Cerebral salt wasting following tuberculous meningoencephalitis in an infant

Abstract

In patients with central nervous system disease, life-threatening hyponatremia can result from either the syndrome of inappropriate secretion of antidiuretic hormone or cerebral salt wasting. Clinical manifestations of the two conditions may be similar, but their pathogeneses and management protocols are different. Cerebral salt wasting syndrome is a disorder in which excessive natriuresis and hyponatremia occurs in patients with intracranial diseases. We report a 6-month-old girl with CSWS associated with tuberculous meningoencephalitis. She was diagnosed as having CSWS on the basis of hypovolemia, polyuria, natriuresis, and the relatively high level of fractional excretion of uric acid. Aggressive replacement of urine salt and water losses using 0.9% or 3% sodium chloride was done. Fludrocortisone was started at 0.1 mg twice daily on the seventh day of admission and was continued for 17 days.

Keywords: Cerebral salt wasting; fludrocortisone; natriuretic peptide; tuberculous meningoencephalitis.

Figure 1

T2 weighted coronal image showing hyperintensity along cortical gyri in parafalci region and bilateral temporal lobes s/o meningoencephalitis. Also seen is a hypotense focus in subcortical parafalcine location s/o focal hemorrhage