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Bernardi S, Zorat F, Calabrò V, Faustini Fustini M, Fabris B. A case of cerebral salt wasting syndrome in a patient with central diabetes insipidus and status epilepticus. J Endocrinol Invest 2023; 46:1275-1277. [PMID: 36932301 DOI: 10.1007/s40618-023-02053-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/27/2023] [Indexed: 03/19/2023]
Affiliation(s)
- S Bernardi
- SS Endocrinologia, UCO Medicina Clinica, Ospedale di Cattinara, ASUGI, 34149, Trieste, Italy.
- Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi di Trieste, 34149, Trieste, Italy.
| | - F Zorat
- SS Endocrinologia, UCO Medicina Clinica, Ospedale di Cattinara, ASUGI, 34149, Trieste, Italy
| | - V Calabrò
- SS Endocrinologia, UCO Medicina Clinica, Ospedale di Cattinara, ASUGI, 34149, Trieste, Italy
| | - M Faustini Fustini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma di Neurochirurgia Ipofisi (Pituitary Unit), Ospedale Bellaria, 40139, Bologna, Italy
| | - B Fabris
- SS Endocrinologia, UCO Medicina Clinica, Ospedale di Cattinara, ASUGI, 34149, Trieste, Italy
- Dipartimento di Scienze Mediche Chirurgiche e della Salute, Università degli Studi di Trieste, 34149, Trieste, Italy
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Tale S, Kolli M, Masaipeta K, Budumuri GVK. Cerebral salt-wasting syndrome in a patient with status epilepticus: a rare association. BMJ Case Rep 2021; 14:14/1/e237740. [PMID: 33462014 PMCID: PMC7816922 DOI: 10.1136/bcr-2020-237740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Hyponatraemia is one of the most common and serious electrolyte abnormalities in patients with neurological diseases. Assessing the intravascular fluid status, urine sodium, urine and serum osmolality helps to narrow down the differential diagnosis. Differentiation between cerebral salt-wasting syndrome (CSWS), diabetes insipidus and syndrome of inappropriate antidiuretic hormone (SIADH) secretion is absolutely necessary for correct management of hyponatraemia in this group of patients. In this case report, we have presented a 46-year-old gentleman who was admitted to intensive care unit (ICU) with status epilepticus and developed hyponatraemia during course of his ICU stay, diagnosed as CSWS and managed with normal saline and fludrocortisone. His serum sodium gradually improved, consciousness was regained and later shifted to general ward on antiepileptic treatment.
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Affiliation(s)
- Sudheer Tale
- Pulmonary and Critical Care Medicine, AIIMS Rishikesh, Rishikesh, India
| | - Mrudula Kolli
- Pulmonary and Critical Care Medicine, AIIMS Rishikesh, Rishikesh, India
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Outin H, Gueye P, Alvarez V, Auvin S, Clair B, Convers P, Crespel A, Demeret S, Dupont S, Engels JC, Engrand N, Freund Y, Gelisse P, Girot M, Marcoux MO, Navarro V, Rossetti A, Santoli F, Sonneville R, Szurhaj W, Thomas P, Titomanlio L, Villega F, Lefort H, Peigne V. Recommandations Formalisées d’Experts SRLF/SFMU : Prise en charge des états de mal épileptiques en préhospitalier, en structure d’urgence et en réanimation dans les 48 premières heures (A l’exclusion du nouveau-né et du nourrisson). ANNALES FRANCAISES DE MEDECINE D URGENCE 2020. [DOI: 10.3166/afmu-2020-0232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
La Société de réanimation de langue française et la Société française de médecine d’urgence ont décidé d’élaborer de nouvelles recommandations sur la prise en charge de l’état mal épileptique (EME) avec l’ambition de répondre le plus possible aux nombreuses questions pratiques que soulèvent les EME : diagnostic, enquête étiologique, traitement non spécifique et spécifique. Vingt-cinq experts ont analysé la littérature scientifique et formulé des recommandations selon la méthodologie GRADE. Les experts se sont accordés sur 96 recommandations. Les recommandations avec le niveau de preuve le plus fort ne concernent que l’EME tonico-clonique généralisé (EMTCG) : l’usage des benzodiazépines en première ligne (clonazépam en intraveineux direct ou midazolam en intramusculaire) est recommandé, répété 5 min après la première injection (à l’exception du midazolam) en cas de persistance clinique. En cas de persistance 5 min après cette seconde injection, il est proposé d’administrer la seconde ligne thérapeutique : valproate de sodium, (fos-)phénytoïne, phénobarbital ou lévétiracétam. La persistance avérée de convulsions 30 min après le début de l’administration du traitement de deuxième ligne signe l’EMETCG réfractaire. Il est alors proposé de recourir à un coma thérapeutique au moyen d’un agent anesthésique intraveineux de type midazolam ou propofol. Des recommandations spécifiques à l’enfant et aux autres EME sont aussi énoncées.
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Ichioka K, Akuzawa N, Takahashi A. Status epilepticus during correction of hyponatremia in a patient with Alzheimer's disease: A case report. SAGE Open Med Case Rep 2020; 8:2050313X20915416. [PMID: 32313652 PMCID: PMC7160763 DOI: 10.1177/2050313x20915416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 02/23/2020] [Indexed: 11/22/2022] Open
Abstract
An 83-year-old Japanese man with Alzheimer’s disease was admitted to our hospital
for treatment of hyponatremia resulting from water intoxication. During
hospitalization, the patient developed focal impaired awareness seizures, focal
to bilateral tonic-clonic seizures, and subsequent status epilepticus.
Electroencephalogram during focal impaired awareness seizures showed rhythmic
5–9 Hz theta activity in the right frontotemporal region. Electroencephalogram
during focal to bilateral tonic-clonic seizures showed bilateral polyspikes.
Electroencephalogram during an interseizure period revealed sharp waves in the
right frontal region. Continuous intravenous administration of midazolam was the
only effective treatment for status epilepticus. The patient died of aspiration
pneumonia on day 58. Hyponatremia-associated status epilepticus is rare; in the
present case, multifocal epileptogenicity resulting from Alzheimer’s disease and
hyponatremia-associated elevation of glutamate levels in the synaptic cleft may
have contributed to the onset of focal to bilateral tonic-clonic seizures with
subsequent status epilepticus.
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Affiliation(s)
- Ken Ichioka
- Department of General Medicine, National Hospital Organization Shibukawa Medical Center, Shibukawa, Japan
| | - Nobuhiro Akuzawa
- Department of General Medicine, National Hospital Organization Shibukawa Medical Center, Shibukawa, Japan
| | - Akio Takahashi
- Division of Neurosurgery, National Hospital Organization Shibukawa Medical Center, Shibukawa, Japan
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Lin YL, Hung KL, Lo CW. Mycoplasma pneumoniae-
associated encephalitis complicated by cerebral salt wasting syndrome. Clin Case Rep 2017; 5:1830-1833. [PMID: 29152280 PMCID: PMC5676292 DOI: 10.1002/ccr3.1192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 05/12/2017] [Accepted: 08/26/2017] [Indexed: 12/04/2022] Open
Abstract
Cerebral salt wasting syndrome can occur in children with encephalitis. Clinicians should be aware of hyponatremia in patients who develop polyuria with the signs of dehydration and deteriorated consciousness. Furthermore, patients who present with status epilepticus or who are suspected to have high intracranial pressure may have an increased risk of cerebral salt wasting syndrome.
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Affiliation(s)
- Ya-Lan Lin
- Department of Pediatrics; Cathay General Hospital; Taipei Taiwan
| | - Kun-Long Hung
- Department of Pediatrics; Cathay General Hospital; Taipei Taiwan
- School of Medicine; Fu Jen Catholic University; New Taipei Taiwan
| | - Chiao-Wei Lo
- Department of Pediatrics; Cathay General Hospital; Taipei Taiwan
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Ahmad S, Majid Z, Mehdi M, Mubarak M. Cerebral salt wasting syndrome due to tuberculous meningitis; a case report. J Renal Inj Prev 2016; 5:53-4. [PMID: 27069970 PMCID: PMC4827388 DOI: 10.15171/jrip.2016.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 02/17/2016] [Indexed: 11/10/2022] Open
Abstract
A 58-year-old male presented with fever, nausea, and vomiting since 15 days along with irritability and confusion since 5 days. His laboratory reports showed low serum sodium, serum osmolality and uric acid. Computerized tomography (CT) scan of brain revealed age-related changes. While on lumbar puncture (LP) and cerebrospinal fluid (CSF) examination, CSF protein, lactate dehydrogenase (LDH) and total leukocyte count (predominant lymphocytes) were all increased. On his 14th day of admission, his serum sodium was 116 mEq/l and he had a high urine output. Fluid restriction was tried in order to rule out syndrome of inappropriate antidiuretic hormone secretion (SIADH) but the patient did not respond to it. Keeping in view the above findings, a final diagnosis of tuberculous meningitis leading to cerebral salt wasting syndrome was made. The patient was started on 3% hypertonic saline, mineralocorticoids and anti-tuberculous therapy (ATT), to which he responded favorably and was later discharged.
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Affiliation(s)
- Syed Ahmad
- Department of Internal Medicine, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Zain Majid
- Department of Internal Medicine, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Mehwish Mehdi
- Department of Internal Medicine, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Muhammed Mubarak
- Department of Histopathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
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