Yonsei Med J.  2012 Jul;53(4):859-862. 10.3349/ymj.2012.53.4.859.

Cerebral Salt Wasting Treated with Fludrocortisone in a 17-Year-Old Boy

  • 1The Institute of Kidney Disease, Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital, Seoul, Korea. shinji@yuhs.ac
  • 2Department of Pediatrics, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea.


Cerebral salt wasting is characterized by inappropriate natriuresis and volume contraction with associated cerebral pathology. It is distinct from the syndrome of inappropriate antidiuretic hormone secretion, which is characterized by inappropriate retention of free water. We report a patient with a porencephalic cyst who developed cerebral salt wasting. His initial treatment was supplementation of water and salt, which did not improve natriuresis or volume contraction. Fludrocortisone administration effectively managed the cerebral salt wasting.


Cerebral salt wasting; hyponatremia; fludrocortisone

MeSH Terms

Fludrocortisone/*therapeutic use
Hyponatremia/*drug therapy
Sodium Chloride/therapeutic use


  • Fig. 1 The computed tomography shows a porencephalic cyst in the left parieto-occipital and right frontal areas, showing the inserted cysto-parietal shunt.

  • Fig. 2 (A) Changes in serum Na level following fludrocortisone use (mmol/L). (B) Changes in random urine Na level following fludrocortisone use (mmol/L). Na, sodium.


1. Rahman M, Friedman WA. Hyponatremia in neurosurgical patients: clinical guidelines development. Neurosurgery. 2009. 65:925–935.
2. Lee P, Jones GR, Center JR. Successful treatment of adult cerebral salt wasting with fludrocortisone. Arch Intern Med. 2008. 168:325–326.
3. Taplin CE, Cowell CT, Silink M, Ambler GR. Fludrocortisone therapy in cerebral salt wasting. Pediatrics. 2006. 118:e1904–e1908.
4. Betjes MG. Hyponatremia in acute brain disease: the cerebral salt wasting syndrome. Eur J Intern Med. 2002. 13:9–14.
5. Ozdemir H, Aycan Z, Degerliyurt A, Metin A. The treatment of cerebral salt wasting with fludrocortisone in a child with lissencephaly. Turk Neurosurg. 2010. 20:100–102.
6. Hegde RM. Cerebral salt wasting syndrome: a case report. Crit Care Resusc. 1999. 1:180–183.
7. Kinik ST, Kandemir N, Baykan A, Akalan N, Yordam N. Fludrocortisone treatment in a child with severe cerebral salt wasting. Pediatr Neurosurg. 2001. 35:216–219.
8. Sakarcan A, Bocchini J Jr. The role of fludrocortisone in a child with cerebral salt wasting. Pediatr Nephrol. 1998. 12:769–771.
9. Nagotkar L, Shanbag P, Dasarwar N. Cerebral salt wasting syndrome following neurosurgical intervention in tuberculous meningitis. Indian Pediatr. 2008. 45:598–601.
10. Ishikawa SE, Saito T, Kaneko K, Okada K, Kuzuya T. Hyponatremia responsive to fludrocortisone acetate in elderly patients after head injury. Ann Intern Med. 1987. 106:187–191.
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