Background: Cerebral Salt Wasting Syndrome (CSW) is a state of sodium loss from the kidneys due to cerebral disorders that cause hyponatremia and decreased extracellular fluid volume. One study found that the main cause of hyponatremia was inappropriate electrolytic therapy, use of diuretics, and a Syndrome of Inappropriate Antidiuretic Hormone (SIADH) as much as 78%, while CSW was as much as 10%. CSW is a cause of hyponatremia which is very difficult to understand and challenging thus, it is very important to distinguish it from the SIADH. This is due to the different management between CSW and SIADH. Case Description: A 47-year-old female complained of weakness, frequent thirst and urination, gradual loss of consciousness, and trembling hands. Physical examination revealed a pulse rate of 120 x/minute. Laboratory results showed that serum Na was 108 mmol/l, urine Na was 511.5 mmol/24 h, urine production was 10.2 L/24 h, urine specific gravity ? 1,005, the fluid balance was minus 3.15 L/24 h, AST 177 U/L, ALT 330 U/L, HbA1C 7.5 %, Random Blood Glucose 234 mg/dL. MRI examination showed small vessel ischemia in the right and left semi-ovale centrum, periventricular and basal ganglia. Abdominal USG showed cholelithiasis. Conclusion: Based on clinical symptoms and laboratory results especially hyponatremia, urine balanced, and MRI possibly the patient was diagnosed with CSW syndrome. Distinguishing CSW from most causes of hyponatremia is usually not difficult. This patient fulfills the diagnosis of Evans Syndrome, but an antiplatelet antibody test is still required. An accurate distinction between the two disorders is essential because SIADH is treated with fluid restriction, whereas CSW requires sodium and fluid replacement.

cerebral salt wasting

SIADH

hyponatremia