Traumatic Brain Injury Case Study

Central Neurogenic Diabetes Insipidus,
Syndrome of Inappropriate Secretion of
Antidiuretic Hormone, and Cerebral SaltWasting Syndrome in Traumatic Brain
Injury
Trauma

Topic Description:
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.

Topic objectives:
At the end of this topic, the participant will be able to:
1. List the potential causes of CNDI, SIADH, CSWS on the hospitalized adult.
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

Cerebral
Syndrome of
Neurogenic
Inappropriate
Diabetes Insipidus secretion of antidiuretic hormone (ADH)

Cerebral of saltwasting syndrome Definition

Fluid imbalance due to decreased secretion of ADH in the posterior lobe of the pituitary glad or to renal unresponsiveness to the release of ADH

Persistent production or over production of
ADH resulting and a volume-expanded state

Renal loss of sodium leading to true hyponatremia & volume-contracted state in which the kidneys don’t reabsorb sodium

Cause

Hypotension, stress, pain, anxiety & an upright position
Trauma, surgery or damage of the hypothalamus Head Trauma, brain tumor, abscess, subarachnoid, hemorrhage, hydrocephalus, meningitis, encephalitis, GuillainBarre, pneumonia,
Drugs assoc. w/ increased secretion
(oral hypoglycemic agents, non steroidal
& anti-inflammatories, opiates, anesthetics)

Cause unclear but often occurs in pt.’s w/ Intracranial abnormalities ( Head
Trauma, stroke, SAH, brain tumors)

Summary
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.

Questions:
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?
e. Falls
c. Sports- related injuries
f. Motor vehicular crashes
d. Penetrating trauma
3. Where is antidiuretic hormone (ADH) stored in the body?
g. Infundibulum
c. Posterior pituitary gland
b. Hypothalamus
d. Kidney

Answers:
1.
d
2. a
3. b

References:
•

Cynthia ( Cindi) A. John, RN,MSN,CNRN and Michael W. Day, RN,MSN, CCRN
Critical Care Nurse Vol. 32. No.2 , April 2012

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Emergency Department Visits, Hospitalizations and deaths 2002-2006. Atlanta, GA
Centers for disease control and prevention. National Center for Injury Prevention and control. http://www.cdc.govt/traumatic brain injury/pdf/blue_book.pdf.Published March
2010. Accessed January 9,2012

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Pangilinan PH Jr. Kelly BM, Hornyak JE IV, et. Al. Classification and complications of traumatic brain injury. http://emedicine.Medscape.com/article /326643. Updated
November 10.2011. Accessed January 2012.

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Hickey JV. Fluid and metabolic disorders in neuroscience patients. In the Clinical
Practice of Neurological and Neurosurgical Nursing 6 th Ed. Philadelphia, PA. Wolters
Kluwer Health/Lippincott Williams & Wilkins, 2009:195-205

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Boughey J. Yost M. Bynoe R. Diabetes insipidus in the head –injured patient. Am Surg.
2004;70-500-503

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Byrum D. Kirkwood PI., Pituitary, thyroid, and adrenal disorders. In: Carlson KK. Ed,
ACCN Advanced Critical Care Nursing. St. Louis. MO: Saunders/Elsevier,
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