Central Neurogenic Diabetes Insipidus,
Syndrome of Inappropriate Secretion of
Antidiuretic Hormone, and Cerebral SaltWasting Syndrome in Traumatic Brain Injury
This article focuses on Central Neurogenic Diabetes Insipidus (CNDI), Syndrome of Inappropriate Secretion of Antidiuretic
Hormone (SIADH), and Cerebral Salt-Wasting Syndrome in
Traumatic Brain injury (CSWS). Comparison of lab results and treatments are reviewed.
At the end of this topic, the participant will be able to:
1. List the potential causes of CNDI, SIADH, CSWS on the
2. Compare and contrast CNDI, SIADH, CSWS
3. Discuss the treatment & nursing management for
CNDI,SIADH and CSWS.
Traumatic Brain Injury (TBI ) in adults continues to be a major cause of death and disability in the United States.
An estimated 1.7 million persons in the United States will sustain TBI , - approximately 52, 000 will die of the injury
- 275,000 will be hospitalized
- and 1.4 million will be treated and released from ED
Older adults ( > 75 years) have the highest rates of TBI- related hospitalization and death Patients who survive the initial injury are likely to have secondary complications that can result in permanent disability.
Approximately 80,000 – 90,000 patients experience long term disability each year because of TBI
THE MOST COMMON CAUSES OF TBI
1. Falls - 35.2 %
2. Motor vehicular accident- 17.3%
3. Being struck by or against objects -16.5%
4. Sports – related injuries- 10%
5. Penetrating trauma- 21%
Table Comparison of central neurogenic, diabetes insipidus, syndrome of inappropriate secretion of antidiuretic hormone, & cerebral salt-wasting syndrome. Feature
Diabetes Insipidus secretion of
Cerebral of saltwasting
Fluid imbalance due
secretion of ADH in
the posterior lobe of
the pituitary glad or to
the release of ADH
or over production of
ADH resulting and a
Renal loss of sodium
leading to true
state in which the
pain, anxiety & an
Trauma, surgery or
damage of the
Head Trauma, brain
encephalitis, GuillainBarre, pneumonia,
Drugs assoc. w/
agents, non steroidal
Cause unclear but
often occurs in pt.’s
abnormalities ( Head
Trauma, stroke, SAH,
Managing and caring for patients with complex neurological problems , specifically patients with TBI & electrolyte imbalance, can be confounding. Understanding and recognizing the signs & symptoms of CNDI, SIADH, & CSWS will guide nurses the correct actions to take in order to avoid further deterioration in patient’s condition. Furthermore, monitoring patients for trends in neurological status, laboratory results and physiological parameters will guide nurses in determining whether treatment and management is effective or not.
1. Which of the following groups is at greatest risk of death from a traumatic brain injury (TBI)?
a. Young children (0-4 years old)
b. Adolescents (15-19 years old)
c. Young adults ( 20-27 years old)
d. Older adults ( older than 75 years)
2. Which of the following is the most common cause of TBI?
c. Sports- related injuries
f. Motor vehicular crashes
d. Penetrating trauma
3. Where is antidiuretic hormone (ADH) stored in the body?
c. Posterior pituitary gland
Cynthia ( Cindi) A. John, RN,MSN,CNRN and Michael W. Day, RN,MSN,...
References: Practice of Neurological and Neurosurgical Nursing 6 th Ed. Philadelphia, PA. Wolters
Kluwer Health/Lippincott Williams & Wilkins, 2009:195-205
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