Hyponatremia hypo-osmolarity in neurosurgical patients. “Appropriate secretion of ADH” and “Cerebral salt wasting syndrome”

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Abstract
This prospective study is based on 256 patients with severe brain injury. Six patients (2.3%) developed the clinical picture of inappropriate secretion of antidiuretic hormone (SIADH): 3 in the first 3 days following the injury, 3 after more than a week. Their ADH plasmatic level were measured by radio-immunoassay. In the former, many factors, largely iatrogenic, can explain the increased secretion of ADH we found and which is then definitely “appropriate”. It should be prevented by fluid restriction. In the latter, we found adequately low ADH levels, when the hypo-osmolarity is taken into account. Here, the aetiology seems to be a renal salt loss, eventually in relation to a natriuric factor (e.g. atrial natriuretic factor), justifying the term: “Cerebral salt wasting syndrome”. With the resistance to fluid restriction, the treatment still remains a problem.