Cerebral salt wasting after traumatic brain injury: a review of the literatureReport as inadecuate

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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

, 23:98

First Online: 11 November 2015Received: 08 August 2015Accepted: 06 November 2015


Electrolyte imbalances are common among patients with traumatic brain injury TBI. Cerebral salt wasting CSW is an electrolyte imbalance characterized by hyponatremia and hypovolemia. Differentiating the syndrome of inappropriate antidiuretic hormone and CSW remains difficult and the pathophysiological mechanisms underlying CSW are unclear. Our intent was to review the literature on CSW within the TBI population, in order to report the incidence and timing of CSW after TBI, examine outcomes, and summarize the biochemical changes in patients who developed CSW. We searched MEDLINE through 2014, hand-reviewed citations, and searched abstracts from the American Association for the Surgery of Trauma 2003–2014. Publications were included if they were conducted within a TBI population, presented original data, and diagnosed CSW. Publications were excluded if they were review articles, discussed hyponatremia but did not differentiate the etiology causing hyponatremia, or presented cases with chronic disease. Fifteen of the 47 publications reviewed met the selection criteria; nine 60 % were case reports, five 33 % were prospective and 1 7 % was a retrospective study. Incidence of CSW varied between 0.8 - 34.6 %. The populations studied were heterogeneous and the criteria used to define hyponatremia and CSW varied. Though believed to play a role in the development of CSW, increased levels of natriuretic peptides in patients diagnosed with CSW were not consistently reported. These findings reinforce the elusiveness of the CSW diagnosis and the need for strict and consistent diagnostic criteria.

KeywordsHyponatremia Water-electrolyte imbalance Traumatic brain injury Incidence Natriuretic peptides Review AbbreviationsAASTAmerican Association for the Surgery of Trauma

ACTHAdrenocorticotropic hormone

ADHAntidiuretic hormone

ANPAtrial natriuretic peptide

aSAHAneurysmal subarachnoid hemorrhage

BNPBrain natriuretic peptide

CNPC type natriuretic peptide

CSWCerebral salt wasting

CTComputed tomography

DNPDendroaspis natriuretic peptide

GCSGlasgow coma score

GOSGlasgow outcome score

LOSLength of stay

PRISMAPreferred reporting items for systematic reviews and meta-analyses

SIADHSyndrome of inappropriate antidiuretic hormone

TBITraumatic brain injury

tSAHTraumatic subarachnoid hemorrhage

Electronic supplementary materialThe online version of this article doi:10.1186-s13049-015-0180-5 contains supplementary material, which is available to authorized users.

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