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Sodium balance impairment in a child with severe traumatic brain injury

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Abstract


We report a case of cerebral salt-wasting syndrome in a 12-year-old boy with severe traumatic brain injury. The child developed refractory intracranial hypertension at the time of injury, which required decompressive craniectomy on the 7th day after injury. Infusion of hypertonic sodium chloride solutions performed at the intensive care unit resulted in hypernatremia on the 5th day and polyuria and hypovolemia on the 11th day, which was regarded as manifestations of central diabetes insipidus. Persistent hyponatremia developed on the 17th day after injury; on the next day, the therapy was supplemented with Fludrocortisone at a dose of 100 µg/day, followed by an increase in the dose to 150 µg/day, which had no significant effect. Fludrocortisone was discontinued on the 30th day of therapy, but it was re-used at a dose of 400 µg/day from the 54th day. During this treatment, polyuria gradually decreased to 4 to 5 l/day, and the plasma sodium concentration remained within the reference values. The dose of Fludrocortisone was increased to 600 µg/day since the 66th day. The child was transferred to a specialized department on the 67th day after injury. At the Department of Neurosurgery, the dose of Cortineff was gradually reduced starting with the 94th day and completely discontinued on the 122nd day after injury. On day 132th of the post-traumatic period, the patient was transferred to another hospital for rehabilitation therapy.


Yuriy S. Aleksandrovich

Saint-Petersburg State Pediatric Medical University

Email: Jalex1963@mail.ru
ORCID iD: 0000-0002-2131-4813
SPIN-code: 2225-1630
http://www.gpmu.org/university/structure/departments/anesteziolfp/staf_anestesiolfp

Russian Federation, 2, Litovskay street, Saint-Peterburg, 194100

MD, PhD, Professor

Konstantin V. Pshenisnov

Saint-Petersburg State Pediatric Medical University

Author for correspondence.
Email: Psh_k@mail.ru
ORCID iD: 0000-0003-1113-5296
SPIN-code: 8423-4294
http://www.gpmu.org/university/structure/departments/anesteziolfp/staf_anestesiolfp

Russian Federation, 2, Litovskay street, Saint-Peterburg, 194100

MD, PhD

Anastasiya S. Ustinova

Children’s City Versatile Clinical Center of High Medical Technologies of K.A. Raukhfus

Email: anastasija.ustinova@rambler.ru
ORCID iD: 0000-0002-2135-9755
SPIN-code: 5697-5377

Russian Federation, 8, Ligovskiy Ave., St. Petersburg, 193036

MD

Vladimir V. Kopylov

Saint-Petersburg State Pediatric Medical University; Children’s City Versatile Clinical Center of High Medical Technologies of K.A. Raukhfus

Email: Kovlad72@mail.ru
ORCID iD: 0000-0001-9956-7055
SPIN-code: 9073-5469

Russian Federation, 2, Litovskay street, Saint-Peterburg, 194100; 8, Ligovskiy Ave., St. Petersburg, 193036

MD, PhD

Irina V. Aleksandrovich

Notrth Western State Medical University Named After I.I. Mechnikov

Email: iralexzz15@gmail.com
ORCID iD: 0000-0002-2837-5256
SPIN-code: 6425-3897

Russian Federation, 41, Kirochnaya street, Saint-Petersburg, 191015

MD, PhD

Vladimir I. Gordeev

Saint-Petersburg State Pediatric Medical University

Email: Vigor50@mail.ru
ORCID iD: 0000-0002-2837-5256
SPIN-code: 6425-3897
http://www.gpmu.org/university/structure/departments/anesteziolfp/staf_anestesiolfp

Russian Federation, 2, Litovskay street, Saint-Peterburg, 194100

MD, PhD, Professor

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Supplementary files

Supplementary Files Action
1. Fig. 1. Dynamics of intracranial pressure within 10 days after injury. View (129KB) Indexing metadata
2. Fig. 2. Dynamics of sodium concentration in plasma. View (174KB) Indexing metadata
3. Fig. 3. Daily diuresis and the volume of the filled fluid during therapy with desmopressin tablets, hypothiazide and fludrocortisone. View (179KB) Indexing metadata

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Copyright (c) 2019 Aleksandrovich Y.S., Pshenisnov K.V., Ustinova A.S., Kopylov V.V., Aleksandrovich I.V., Gordeev V.I.

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