{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T18:16:07Z","timestamp":1772993767674,"version":"3.50.1"},"reference-count":12,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T00:00:00Z","timestamp":1766016000000},"content-version":"vor","delay-in-days":351,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Critical Care"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:p>The use of left ventricular assist devices (LVADs) is now commonplace in the management of nonischemic cardiomyopathy. LVADs are preload\u2010dependent and afterload\u2010sensitive, meaning rapid changes in a patient\u2032s volume status can significantly impact device function. Cerebral salt\u2010wasting syndrome (CSWS), a rare cause of hyponatremia, is characterized by an acute increase in urine output and low serum sodium. Here, we present the case of a 43\u2010year\u2010old man with end\u2010stage heart failure supported by an LVAD, who experienced refractory low\u2010flow alarms due to CSWS. The patient initially presented with a new\u2010onset headache. Brain computed tomography (CT) scan revealed an acute subdural hematoma with midline shift, requiring emergency craniotomy, which was performed without complications. After discharge from the intensive care unit (ICU), he returned with multiple low\u2010flow alarms on his LVAD (flow less than 1.5\u2009L\/h), despite high mean arterial pressures and normal perfusion indexes. Laboratory evaluation showed a serum sodium of 130\u2009mmol\/L, a urine osmolality of 522\u2009mmol\/kg, a serum osmolality of 282\u2009mmol\/kg, and a urine sodium of 147\u2009mEq\/day. His urine output was 4\u2009L\/day. A diagnosis of CSWS was made. Treatment included normal saline drip for 1:1 volume replacement, daily fludrocortisone, low\u2010dose desmopressin, and intermittent 3% hypertonic saline boluses. Salt tablets were prescribed to maintain a serum sodium goal of 135\u2013140\u2009mmol\/L and a urine output of 2.5\u20133.5\u2009L\/day. Over time, the frequency of low\u2010flow alarms decreased significantly, and the patient was discharged. CSWS is an unlikely cause of hyponatremia in the ICU. Aggressive fluid hydration and sodium supplementation are necessary for positive clinical outcomes. This is especially true in patients with LVADs, who are both preload\u2010dependent and afterload\u2010sensitive. Failure to rapidly treat CSWS can lead to respiratory arrest, brainstem herniation, and even death.<\/jats:p>","DOI":"10.1155\/crcc\/7068825","type":"journal-article","created":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T12:48:52Z","timestamp":1766062132000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Management of LVAD in Cerebral Salt\u2010Wasting Syndrome"],"prefix":"10.1155","volume":"2025","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5149-1004","authenticated-orcid":false,"given":"Kevin Emmanuel","family":"Moriles","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6777-4689","authenticated-orcid":false,"given":"Ryu Peter","family":"Tofts","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8985-4567","authenticated-orcid":false,"given":"Denny","family":"Oliveira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bibidh","family":"Subedi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8950-2087","authenticated-orcid":false,"given":"Arnaldo","family":"Lopez-Ruiz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,12,18]]},"reference":[{"key":"e_1_2_12_1_2","volume-title":"StatPearls","author":"Vaidya Y.","year":"2025"},{"key":"e_1_2_12_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa012175"},{"key":"e_1_2_12_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2022.11.023"},{"key":"e_1_2_12_4_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11092575"},{"key":"e_1_2_12_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-017-0386-7"},{"key":"e_1_2_12_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2006.02432.x"},{"key":"e_1_2_12_7_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12871-015-0157-y"},{"key":"e_1_2_12_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.11176"},{"key":"e_1_2_12_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/MAT.0b013e3181c40048"},{"key":"e_1_2_12_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/MAT.0000000000001691"},{"key":"e_1_2_12_11_2","doi-asserted-by":"publisher","DOI":"10.7812\/TPP\/08-066"},{"key":"e_1_2_12_12_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13049-015-0180-5"}],"container-title":["Case Reports in Critical Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/crcc\/7068825","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1155\/crcc\/7068825","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/crcc\/7068825","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T14:54:56Z","timestamp":1772981696000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/crcc\/7068825"}},"subtitle":[],"editor":[{"given":"Lipi","family":"Buch","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":12,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1155\/crcc\/7068825"],"URL":"https:\/\/doi.org\/10.1155\/crcc\/7068825","archive":["Portico"],"relation":{},"ISSN":["2090-6420","2090-6439"],"issn-type":[{"value":"2090-6420","type":"print"},{"value":"2090-6439","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1]]},"assertion":[{"value":"2025-03-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-11-18","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-18","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"7068825"}}