Circulating Sodium in Acute Meningitis

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Abstract

Background: In acute meningitis hyponatremia is common and traditionally attributed exclusively to inappropriate water retention. However, the exact mechanisms underlying hyponatremia are unknown. Methods: The files of 300 pediatric patients with acute bacterial (n = 190) or aseptic (n = 110) meningitides were retrospectively analyzed. Results: The plasma sodium level ranged from 122 to 148 mmol/l and was low (<133 mmol/l) in 97 patients. Fluid volume contraction was significantly more pronounced in hyponatremia (median 6.0 · 10–2) than in normonatremia (median 2.0 · 10–2). The fractional sodium excretion was less than 1.00 · 10–2 in the 26 hyponatremic children with this measurement. Conclusion: In acute meningitis hyponatremia is not exclusively brought about by inappropriate water retention.

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Aquaporins in the kidney: emerging new aspects.

Masao Sasaki, Y. Yamamoto (1998)

Since 1992 and the discovery of an MIP (major intrinsic protein of lens fiber cell) homologue protein that selectively permeates water, aquaporin (AQP), there has been an explosion of research in this field. Early research speculated that aquaporins played indispensible physiological roles in bacteria and plants, as well as in mammalian organs such as red blood cells, kidney, eye, brain and lung, where water transport rapidly takes place. Yet human subjects were identified who lacked AQP1 and yet had no apparent phenotypical changes clinically. To date 10 aquaporins have been discovered and a plethora of MIP members, and their prevalance in almost all organisms is a testament to their indispensible roles in the body, possibly as water and small neutral solute transporting channels. The recent localization of many different aquaporins in the same organ indicates that they may work cooperatively, which may partially explain the mystery of their physiological mechanism. Because the physiological roles of most aquaporins are currently only speculation, more extensive research is necessary to understand the exact function of each aquaporin.

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Cerebral Salt-Wasting Syndrome

Man S. Oh, Hugh Carroll (1999)

It is widely believed that the cerebral salt-wasting syndrome (CSWS) exists as an entity distinct from the syndrome of inappropriate ADH secretion, and that it is characterized by evidence of severe renal salt wasting that results in volume depletion and hyponatremia. Proof of the existence of CSWS as an entity requires documentation of renal salt wasting and volume depletion. The present review has been undertaken to examine the evidence that the CSWS is a separate entity. In this effort, we have discussed various methods of documentation of volume depletion, and then reviewed reported cases of CSWS to determine whether volume depletion and renal salt wasting have been clearly demonstrated. Our review has led us to conclude that not one case of purported CSWS has demonstrated clear evidence of volume depletion and renal salt wasting. If renal salt wasting had been proven in these cases, we would conclude that the likely site of renal salt transport was the proximal tubule. The proximal site of salt transport defect has been suggested by the absence of hyperreninemia and hypokalemia, which would be a distinguishing feature of Bartter’s syndrome and Gitelman’s syndrome.

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Journal

Journal ID (publisher-id): AJN

Journal ID (nlm-ta): Am J Nephrol

Journal ID (doi): 10.1159/issn.0250-8095

Title: American Journal of Nephrology

Publisher: S. Karger AG

ISSN (Print): 0250-8095

ISSN (Electronic): 1421-9670

Publication date Subscription-year: 2001

Publication date (Print): April 2001

Publication date (Electronic): 07 May 2001

Volume: 21

Issue: 2

Pages: 87-90

Affiliations

Department of Pediatrics, University of Bern, Switzerland

Article

Publisher ID: 46229 Other ID: Am J Nephrol 2001;21:87–90

DOI: 10.1159/000046229

PubMed ID: 11359014

SO-VID: 45af8d63-5565-4427-a739-b7c515afd1d6

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Circulating Sodium in Acute Meningitis

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Abstract

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Karger: Nephrology

Most cited references 2

Aquaporins in the kidney: emerging new aspects.

Cerebral Salt-Wasting Syndrome

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