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Review
. 2025 Jul 29;25(1):578.
doi: 10.1186/s12887-025-05862-8.

Multiphase management of sodium imbalance following traumatic brain injury: a case-based review

Vinson James  1 , Laura Nimkoff  2
Affiliations
Review

Multiphase management of sodium imbalance following traumatic brain injury: a case-based review

Vinson James et al. BMC Pediatr. .

Abstract

Background: This review article discusses a case of sodium imbalance and fluid dysregulation in a patient with traumatic brain injury (TBI), progressing through phases including mannitol-induced osmotic diuresis, arginine vasopressin deficiency (central diabetes insipidus), and syndrome of inappropriate antidiuresis (SIAD), before eventual resolution with euvolemia. The timeline of clinical interventions, laboratory trends, and diagnostic insights highlights the complexity of managing sodium and fluid balance in TBI patients.

Objective: To illustrate the diagnostic and management challenges of a pediatric TBI case complicated by the sequential development of osmotic diuresis, arginine vasopressin deficiency, syndrome of inappropriate antidiuretic hormone secretion (SIAD), and subsequent stabilization.

Methods: We present a detailed case report of a child with severe TBI who experienced multiple phases of sodium and fluid dysregulation, necessitating vigilant monitoring and dynamic management adjustments.

Results: The patient initially developed profound polyuria due to mannitol-induced osmotic diuresis, which obscured the emerging arginine vasopressin deficiency. The transition to SIAD further complicated management, requiring careful fluid and sodium correction. This case underscores the importance of close monitoring in post-TBI patients to detect evolving endocrine disturbances that necessitate timely interventions.

Conclusion: The sequential manifestation of osmotic diuresis, arginine vasopressin deficiency, SIAD, and eventual stabilization in a single patient is a rare and complex occurrence. This case emphasizes the need for dynamic fluid and electrolyte management, with ongoing assessment to tailor interventions appropriately. Our findings highlight the critical role of multidisciplinary teams in optimizing patient outcomes in pediatric TBI cases.

Keywords: Arginine vasopressin deficiency; Electrolyte imbalance; Endocrine complications in TBI; Fluid and sodium homeostasis; Hypothalamic-Pituitary dysfunction; Mannitol diuresis; Osmotic diuresis; Pediatric neurocritical care; Polyuria and hypernatremia; Syndrome of inappropriate antidiuretic hormone secretion (SIAD); Traumatic brain injury (TBI).

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Approved by Good Samaritan University Hospital IERB. Consent for publication: written informed consent for publication was obtained from the legal guardian. The signed consent form has been securely saved and is available upon request if required by the editorial office. Competing interests: The authors declare no competing interests. Clinical trial number: Not applicable..

Figures

Fig. 1
Fig. 1
Timeline of sodium levels and interventions in Pediatric TBI
Fig. 2
Fig. 2
Graph plotting serum sodium and urine output over time
See this image and copyright information in PMC

References

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