A Case Report of Cerebral Salt Wasting Syndrome in a Patient with Subarachnoid Hemorrhage
Hyponatremia is a common condition following acute brain injury, the two main causes of which are the Syndrome of Inappropriate Antidiuretic Hormone (SIADH) and the Cerebral Salt Wasting Syndrome (CSWS). Differentiating between the two conditions is important due to the divergent management approach. We present a case of hyponatremia in a 36-year-old female attributed to CSWS after subarachnoid hemorrhage and endovascular coiling of cerebral aneurysm. As there are no established guidelines for the diagnosis of CSWS, a high degree of suspicion and accurate assessment of the volume status with clinical and objective parameters is essential in differentiating it from SIADH to avoid catastrophic complications. Aggressive salt and fluid management in addition to the use of fludrocortisone, a potent mineralocorticoid, was successfully used to achieve hemodynamic stability, fluid and salt balance in this case.
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