Neurogenic Hypernatremia and Hyperchloremia

IT IS the purpose of this report to bring attention to the not infrequent occurrence of unusual electrolyte disturbances associated with disease of the central nervous system. The electrolyte abnormalities with which this paper is particularly concerned are the development of marked hypernatremia, hyperchloremia, and hypochloruria during the course of a disease involving primarily the brain. The unusual electrolyte disturbances in these cases can not be satisfactorily accounted for on the basis of our present knowledge of the control of electrolyte metabolism. Accordingly, it is considered worthwhile at this time to review those cases which have been reported to date and to report briefly 4 additional cases. The first report dealing specifically with hypernatremia and hyperchloremia associated with cerebral lesions, in the absence of renal disease, was that of Allott in 1939 (1). This author presented 5 cases in which such electrolyte abnormalities were noted during the course of fatal disease of the brain. Allott's cases demonstrated hypernatremia, hyperchloremia and azotemia associated with a markedly decreased urinary excretion of sodium and chloride. However, there was an elevated urinary excretion of potassium, phosphate and sulphate ions. The pathologic processes of the cerebrum in 3 of these cases were ruptured aneurysm of the anterior cerebral artery, recent cerebral infarct, and tumor of the choroid plexus, respectively. Sweet and associates (2) reported a case of hypernatremia, hyperchloremia, hyperglycemia, hypokaliemia and gastro-intestinal hemorrhages following a prefrontal lobotomy in a 47-year-old woman who died on the thirty-second day after operation. This case was carefully studied and excellently reported. These authors also mentioned 3 additional cases of bizarre electrolyte abnormalities associated with neurologic disease. Biemond (3) has described a syndrome of intermittent oliguria with edema of the face secondary to a hypothalamic lesion in a 32-year-old woman. This author pointed out that the only electrolyte abnormality was elevation of the level of serum sodium to 155 mEq./liter.