, 4/9 patients presented with an acute complication of their prevalent chronic brain disease. 7/9 patients were subject to surgical procedures in general anesthesia, 4 of whom with manipulations of the brain or spinal chord. 2/9 children had CSW as an acute symptom of severe chronic brain disease triggered by unknown causes. Natriuresis and polyuria with increased Na+ turnover vanished within 2 weeks in 6/9 patients leaving 3 patients with longer courses of several weeks. Atrial and brain natriuretic peptides as a suspected cause of salt wasting were increased in only 5/9 of our patients. All children showed depressed plasma renin activity and low aldosterone levels.
Conclusions
CSW is eventually seen in chronic brain diseased children and can be triggered by a variety of acute brain complications or stressful stimuli. The length of the disease is self-limited and generally ceases within two weeks while substitution with adequate water and sodium intake should be monitored carefully.
