Trauma of the brain skull with syndrome of inappropriate secretion of antidiuretic hormone (SIADH). About a case

Abstract

Hyponatremia is the most frequent hydro-electrolyte disorder, it is caused by the inability to excrete water normally. The anamnesis and the physical examination constitute useful tools now of the diagnostic confrontation. The problem is that reaching a definitive diagnosis, although he has a history of head trauma and the general practitioners do not know how to distinguish between a trauma that loses Sal (SPC) and a Syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Give specific guidelines for differentiation between two pathologies that appear after traumatic brain injury to general practitioners for their prompt treatment and to avoid future complications. Methodology. Research was the compilation of information retrospectively from a medical history in a private clinic in Guayaquil, follow its in-hospital evolution and see its definitive treatment. Outcome. The following is a case of a 19-year-old patient who, after suffering traumatic brain injury and with a simple brain tomography without brain alterations, presented hyponatremia with alteration of consciousness and that when giving specific treatment for SIADH improves adequately. Hyponatremia is the most frequent electrolyte disorder in the neurocritical patient, being a major cause of morbidity and mortality if adequate therapeutic measures are not instituted immediately. SIADH and CPS have been described as the 2 syndromes that most frequently explain the presence of hyponatremia associated with increased natriuresis in the neurocritical patient. In them, the evaluation of blood volume allows establishing the differential diagnosis between the two entities, although this is often a real diagnostic challenge. Conceptually, the diagnosis of "brain lacking salt" seems to be more appropriate to define hyponatremia in the neurocritical patient, since regardless of its cause, the mainstay of therapy is always the same.