Saturday February 6, 2010


Q: All of the following can be use as treatment of hyponatremia in Cerebral salt wasting (CSW) after Subarachnoid hemorrhage except:

A) Hypertonic saline (3%)

B) Normal Saline or Salt tablets

C) Conivaptan (Vaprisol)

D) Fluid restriction

E) fludrocortisone (Florinef)


Answer: D

Overall, the treatment for hyponatremia in CSW is aimed at restoring normovolemia with normal serum sodium levels. Often if the patient is without symptoms, aggressive treatment is unnecessary.

In general, patients with CSW will receive an order for intravenous normal saline. Depending on the sodium and fluid balance and the patient's symptoms, hypertonic 3% saline at an initial rate of 25-50 ml/hour, 325 mg salt tablets, and/or 1-2 mg daily of oral fludrocortisone (Florinef) may also be used.

In SIADH, the preferred treatment in the general population is fluid restriction. However, in patients with aneurysmal Subarachnoid hemorrhage (SAH), great care must be taken because of the risk of vasospasm in these patients. It carries risk of increased incidence of infarction in patients treated for supposed SIADH with fluid restriction. Other types of treatment include the infusion of hypertonic saline in conjunction with loop diuretics or newly available arginine vasopressin antagonist (Conivaptan).