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Cerebral salt wasting syndrome in meningoencephalitis: a case report

Acute hyponatraemia is a common finding in patients with intracranial pathology. The diagnosis of the syndrome of inappropriate antidiuretic hormone (SIADH) is often made, but it is important to distinguish this from cerebral salt wasting syndrome, which responds to very different management. Cerebral salt wasting is well documented in neurosurgical patients and in patients with space occupying pathology. We present a case of a 26 year old man who developed cerebral salt wasting syndrome during an episode of meningoencephalitis.

A 26 year old man was admitted through the A&E department to a local district general hospital with four days of episodic confusion. There was no significant past medical or family history. Recreational drug use was denied and a urine screen was negative. A diagnosis of toxic encephalopathy was made. On day 2 he became pyrexial and agitated, and was sedated with haloperidol. Otherwise his examination was unremarkable, and his Glasgow coma scale (GCS) was 15, with no focal neurology. Routine blood tests, chest x ray, and computed tomography (CT) of the head were normal. CSF examination …