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Masked cerebral salt wasting syndrome with post-obstructive polyuria: a diagnostic challenge
Masked cerebral salt wasting syndrome with post-obstructive polyuria: a diagnostic challenge
Héctor M. Marmolejo-Bedolla 1 
, Omar Chirinos-Gómez 2 , Paulo A. Parada-Reynoso 2 , Andrea Y. López-Sánchez 3 , Pauly Carrera-Camacho 4 , Mayte Valdés-Ruiz 2 , Martín López-Zendejas 2 , Lucio O. Sánchez-Macías 1
1 Servicio de Nefrología, Hospital San Javier, Guadalajara, Jalisco, México; 2 Servicio de Medicina Interna, Hospital San Javier, Guadalajara, Jalisco, México; 3 Escuela de Medicina y Ciencias de la Salud, Instituto Tecnológico de Estudios Superiores de Monterrey, Campus Guadalajara, Zapopan, Jalisco, México; 4 Escuela de Medicina y Ciencias de la Salud, Instituto Tecnológico de Estudios Superiores de Monterrey, Campus Guadalajara, Zapopan. Jalisco, México
*Correspondence: Héctor M. Marmolejo-Bedolla. Email: Drhectormarmolejo141@gmail.com
Abstract
Post-craniotomy cancer female patient who presented with fluid and electrolyte imbalances, including massive polyuria, severe hyponatremia, and hypovolemia, exacerbated by superimposed post-obstructive diuresis. The differential diagnosis was based on the persistence of hypotonic hyponatremia with clinical hypovolemia and an elevated excreted urate fraction after volume correction. Intervention with mineralocorticoids and sodium supplementation reversed the condition, validating the etiology of cerebral salt loss. This report highlights the usefulness of accessible biomarkers such as uric acid and therapeutic response in differentiating cerebral salt wasting syndrome from inappropriate antidiuresis syndrome.
Keywords: Cerebral salt wasting syndrome. Hyponatremia. Inappropriate antidiuresis syndrome. Neurosurgery.
