[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-452851-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-452851-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","improvement-in-post-hemispherotomy-cerebral-salt-wasting-syndrome-following-intubation-a-case-report","Improvement in post-hemispherotomy cerebral salt-wasting syndrome following intubation - A case report","","Cerebral salt-wasting syndrome (CSWS) involves renal sodium loss after intracranial disorders, causing hyponatremia, reduced extracellular volume, and dehydration. Mechanisms remain unclear, and reports describing CSWS together with arginine vasopressin deficiency (AVPD), also termed central diabetes insipidus, after hemispherotomy are lacking. A 7-month-old girl developed AVPD on POD 1 treated with intravenous AVP, then CSWS on POD 3. CSWS improved after intubation on POD 5 but recurred after extubation on POD 8, improving by POD 14, with stable AVPD control.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/improvement-in-post-hemispherotomy-cerebral-salt-wasting-syndrome-following-intubation-a-case-report/452851/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/improvement-in-post-hemispherotomy-cerebral-salt-wasting-syndrome-following-intubation-a-case-report/452851.png","ImageObject",300,407,{"name":42,"@type":43},"moss~","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-31","2026-09-30",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",10,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What is cerebral salt-wasting syndrome (CSWS) and what problem does it cause?","Question",{"text":63,"@type":64},"CSWS is an electrolyte imbalance characterized by renal sodium loss, leading to hyponatremia and hypovolemia (dehydration). It is described as developing after intracranial disorders and gradually improving over weeks in typical settings.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How did AVPD and CSWS evolve after hemispherotomy in this case?",{"text":68,"@type":64},"On postoperative day (POD) 1, AVPD was diagnosed and treated with intravenous AVP. By POD 3, CSWS developed with increased urinary sodium excretion, falling serum sodium, dehydration, polyuria, and negative fluid balance.",{"name":70,"@type":61,"acceptedAnswer":71},"What was the effect of intubation versus extubation on CSWS?",{"text":72,"@type":64},"CSWS improved markedly after intubation on POD 5. Within one day of extubation, CSWS recurred on POD 8, followed by gradual improvement between POD 8 and POD 14.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},452851,1791082178,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,120,123,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":116,"doc_module":4,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},9,"Religion & Spirituality",20,"religion-spirituality",{"id":118,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":118,"slug":122},"World Cup","world-cup",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":55,"slug":125},"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":102,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":144,"preview_page_count":4},962090895452,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","Clinical Pediatric Endocrinology  \nVol.35 / No.1 January 2026 pp 104–109  \nCase Report  \nImprovement in post-hemispherotomy cerebral salt-wasting syndrome following intubation: A case report  \nReiko Saito1, 2 , Marie Mitani-Konno1 , Osamu Saito3 , and Yukihiro Hasegawa1, 4  \n1Division of Endocrinology and Metabolism, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan  \n2Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Japan  \n3Department of Pediatric Emergency and Critical Care Medicine, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan  \n4Department of General Pediatrics, Tokyo Metropolitan Tokyo Hokubu Medical Center, Tokyo, Japan  \nHighlights  \n● First report of CSWS recurrence triggered by extubation after hemispherotomy.  \n● Intubation with PEEP contributed to improvement of severe CSWS.  \n● Coexistence ofCSWS and AVPD may complicate perioperative management.  \nAbstract. Cerebral salt-wasting syndrome (CSWS) is characterized by renal sodium loss following intracranial disorders, leading to hyponatremia, reduced extracellular volume, and dehydration. The mechanisms underlying CSWS remain unclear. To date, no reports have described the coexistence ofarginine vasopressin deficiency (AVPD), also known as central diabetes insipidus (cDI), and CSWS following hemispherotomy. We report a case ofcDI and CSWS occurring after hemispherotomy, in which CSWS improved following intubation. A 7-month-old girl with right hemimegalencephaly and cortical dysplasia underwent hemispherotomy. On postoperative day (POD) 1, AVPD was diagnosed and treated with intravenous AVP. By POD 3, she developed CSWS, characterized by increased urinary sodium excretion, decreased serum sodium levels, dehydration, polyuria, and negative fluid balance. Notably, CSWS improved markedly after intubation on POD 5. However, within one day of extubation, CSWS recurred on POD 8. Her condition gradually improved between POD 8 and POD 14. She is currently clinically stable, with her AVPD well-controlled. Conclusion: AVPD and CSWS can co-occur after hemispherotomy, even without hypothalamic-pituitary involvement. The improvement and recurrence of CSWS associated with intubation and extubation suggest that positive end-expiratory pressure may represent a novel therapeutic strategy for CSWS.  \nKey words: cerebral salt-wasting syndrome, diabetes insipidus, hemispherotomy, intubation, surgery  \nReceived: May 20, 2025 Accepted: August 29, 2025 Advanced Epub: September 10, 2025  \nCorresponding Author: Yukihiro Hasegawa, M.D., Ph.D., Division of Endocrinology and Metabolism, Tokyo Metropolitan  \nChildren’s Medical Center, 2-8-20 Musashi-dai, Fuchu, Tokyo 183-8561, Japan [E-mail: yhaset@gmail.com](E-mail: yhaset@gmail.com)  \nThis is an open-access article distributed under the terms of the Creative Commons Attribution NonCommercial No Derivatives (by-nc-nd) License \u003C[http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/)> .  \nCopyright© 2026 by The Japanese Society for Pediatric Endocrinology  \nClin Pediatr Endocrinol 105  \nIntroduction  \nCerebral salt-wasting syndrome (CSWS) is an electrolyte imbalance characterized by renal sodium loss, leading to hyponatremia and hypovolemia. CSWS typically occurs within the first week after subarachnoid hemorrhage, trauma, or brain surgery and improves gradually after 3–4 wk (1–3) .  \nThe pathophysiological mechanisms underlying CSWS remain unclear. CSWS-induced hyponatremia results from excessive renal sodium loss and is accompanied by dehydration. The hypersecretion of brain and atrial natriuretic peptides (BNP and ANP, respectively), which are key markers in the laboratory diagnosis of CSWS, may contribute to decreased aldosterone levels and consequent renal sodium loss (4, 5). ANP and BNP are endogenous peptides activated in response to atrial and ventricular volume or pressure expansion. ANP is secreted by the atria, while ","cbCairZOG5nC8kkW","https://ap.wps.com/l/cbCairZOG5nC8kkW","pdf",1517655,"English","# Introduction\n## Case Report\n# Conclusion","[{\"question\":\"What is cerebral salt-wasting syndrome (CSWS) and what problem does it cause?\",\"answer\":\"CSWS is an electrolyte imbalance characterized by renal sodium loss, leading to hyponatremia and hypovolemia (dehydration). It is described as developing after intracranial disorders and gradually improving over weeks in typical settings.\"},{\"question\":\"How did AVPD and CSWS evolve after hemispherotomy in this case?\",\"answer\":\"On postoperative day (POD) 1, AVPD was diagnosed and treated with intravenous AVP. By POD 3, CSWS developed with increased urinary sodium excretion, falling serum sodium, dehydration, polyuria, and negative fluid balance.\"},{\"question\":\"What was the effect of intubation versus extubation on CSWS?\",\"answer\":\"CSWS improved markedly after intubation on POD 5. Within one day of extubation, CSWS recurred on POD 8, followed by gradual improvement between POD 8 and POD 14.\"}]","Improvement in post-hemispherotomy cerebral salt-wasting syndrome following intubation - A case report | PDF",1790737775,15]