Home / Journals American Journal of Internal Medicine / Cerebral Salt Wasting Syndrome in Critically Ill Patients: Epidemiology, Clinical Features and Treatment Controversy
Cerebral Salt Wasting Syndrome in Critically Ill Patients: Epidemiology, Clinical Features and Treatment Controversy
Submission DeadlineMay 25, 2020

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Lead Guest Editor
Professor Gabriel Aranalde
Department of Internal Medicine, Emergency Hospital Clemente Álvarez, National University of Rosario, Rosario, Santa Fe, Argentina
Guest Editor
  • Santiago Adriani
    School of Medical Sciences,Universidad Nacional de Rosario, Rosario, Santa Fe, Argentina
Cerebral salt wasting syndrome, describe for first time by Peters and col in 1950, it defined as a total body water and sodium disorder due to a central nervous system injury in presence of normal renal function. Clinical manifestations are hyponatremia (serum sodium concentration less than 135 mEq/l), hypovolemia and natriuresis. It is a hydroelectrolyte disorder characterized by hypovolemia, hyponatremia and inappropriate natriuresis. It is presents in critically ill patients and frequently the differential diagnostic such diabetes insipidus and syndrome of inappropriate antidiuretic hormone secretion must be established. Pathophysiology is not fully understood, but renin-angiotensin system, autonomic nervous system factors and increased natriuretic peptides after central nervous system injuries exert total body water and sodium balances disorders. One of the most important problems is if this syndrome could be treated with fludrocortisone in all cases. Cerebral salt wasting syndrome treatment consists in increase not only of serum sodium levels but also intravascular volume. Volumen replacement is first performed by sodium chloride 0.9% intravenous infusion until volemia is restored. Hypertonic saline solution is not prescribed. Once euvolemia is achieved, hypertonic saline solution can be indicated if profound hyponatremia persists. Corticosteroids treatment, mainly fludrocortisone acetate, is frequently used as therapeutic in cerebral salt wasting syndrome treatment, although there is not trails with statistical significance that demonstrate the clinical utility of this drug in this clinical setting.
This special issue intends to improve the knowledge of cerebral salt wasting syndrome related to epidemiology, pathophysiology, clinical settings and specifically the importance of fludrocortisone in the treatment.
Aims and Scope:
  1. Relations between renal sodium physiology and cerebral salt wasting syndrome
  2. Advances in pathophysiology
  3. Impact on critically ill patients of profound hydroelectrolytic disorders
  4. Analysis of clinical features and outcomes in different clinical settings
  5. Effects of fludrocortisone on renal sodium and water handling
  6. Evaluation of fludrocortisone effect in the treatment
  7. Keywords: cerebral salt wasting syndrome, natriuretic peptides, natriuresis, intracranial diseases
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