Q: Which is more common in subarachnoid hemorrhage (SAH)? (select one)
A) Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
B) Cerebral salt wasting (CSW)
Answer: A
Due to its novel presentation, CSW is often reflexly get over-diagnosed in SAH, whenever hyponatremia is manifested. In fact, hyponatremia in SAH is almost always due to SIADH unless ruled out. It is always hard to differentially diagnose both conditions as they have similar manifestations. Clinical exam plays an important role in the diagnosis of CSW with hypotension, decreased skin turgor, and possibly increased blood urea nitrogen/serum creatinine ratio (signs of volume depletion).
The major differential diagnosis point is urine sodium concentration, which should be low in SIADH but in CSW.
#electrolytes
#neurology
#nephrology
References:
1. Sterns RH, Silver SM. Cerebral salt wasting versus SIADH: what difference? J Am Soc Nephrol 2008; 19:194.
2. Deslarzes T, Turini P, Friolet R, Meier P. Perte de sel d'origine cérébrale versus sécrétion inappropriée d'hormone antidiurétique [Cerbral salt wasting syndrome versus SIADH]. Rev Med Suisse. 2009 Nov 11;5(225):2281-4. French. PMID: 19999317.
3. Maesaka JK, Imbriano L, Mattana J, Gallagher D, Bade N, Sharif S. Differentiating SIADH from Cerebral/Renal Salt Wasting: Failure of the Volume Approach and Need for a New Approach to Hyponatremia. J Clin Med. 2014 Dec 8;3(4):1373-85. doi: 10.3390/jcm3041373. PMID: 26237607; PMCID: PMC4470189.
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