A recent case study has been published about a young man who was treated with therapeutic barbiturate coma after a traumatic brain injury. Coma was induced after the patient showed signs of intracranial pressure that did not subside. He remained in the barbiturate coma for three days, with no abnormal lab findings.
When he was brought out of the coma, however, his labs showed a steep rise in potassium and sodium, then a subsequent drop in sodium that is indicative of cerebral salt wasting syndrome. Saline was administered, and he improved within a week.
Cerebral salt wasting syndrome can sometimes occur after traumatic brain injury. But in this case study, the reaction was related to the increased excretion of sodium after termination of barbiturate therapy. Clinicians should therefore be aware of this possibility, especially in traumatic brain injury patients for whom the syndrome is especially critical.
Kontogiorgi M, Opsimoulis P, Diamanti-Kandarakis E, & Karabinis A. Cerebral salt wasting syndrome in traumatic brain injury following therapeutic barbiturate coma. Acta Neurochirurgica. (August 2011).