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Multiple electrolyte disorders in a neurosurgical patient: solving the rebus

Valeria Corradetti1, Pasquale Esposito1*, Teresa Rampino1, Marilena Gregorini1, Carmelo Libetta1, Francesca Bosio1, Teresa Valsania1, Eleonora Francesca Pattonieri1, Chiara Rocca1, Stefania Bianzina2 and Antonio Dal Canton1

Author Affiliations

1 Unit of Nephrology, Dialysis and Transplantation, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Piazzale Golgi 19, 27100 Pavia, Italy

2 First Department of Anesthesia and Intensive Care, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy

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BMC Nephrology 2013, 14:140  doi:10.1186/1471-2369-14-140

Published: 10 July 2013



It is important to ensure an adequate sodium and volume balance in neurosurgical patients in order to avoid the worsening of brain injury.

Indeed, hyponatremia and polyuria, that are frequent in this patient population, are potentially harmful, especially if not promptly recognized.

Differential diagnosis is often challenging, including disorders, which, in view of similar clinical pictures, present very different pathophysiological bases, such as syndrome of inappropriate antidiuresis, cerebral/renal salt wasting syndrome and diabetes insipidus.

Case presentation

Here we present the clinical report of a 67-year-old man with a recent episode of acute subarachnoid haemorrhage, admitted to our ward because of severe hyponatremia, hypokalemia and huge polyuria.

We performed a complete workup to identify the underlying causes of these alterations and found a complex picture of salt wasting syndrome associated to primary polydipsia. The appropriate diagnosis allowed us to correct the patient hydro-electrolyte balance.


The comprehension of the pathophysiological mechanisms is essential to adequately recognize and treat hydro-electrolyte disorders, also solving the most complex clinical problems.

Hyponatremia; Polyuria; Hypokalemia; Primary polydipsia; Salt wasting syndromes; Subarachnoid haemorrhage