Cerebral salt-wasting syndrome in a child with Wernicke encephalopathy treated with fludrocortisone therapy: A case report. Issue 36 (September 2016)

• Record Type: Journal Article
• Authors: Han, Min Jeong; Kim, Soon Chul; Joo, Chan Uhng; Kim, Sun Jun
• Editors: Schaller., Bernhard
• Is Part Of: Medicine. Volume 95:Issue 36(2016)
• Page Start: e4393
• Publication Date: 2016-09
• Subjects: cerebral salt-wasting syndrome -- hyponatremia -- Wernicke encephalopathy; Medicine -- Periodicals; Medicine -- Periodicals; Médecine -- Périodiques; Geneeskunde; Medicine; Periodicals; Periodicals; 610.5
• DOI: 10.1097/MD.0000000000004393
• Languages: English
• ISSNs: 0025-7974

Abstract

Abstract: Rationale for this case report: Cerebral Salt-Wasting Syndrome (CSWS) is characterized by hyponatremia and sodium wasting in the urine. [1] These conditions are triggered by various neurosurgical disorders such as subarachnoid hemorrhage, brain tumor, head injury, and brain surgery. [2, 3] To our knowledge, CSWS caused by Wernicke encephalopathy (WE) has been rarely reported. Presenting concerns of the patient: A 2-year-old male patient presented to our hospital due to a seizure attack. He had been neglected and refused to take food for a long time (body weight < 3rd percentile). During admission, the patient showed low serum osmolality, high urine osmolality, dehydration state, increased urine output, and negative water balance, a diagnosis of CSWS was made. Diagnoses, interventions, and outcomes: Brain MRI displayed symmetrical lesions of T2WI and FLAIR high signal intensity in the peri-aqueductal and hypothalamic areas, which suggests Wernicke encephalopathy. For the early diagnosis of WE, neuroimaging studies can be an important marker. Thiamine hydrochloride was administered at a dose of 100 mg/day for 3 weeks. Cerebral salt-wasting syndrome was subsequently diagnosed due to persistent hyponatremia, dehydrated state, and high urine sodium with massive urination. Main lessons learned from this case: Wernicke encephalopathy is a very rare cause of cerebral salt-wasting syndrome in pediatrics patients. The patient had a good outcome after hypertonic solution and fludrocortisone therapy.