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    "textoCompleto" => "To the editor&#58; Hyponatremia is the most prevalent water and electrolyte disorder in standard clinical practice&#46;1 The cerebral salt-wasting syndrome &#40;CSWS&#41; is an uncommon cause of hyponatremia&#46; The case of a male patient with bacterial meningitis who developed hyponatremia secondary to CSWS is reported below&#46; <br></br><br></br>CASE REPORT <br></br>A 21-year-old male patient with an unremarkable history was admitted to the intensive care unit &#40;ICU&#41; with a diagnosis of meningococcal meningitis associated to sepsis with multiorgan failure that required mechanical&#160; ventilation&#44; hemodynamic support with dopamine&#44; treatment with human recombinant activated C protein&#44; and anticonvulsant drugs&#160; due&#160; to&#160; a&#160; secondary&#160; irritative focus&#46;&#160; Empiric&#160; treatment&#160; was&#160; started with&#160; ampicillin&#44;&#160; cefotaxime&#44; vancomycin&#44; and dexamethasone&#44; and was switched to cefotaxime alone after the causative&#160; germ was isolated &#40;Neisseria meningitidis&#41; and the results of susceptibility testing were known&#46; Serum creatinine &#40;SCr&#41; levels&#160; at ICU admission were 3&#46;2 mg&#47;dL&#44; and normalized after two days &#40;0&#46;9 mg&#47;dL&#41;&#46; Once hemodynamic stabilization&#44; renal function control&#44;&#160; and&#160; spontaneous&#160; breathing&#160; had been&#160; achieved&#44;&#160; the&#160; patient was moved to the ward&#46; <br></br><br></br>During&#160; the&#160; final&#160; days&#160; of&#160; stay&#160; at&#160; the ICU&#44; a progressive decrease in natremia was documented &#40;see table I&#41;&#44; associated to polyuria of 4-5 liters daily&#44; with normal serum levels of antidiuretic hormone &#40;ADH&#41; and high levels of&#160; brain natriuretic peptide &#40;pro-BNP&#41;&#46; Adequate&#160; intravenous&#160; volume&#160; replacement with physiological saline based on urinary&#160; sodium&#160; loss&#160; allowed&#160; for normalization of natremia and a normal volume status &#40;table I&#41;&#46; <br></br><br></br>DISCUSSION <br></br>In&#160; patients&#160; with&#160; central&#160; nervous&#160; system&#160; diseases&#44;&#160; hyponatremia&#160; does&#160; not have to be necessarily related to&#160; a syndrome&#160; of&#160; inappropriate&#160; ADH&#160; secretion&#160; &#40;SIADH&#41;&#44;&#160; but may&#160; be&#160; secondary to a CSWS&#46;2&#44;3 Subarachnoid&#160; hemorrhage&#160; is&#160; the most&#160; common&#160; cause of&#160; CSWS&#44;&#160; but&#160; this&#160; has&#160; also&#160; been&#160; reported&#160; to&#160; be&#160; associated&#160; to meningitis of an infectious origin&#46; A new case of CSWS&#160; occurring&#160; in&#160; a&#160; young&#160; adult after resolution of a bacterial meningitis is reported&#46; <br></br><br></br>Diagnosis&#160; of&#160; CSWS&#160; requires&#160; the presence&#160; of&#160; an&#160; inappropriate diuresis for circulating sodium levels and volume depletion&#46;4 Diagnostic suspicion of CSWS&#160; is&#160; essential&#160; for&#160; hyponatremia control&#44; because its treatment is totally different&#160; from&#160; that&#160; of&#160; SIADH&#46; While volume and sodium replacement is essential&#160; in CSWS&#44; SIADH&#160; responds&#160; to water restriction&#46;5 In the case reported&#44; CSWS&#160; was&#160; suspected&#160; based&#160; on&#160; the existence of polyuria associated to hyponatremia&#160; and&#160; elevated&#160; natriuresis&#46; Elevated&#160; serum&#160; levels&#160; of&#160; pro-BNP confirmed diagnosis of CSWS&#46; The increase in pro-BNP serum levels secondary to the inflammatory process in the central nervous system could be related&#160; to&#160; the&#160; inappropriately high natriuresis&#46; <br></br><br></br>To sum up&#44; occurrence of hyponatremia combined with increased natriuresis and volume depletion in patients with&#160; central&#160; nervous&#160; system&#160; disease should raise the suspicion of a CSWS&#46; <br></br>"
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Hyponatremia secondary to cerebral salt-wasting syndrome associated to bacterial meningitis
Hiponatremia secundaria a síndrome pierde sal cerebral asociado a meningitis bacteriana.
MANUEL HERAS BENITOa, ROSA SANCHEZ HERNANDEZa, MARIA JOSE FERNANDEZ-REYESb, PEDRO IGLESIASc, PALOMA GUEVARAd
a Servicios de Nefrología, Hospital General, Segovia, Segovia, España,
b Servicios de Nefrología, Hospital General Segovia, Segovia, España,
c Servicios de Endocrinología, Hospital General, Segovia, Segovia, España,
d Servicios de Bioquímica, Hospital General, Segovia, Segovia, España,
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ISSN: 20132514
Original language: English
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