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Published online November 13, 2006
PEDIATRICS Vol. 118 No. 6 December 2006, pp. e1904-e1908 (doi:10.1542/peds.2006-0702)
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EXPERIENCE & REASON

Fludrocortisone Therapy in Cerebral Salt Wasting

Craig E. Taplin, MBBS, Christopher T. Cowell, MBBS, Martin Silink, MD, Geoffrey R. Ambler, MD

Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia

ABSTRACT

Cerebral salt wasting is an increasingly recognized condition in pediatrics and is characterized by inappropriate natriuresis and volume contraction in the presence of cerebral pathology. Diagnosis can be difficult and therapy challenging. A few single case reports of the successful use of fludrocortisone exist. We report 4 patients with cerebral salt wasting, all of whom presented with hyponatremia in the presence of known intracerebral pathology. All had clinically significant hyponatremia, and 3 had hyponatremic seizures. Two of the patients also satisfied clinical criteria for diabetes insipidus. They all were treated with regimens using increased sodium and fluid administration but experienced ongoing salt wasting. Fludrocortisone was instituted in all 4 patients and in 3 resulted in rapid improvement in net sodium balance, enabling the weaning of hypertonic fluids and stabilization of serum electrolytes. In 3 patients, fludrocortisone treatment was complicated by hypokalemia, and in 1 patient by hypertension, which necessitated a dose reduction or brief cessation of therapy. Duration of therapy was 4 to 125 days. Cerebral salt wasting presents considerable management challenges; however, fludrocortisone therapy can be an effective adjunct to treatment.

Key Words: cerebral salt wasting • hyponatremia • fludrocortisone

Abbreviations: SIADH, syndrome of inappropriate antidiuretic hormone secretion • CSW, cerebral salt wasting • DI, diabetes insipidus • ADH, antidiuretic hormone

Accepted Jun 29, 2006.


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