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Cerebral salt wasting syndrome (CSWS) also presents with hyponatremia, there are signs of dehydration for which reason the management is diametrically opposed to SIADH. Importantly CSWS can be associated with subarachnoid hemorrhage (SAH) which may require fluid supplementation rather than restriction to prevent brain damage.
Hypoosmolar hyponatremia is a condition where hyponatremia is associated with a low plasma osmolality. [1] The term "hypotonic hyponatremia" is also sometimes used.[2]When the plasma osmolarity is low, the extracellular fluid volume status may be in one of three states: low volume, normal volume, or high volume.
Normal volume hyponatremia, wherein the increase in ADH is secondary to either physiologic but excessive ADH release (as occurs with nausea or severe pain) or inappropriate and non-physiologic secretion of ADH, that is, syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH).
More severe hyponatremia (levels less than 120 mEq/L), particularly if it develops rapidly (defined as occurring over less than 48 hours), can cause confusion, seizures and even lead to death ...
The term "cerebral hyponatremia" was suggested in the work of Epstein, et al. 1961. Inappropriate release of endogenous vasopressin is probably responsible for hyponatremia in tuberculous meningitis. Inability to excrete water normally is also a feature of the salt wasting of certain hyponatremic patients with pulmonary tuberculosis.
Hyponatremia is believed to arise as a result of a diet poor in salt and protein with large water intake in combination with a low glomerular filtration rate (GFR). The low GFR causes a lowered rate of osmole excretion, and an increase in the amount of water reabsorbed; thus, hyponatremia occurs when the amount of water intake exceeds the renal ...
[8] [9] Theoretically, fluid restriction could also correct the electrolyte imbalance in hyponatremia, but again, diuretics, mainly vasopressin receptor antagonists, show better efficiency. [6] Nevertheless, in hyponatremia secondary to SIADH, long-term fluid restriction (of 1,200–1,800 mL/day) in addition to diuretics is standard treatment. [10]
Hyponatremia means that the concentration of sodium in the blood is too low. It is generally defined as a concentration lower than 135 mEq/L. [ 3 ] This relatively common electrolyte disorder can indicate the presence of a disease process, but in the hospital setting is more often due to administration of Hypotonic fluids.