Research On The Diagnosis And Treatment Of Cerebral Salt Wasting Syndrome

Objective:Through studying the method for early identification of cerebral salt wasting syndrome(CSWS)and syndrome of inappropriate antidiuretic hormone secretion(SIADH)in clinical work,and the efficacy of hydrocortisone in treating refractory CSWS,this thesis provides a reference for clinical diagnosis and treatment of CSWS.Methods:A total of 136 patients with CSWS and SIADH secondary to central nervous system diseases who were admitted to the First Affiliated Hospital of Gannan Medical University from January 2017 to January 2021 were compared and analyzed using a retrospective study method.Differences in gender,age,comorbidities,symptoms of hyponatremia and early blood and urine-related indicators between CSWS patients and SIADH patients are examined.Furthermore,blood sodium concentration,24 h urinary sodium,and urine volume in CSWS patients before and after hydrocortisone treatment were compared.Statistical analysis was performed by t test,chi-square test and logistic regression.Results:A total of 194 patients with central nervous system diseases and hyponatremia(serum sodium concentration <130mmol/L)were collected from January 2017 to January 2021,including 71 patients(36.6%)with SIADH,65 patients(33.5%)with CSWS,and 58 other patients(29.9%).Among these patients,SIADH and CSWS were mainly secondary to spontaneous subarachnoid hemorrhage,craniocerebral trauma,stroke,intracranial infection,and postoperative brain tumor.Analysis of symptoms and indicators related to hyponatremia: the proportion of severe symptoms in the CSWS group was significantly higher than that in the SIADH group(56.92% vs 38.03%,P<0.05);among blood volume-related indicators,the mean systolic blood pressure in the CSWS group was lower than that in the SIADH group,the mean heart rate was higher than that in the SIADH group with significant differences(P<0.05);the blood urea nitrogen and the ratio of blood urea nitrogen/creatinine in the CSWS group were higher than those in the SIADH group(P<0.01),while the hemoglobin and serum albumin of the two groups were no significant difference(P>0.05).The 24 h urine volume,24 h urine sodium,24 h urine potassium and 24 h urine chloride of the CSWS group were significantly higher than those of the SIADH group(P<0.001),but there was no significant difference in serum sodium,serum potassium,plasma osmotic pressure and urinary sodium concentration(P>0.05).The initial blood uric acid level of the SIADH group was lower than the CSWS group(P=0.0237).When blood sodium increased to 130.0mmol/L,the level and rising change of the blood uric acid in the SIADH group was significantly higher than the CSWS group(P=0.0017,P <0.001).There was no significant difference in NT-pro BNP value between the two groups(P=0.0988).Logistic analysis showed that the patients with high blood urea nitrogen/creatinine ratio,high 24 h urine volume and high urine sodium volume were more likely to be diagnosed with CSWS(P=0.014,P=0.01,P=0.019).In the CSWS group,32 patients(49.2%)did not return to normal serum sodium after a large amount of fluid and sodium supplementation,and their 24 h urine volume and 24 h urinary sodium did not decrease.However,after receiving hydrocortisone treatment(300 mg/day,average treatment time 5.3 days),the blood sodium concentration returned to normal level,the 24 h urine volume and 24 h urine sodium volume also decreased significantly,and the negative balance of 24 h intake and output also improved significantly.A total of 8 patients developed mild complications during treatment,and 11 patients(34.4%)developed hyponatremia recurrence.Conclusion:The ratio of blood urea nitrogen/creatinine,24 h urine volume,and 24 h urine sodium in patients with CSWS are higher.Combined with the dynamic monitoring of key indicators such as blood volume and blood uric acid,which will be more helpful for the identification of SIADH.In addition,hydrocortisone can be an effective treatment for refractory CSWS.