Fludrocortisone treatment in a child with severe cerebral salt wasting

Hyponatremia is a common complication of intracranial disease or surgery. A n evaluation should be undertaken to determine whether cerebral salt wastin g (CSW) or inappropriate secretion of antidiuretic hormone is present as a cause. Since the treatment principles are completely different in the two p athological states, differential diagnosis is very important. CSW is define d as the renal loss of sodium leading to hyponatremia and decreased extrace llular fluid volume. In the literature, it has been noted that mineralocort icoid administration can be useful in CSW cases. We herein present an 11-ye ar-old boy who developed hyponatremic seizures after intracranial tumor res ection. He was diagnosed with CSW on the basis of high urinary sodium excre tion and increased urine output, together with signs and symptoms of dehydr ation. Despite intensive fluid and salt therapy, we were unable to decrease the urinary output. Therefore, fludrocortisone therapy was administered an d his urinary output and sodium excretion were decreased and his serum sodi um level was normalized. In conclusion, in addition to fluid and salt repla cement, mineralocorticoid supplementation also seems to be a safe and effec tive treatment for CSW. Copyright (C) 2001 S. Karger AG, Basel.