https://doi.org/10.4081/ecj.2026.14952
Cerebral salt wasting in myelin oligodendrocyte glycoprotein antibody–associated disease: avoiding the syndrome of inappropriate antidiuretic hormone secretion fluid-restriction trap in the emergency department. A case report
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Published: 24 August 2026
Hyponatremia is a frequent metabolic emergency in patients with acute neurological disease and may precipitate seizures, cerebral edema, and hemodynamic collapse. Distinguishing cerebral salt wasting from syndrome of inappropriate antidiuretic hormone secretion is clinically challenging because both share similar laboratory features but require opposite management strategies. We report a 66-year-old man with myelin oligodendrocyte glycoprotein antibody–associated disease presenting with generalized seizure and profound hyponatremia. Bedside ultrasound demonstrated hypovolemia, guiding early resuscitation. Serum and urine osmolality, together with marked natriuresis and concentrated urine, supported the diagnosis of cerebral salt wasting. Treatment with hypertonic saline, aggressive isotonic replacement, and short-course fludrocortisone resulted in rapid correction of sodium and hemodynamic stabilization. This case highlights the emergency danger of reflex fluid restriction in neuro-hyponatremia and emphasizes structured volume assessment to differentiate cerebral salt wasting from syndrome of inappropriate antidiuretic hormone secretion.
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CRediT authorship contribution
Pratik Kanani, patient care and clinical management; Himaja Komatineni, manuscript writing and bedside ultrasound; Sarbari Swaika, critical revision of the manuscript. All authors read and approved the final manuscript.
Data Availability Statement
All data underlying the findings are fully available.
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