Cerebral salt wasting: pathophysiology, diagnosis, and treatment

Neurosurg Clin N Am. 2010 Apr;21(2):339-52. doi: 10.1016/j.nec.2009.10.011.


Cerebral salt wasting (CSW) is a syndrome of hypovolemic hyponatremia caused by natriuresis and diuresis. The mechanisms underlying CSW have not been precisely delineated, although existing evidence strongly implicates abnormal elevations in circulating natriuretic peptides. The key in diagnosis of CSW lies in distinguishing it from the more common syndrome of inappropriate secretion of antidiuretic hormone. Volume status, but not serum and urine electrolytes and osmolality, is crucial for making this distinction. Volume and sodium repletion are the goals of treatment of patients with CSW, and this can be performed using some combination of isotonic saline, hypertonic saline, and mineralocorticoids.

Publication types

  • Review

MeSH terms

  • Brain Diseases / complications*
  • Critical Illness / therapy
  • Diagnosis, Differential
  • Humans
  • Hyponatremia / diagnosis*
  • Hyponatremia / physiopathology*
  • Hyponatremia / therapy
  • Hypovolemia / complications
  • Hypovolemia / physiopathology
  • Kidney / physiopathology
  • Natriuretic Agents / metabolism*
  • Natriuretic Peptides / metabolism
  • Renin-Angiotensin System / physiology
  • Sodium / urine*
  • Sympathetic Nervous System / physiopathology
  • Water-Electrolyte Balance / physiology*


  • Natriuretic Agents
  • Natriuretic Peptides
  • Sodium