Fludrocortisone treatment in a patient with cerebral salt wasting associated with cryptococcosis meningitis
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Keywords

hiponatremia
hipovolemia
criptococosis
síndrome de secreción inadecuada de ADH
desequilibrio hidroelectrolítico

How to Cite

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

Abstract

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.

https://doi.org/10.53853/encr.8.4.598
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References

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;3(4):1373-85. DOI: https://doi.org/10.3390/jcm3041373

Spasovski G, Vanholder R, Allolio B, Annane D, Ball S, Bichet D, et al. Guía de práctica clínica sobre el diagnóstico y tratamiento de la hiponatremia. Nefrología. 2017;37(4):370-80. DOI: https://doi.org/10.1016/j.nefro.2017.03.021

Castellanos L, Cárdenas L, Carrillo ML. Revisión hiponatremia. Horiz Méd Lima. 2016;16(4):60-71. DOI: https://doi.org/10.24265/horizmed.2016.v16n4.10

Cui H, He G, Yang S, Lv Y, Jiang Z, Gang X, et al. Inappropriate Antidiuretic Hormone Secretion and Cerebral Salt-Wasting Syndromes in Neurological Patients. Front Neurosci. 2019;13. DOI: https://doi.org/10.3389/fnins.2019.01170

Yee AH, Burns JD, Wijdicks EF. Cerebral salt wasting: pathophysiology, diagnosis, and treatment. Neurosurg Clin. 2010;21(2):339-52. DOI: https://doi.org/10.1016/j.nec.2009.10.011

Sterns RH, Silver SM. Cerebral salt wasting versus SIADH: what difference? J Am Soc Nephrol. 2008;19(2):194-6. DOI: https://doi.org/10.1681/ASN.2007101118

Palmer BF. Hyponatremia in patients with central nervous system disease: SIADH versus CSW. Trends Endocrinol Metab. 2003 my.-jun.;14(4):182-7. DOI: https://doi.org/10.1016/S1043-2760(03)00048-1

Berendes E, Walter M, Cullen P, Prien T, Van Aken H, Horsthemke J, et al. Secretion of brain natriuretic peptide in patients with aneurysmal subarachnoid haemorrhage. Lancet. 1997;349(9047):245-9. DOI: https://doi.org/10.1016/S0140-6736(96)08093-2

Leonard J, Garrett RE, Salottolo K, Slone DS, Mains CW, Carrick MM, et al. Cerebral salt wasting after traumatic brain injury: a review of the literature. Scand j trauma, resusc emerg med. 2015;23(1):1-7. DOI: https://doi.org/10.1186/s13049-015-0180-5

Pappas PG, Perfect JR, Cloud GA, Larsen RA, Pankey GA, Lancaster DJ, et al. Cryptococcosis in human immunodeficiency virus-negative patients in the era of effective azole therapy. Clin Infect Dis. 2001;33(5):690-9. DOI: https://doi.org/10.1086/322597

Castañeda E, Lizarazo J. Protocolo de estudio y manejo de los pacientes con criptococosis. Infectio. 2012;16(3S). DOI: https://doi.org/10.1016/S0123-9392(12)70038-3

Colombo AC, Rodrigues ML. Fungal colonization of the brain: anatomopathological aspects of neurological cryptococcosis. Anais da Academia Brasileira de Ciências. 2015;87:1293-309. DOI: https://doi.org/10.1590/0001-3765201520140704

Misra UK, Kalita J, Kumar M, Tripathi A. A study of atrial and brain natriuretic peptides in tuberculous meningitis and acute encephalitis. Int J Tuberc Lung Dis. 2018;22(4):452-7. DOI: https://doi.org/10.5588/ijtld.17.0479

Tobin G, Chacko AG, Simon R. Evaluation of NT-ProBNP as a marker of the volume status of neurosurgical patients developing hyponatremia and natriuresis: A pilot study. Neurol India. 2018 sept.-oct.;66(5):1383-8. DOI: https://doi.org/10.4103/0028-3886.241401

Arieff AI, Gabbai R, Goldfine ID. Cerebral salt-wasting syndrome: diagnosis by urine sodium excretion. Am J Med Sci. 2017;354(4):350-4. DOI: https://doi.org/10.1016/j.amjms.2017.05.007

Gurnurkar S, Villacres S, Warner L, Chegondi M. Successful use of fludrocortisone in a child with refractory cerebral salt wasting syndrome: a case report and review of literature. Cureus. 2018;10(10). DOI: https://doi.org/10.7759/cureus.3505

Manzanares W, Aramendi I, Langlois PL, Biestro A. Hiponatremias en el paciente neurocrítico: enfoque terapéutico basado en la evidencia actual. Med Intensiva. 2015;39(4):234-43. DOI: https://doi.org/10.1016/j.medin.2014.11.004

Misra UK, Kalita J, Kumar M. Safety and Efficacy of Fludrocortisone in the Treatment of Cerebral Salt Wasting in Patients With Tuberculous Meningitis: A Randomized Clinical Trial. JAMA Neurology. 2018;75:1383-91. DOI: https://doi.org/10.1001/jamaneurol.2018.2178

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