Diagnosis and management of cerebral salt wasting (CSW) in children: the role of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP)
| Autor: | Philipp von Bismarck, Alexander Claviez, Tobias Ankermann, Martin F. Krause, Paul Eggert, Michael J. Fritsch |
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| Rok vydání: | 2006 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Adolescent Vasopressins medicine.drug_class Radioimmunoassay chemistry.chemical_compound Atrial natriuretic peptide Internal medicine Natriuretic Peptide Brain medicine Natriuretic peptide Humans cardiovascular diseases Child Brain Diseases Aldosterone business.industry Infant General Medicine Brain natriuretic peptide medicine.disease Endocrinology chemistry Child Preschool Pediatrics Perinatology and Child Health cardiovascular system Female Salts Neurology (clinical) Salt-wasting Hyponatremia business Atrial Natriuretic Factor hormones hormone substitutes and hormone antagonists circulatory and respiratory physiology |
| Zdroj: | Child's Nervous System. 22:1275-1281 |
| ISSN: | 1433-0350 0256-7040 |
| Popis: | The aim of this study is to report our experience with diagnosis and management of cerebral salt wasting (CSW) in children and to evaluate the role of atrial natriuretic peptide/brain natriuretic peptide (ANP/BNP) in pediatric patients.We present nine children suffering from prevalent cerebral disease--seven of whom underwent anesthesia and surgical procedures--with features of CSW, seen within a 22-month period. The symptoms, patient characteristics (including hormone status), monitoring, treatment protocol, and outcome are described.Natriuresis (urine Na+ concentrations 131 to250 mmol/l) and polyuria (5.5+/-1.5 ml/kg/h) with increased Na+ turnover (maximum Na+ loss: median 1.50 mmol Na+/kg/h, range 0.47 to3.50) vanished within 2 weeks in 6/9 patients (increase in serum Na+ from 127+/-2 mmol/l to 136+/-1). K+ excretion was also high (maximum K+ loss: median 0.18 mmol K+/kg/h, range 0.09-0.53). ANP/BNP as suspected causes of salt wasting were elevated only in 1/6 and 2/7 patients, respectively. Plasma renin activities and aldosterone levels were either suppressed or in the low normal range.Natriuresis and polyuria are the main diagnostic criteria for CSW. The fluid balance in CSW is negative, in contrast to a positive fluid balance in SIADH. The length of the disease is self-limited and generally ceases within 2 weeks, while Na+, K+, and fluid turnover should be monitored carefully. Only a minority of our children showed elevated ANP/BNP levels. A dose/effect relationship for natriuretic peptide levels and increased Na+ turnover could not be established. |
| Databáze: | OpenAIRE |
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