소아에서 뇌수막염에 동반된 대뇌 염류 소모증후군 1례

Cerebral Salt Wasting Syndrome Associated with Meningitis in a Child

급성 뇌병증이 있을 때 저나트륨혈증은 흔하게 보이는 소견이며 감별해야하는 질환으로는 항이뇨호르몬 분비과다증후군과 대뇌 염류 소모증후군, 요붕증 등이 있으며 각각은 발생기전과 치료방법이 다르다. 저자들은 급성 뇌수막염에 이환된 환아에서 수분과 염류를 충분히 보충해 줌으로써 치료할 수 있었던 대뇌 염류 소모증후군 1례를 경험하였기에 보고하는 바이다.

Hyponatremia is commonly seen in those patients with central nervous system injury associated with infection or trauma. And decreasing intracranial pressure through restriction of maintenance fluid and salt is practiced as a routine therapeutic measure in the early stages of meningitis to prevent or ameliorate the syndrome of inappropriate secretion of antidiuretic hormone(SIADH). However, lots of patient do not show the typical symptoms of SIADH, instead they are dehydrated, have low plasma volume, increased urine sodium concentration and increased net sodium loss, which are the symptoms of cerebral salt wasting syndrome(CSW). Recent reports have prompted a reconsideration of CSW distinct from SIADH and moreover CSW has more proportion of hyponatremia associated with acute brain insult. CSW involves renal salt loss leading to hyponatremia and volume loss, whereas SIADH is a euvolemic or hypervolemic condition. While fluid restriction is the treatment of choice in SIADH, the treatment of CSW consists of vigorous sodium and volume replacement. And by correcting hyponatremic state as soon as possible, we can reduce mortality rate and improve neurologic sequelae. We report a case of CSW which was treated by replacement of vigorous sodium and volume replacement.