How is cerebral salt-wasting syndrome (CSWS) (renal salt wasting) treated?

Updated: May 13, 2020
  • Author: Sudha Garimella, MBBS; Chief Editor: Sasigarn A Bowden, MD  more...
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Evaluation and treatment of cerebral salt-wasting syndrome, or renal salt wasting, typically occurs in the inpatient setting because most patients are seriously ill with acute CNS disease.

Management centers on correction of intravascular volume depletion and hyponatremia, as well as on replacement of ongoing urinary sodium loss, usually with intravenous (IV) hypertonic saline solutions. [3] Some clinicians have reported a favorable response to mineralocorticoid therapy in cerebral salt-wasting syndrome. Once the patient is stabilized, enteral salt supplementation can be considered.

Ongoing monitoring of body weight, fluid balance, and serum sodium concentration is essential during the hospital course.

A retrospective, single-center study by Sigmon et al found an increased risk of hyperchloremia and acute kidney injury in patients with neurologic injury who undergo hypertonic sodium therapy with a large chloride load. The 142 patients in the study received high volumes of intravenous hypertonic sodium chloride, with acute kidney injury and hyperchloremia developing in 13% and 38% of them, respectively. [18]

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