Fludrocortisone treatment in a patient with cerebral salt wasting associated with cryptococcosis meningitis
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síndrome de secreción inadecuada de ADH
desequilibrio hidroelectrolítico

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González-Clavijo, A. M., Bermúdez-Silva, L. N. ., Galezo-Cuevas, S., Correa Martínez, V., López-Rodríguez, L. V. ., Parra-Castañeda, A. L. ., Parada-Aguilar, M. A. ., Chamorro-Guerrero, C. A. ., & Fierro Maya, L. F. (2022). Fludrocortisone treatment in a patient with cerebral salt wasting associated with cryptococcosis meningitis. Revista Colombiana De Endocrinología, Diabetes &Amp; Metabolismo, 8(4). https://doi.org/10.53853/encr.8.4.598


Introduction: Cerebral salt-wasting (CSW) is a hydroelectrolytic disorder with a confusing etiology, whose main characteristic is a significant hypovolemic hyponatremia, frequently diagnosed in patients with central nervous system (CNS) conditions secondary to trauma or infection.
Objective: To describe the case of a patient with atypical presentation of CSW, who required fludrocortisone as a novel treatment option.
Case presentation: 65-year-old woman who entered the emergency department due to
an altered state of consciousness and severe hyponatremia and stable vital signs. There was no diarrhea, emesis, or severe fever. Syndrome of inappropriate antidiuretic hormone secretion was suspected and administration of fluid restriction was started, worsening the hyponatremia. After identifying hemoconcentration and high urinary volumes, the diagnosis was directed to a Cerebral Salt Wasting (CSW), which led to treatment with hypertonic solution supplemented with fludrocortisone, which allowed reaching levels of safety. Finally, a lumbar puncture was performed, which confirmed cryptococcal meningitis as the origin of the syndrome.
Discussion and conclusion: Cerebral Salt Wasting (CSW) is an infrequent syndrome
of unusual presentation; therefore, it is essential to make an accurate diagnosis since its treatment is different and even opposite to that of other hyponatremia disorders.

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