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Distinguishing cerebral salt wasting syndrome and syndrome of inappropriate ADH in a patient with traumatic brain injury
  1. Hassan Mohamed1,2 and
  2. George Shorten3,4
  1. 1Department of Anaesthesia, Intensive Care and Pain Management, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
  2. 2Department of Anaesthesia and Intensive Care, Leeds Teaching Hospitals, Leeds, West Yorkshire, UK
  3. 3Department of Anaesthesia and Intensive Care, University College Cork, Cork, Ireland
  4. 4Department of Anaesthesia and Intensive Care, Cork University Hospital, Cork, Cork, Ireland
  1. Correspondence to Dr Hassan Mohamed; hassan.ahmed7{at}


A previously healthy 48-year-old woman was referred to our intensive care unit (ICU) from a neurosurgical ward due to deterioration of her conscious level. She had a road traffic accident 6 days earlier. On admission to the hospital, a brain CT demonstrated subarachnoid haemorrhage which was considered not amenable to surgical intervention. A second CT brain performed shortly after admission to ICU showed no change in comparison to the initial CT. Serum sodium level on ICU admission was 108 mEq/L; serum and urine osmolalities were 223 mOsm/kg and 438 mOsm/kg, respectively. Her hyponatraemia was initially attributed to syndrome of inappropriate antidiuretic hormone. However, a clinical impression of low volume status raised the suspicion of cerebral salt wasting syndrome. She was managed by infusion of hypertonic saline and fluids for 5 days and discharged from ICU after improvement of her conscious level and normalisation of serum sodium.

  • adult intensive care
  • fluid electrolyte and acid-base disturbances
  • trauma CNS /PNS

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  • Presented at The College of Anaesthesiologists of Ireland Congress, Dublin, May 2019.

  • Contributors HM: analysed and interpreted the patient data, wrote the primary draft of the manuscript. GS: Substantially edited and revised the manuscript. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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