IMPE Abstracts

Impairment of body water and electrolytes homeostasis are frequently observed in pre and post-surgical patients with central nervous system tumors. Central diabetes insipidus (CDI) and the Syndrome of inadequate secretion of antidiuretic hormone represent the most frequently recognized entities with dysnaetremia. However, concomitant cerebral salt wasting syndrome (CSWS), with the characteristic triad of polyuria, hyponaetremia and natriuresis, might challenge the diagnostic suspicion and ultimate appropriate treatment. Prostaglandin E2 (PGE2) has a putative role in the regulation of renal blood flow, fluids and transporter check points within the nephron. Ibuprofen, is a non-selective inhibitor of cyclooxygenase, decreases PGE2 serum concentration, thus it produces vasoconstriction of the afferent arteriole, stimulates sodium and water reabsorption by the Na-K-2CL cotransporter and aquaporin 2 channels respectively. The use of Ibuprofen adds a novel and accessible tool for controlling polyuria in patients with CSWS. A series of 7 well-controlled CDI after central nervous system disease patients, with a mean age of 6.2 years (range: 6-19 years), disrupted with severe polyuria, hyponaetremia and natriuresis regardless high saline volume load, mineralocorticoids, desmopressin and thiazides. The use of Ibuprofen at a mean dose of 10.7 mg/kg/dose (range: 10-15 mg/kg/dose), b.i.d or t.i.d, reduced urine output from mean pre-treatment diuresis of 10 ml/kg/h (r: 3.5-10 ml/kg/h) to mean during treatment diuresis of 2 ml/kg/h (r: 1.5-2.5 ml/kg/h). In addition, previous serum sodium fluctuated in the range of hyponatremia mean 119 mEq/l (range: 109-125 mEq/l) and concomitantly with the improvement of urine output reach a mean serum sodium of 143 mEq/l (range: 139-146 mEq/l). No adverse events were reported after a mean Ibuprofen treatment period of 55 days (range: 15-60 days). The use of oral Ibuprofen at regular doses represents a tempting and effective therapeutic alternative with a well-tolerated safety profile for the management of paediatric refractory polyuria due to CSWS.