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Hypernatraemia

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https://www.readbyqxmd.com/read/29700220/intensive-care-management-of-severe-hypernatraemia-in-the-context-of-group-a-streptococcal-septicaemia
#1
Bethan Davies, Robert Jesty, Shahana Uddin, Victoria Metaxa
This case describes a 54-year-old woman with exudative eczema, who was admitted to the intensive care unit with a serum sodium concentration of 191 mmol/L, secondary to profound dehydration in the context of group A streptococcal septicaemia. Successful rehydration and electrolyte normalisation was achieved with continuous venovenous haemodiafiltration (CVVHDF), the replacement fluid of which was infused with hypertonic saline to limit the rate of sodium reduction. This case report comments on three areas of interest...
April 26, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29675260/one-too-many-diabetes-the-combination-of-hyperglycaemic-hyperosmolar-state-and-central-diabetes-insipidus
#2
Snezana Burmazovic, Christoph Henzen, Lukas Brander, Luca Cioccari
The combination of hyperosmolar hyperglycaemic state and central diabetes insipidus is unusual and poses unique diagnostic and therapeutic challenges for clinicians. In a patient with diabetes mellitus presenting with polyuria and polydipsia, poor glycaemic control is usually the first aetiology that is considered, and achieving glycaemic control remains the first course of action. However, severe hypernatraemia, hyperglycaemia and discordance between urine-specific gravity and urine osmolality suggest concurrent symptomatic diabetes insipidus...
2018: Endocrinology, Diabetes & Metabolism Case Reports
https://www.readbyqxmd.com/read/29590494/endocrinopathies-and-renal-outcomes-in-lithium-therapy-impact-of-lithium-toxicity
#3
R Dineen, D Bogdanet, D Thompson, C J Thompson, L A Behan, A P McKay, G Boran, C Wall, J Gibney, V O'Keane, M Sherlock
Background: Lithium is the mainstay of treatment for bipolar disorder, mania and an augmentation therapy in patients with treatment resistant depression. It has a narrow therapeutic index, with recognized adverse multi-system and endocrine side effects. Aim: To assess the impact of lithium therapy, in particular lithium toxicity, on the development of endocrine and renal disorders in a cohort of patients in a single tertiary referral centre in Ireland. Study design: A retrospective analysis was performed of the prevalence of lithium toxicity and renal, thyroid and parathyroid dysfunction in our study population...
December 1, 2017: QJM: Monthly Journal of the Association of Physicians
https://www.readbyqxmd.com/read/29440241/-if-there-were-water-we-should-stop-and-drink-neurofibromatosis-presenting-with-diabetes-insipidus
#4
Rachel Barry, Antoinette O' Connor, Mohn Hazriq Awang, Orna O' Toole
A 58-year-old right-handed woman presented to our institution with a 1-month history of polydipsia and polyuria. She had a remote history of neurofibroma excision by dermatology and, on examination, was noted to meet the clinical diagnostic criteria for neurofibromatosis type 1. Laboratory investigations revealed hypernatraemia and elevated serum osmolality, accompanied by reduced urinary osmolality. A subsequent water deprivation test confirmed central diabetes insipidus, which responded to treatment with desmopressin...
February 11, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29422070/copeptin-levels-and-commonly-used-laboratory-parameters-in-hospitalised-patients-with-severe-hypernatraemia-the-co-med-study
#5
Nicole Nigro, Bettina Winzeler, Isabelle Suter-Widmer, Philipp Schuetz, Birsen Arici, Martina Bally, Julie Refardt, Matthias Betz, Gani Gashi, Sandrine A Urwyler, Lukas Burget, Claudine A Blum, Andreas Bock, Andreas Huber, Beat Müller, Mirjam Christ-Crain
BACKGROUND: Hypernatraemia is common in inpatients and is associated with substantial morbidity. Its differential diagnosis is challenging, and delayed treatment may have devastating consequences. The most important hormone for the regulation of water homeostasis is arginine vasopressin, and copeptin, the C-terminal portion of the precursor peptide of arginine vasopressin, might be a reliable new parameter with which to assess the underlying cause of hypernatraemia. METHODS: In this prospective, multicentre, observational study conducted in two tertiary referral centres in Switzerland, 92 patients with severe hyperosmolar hypernatraemia (Na+  > 155 mmol/L) were included...
February 9, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29158902/hypernatraemic-hypovolaemia-with-anaemia-an-unusual-presentation-of-primary-testicular-insufficiency
#6
Usman Javaid, Vikram Lal, Catherine Napier, Alison Burbridge, Richard Quinton
Hypogonadal men may experience intense vasomotor symptoms, and vasomotor sweating can occasionally be associated with profound fluid losses. We describe a 37-year-old male, who exhibited persistent hypovolaemic hypernatraemia that was challenging to treat despite a continuous high fluid input (>4-5 L/day). He was noted to have drenching sweats and normochromic anaemia. He had recent traumatic head injury, which resulted in neurocognitive dysfunction, so pituitary function tests were done which showed primary hypogonadism...
2017: Endocrinology, Diabetes & Metabolism Case Reports
https://www.readbyqxmd.com/read/29118841/management-of-severe-dehydration
#7
Stephanie Ruth Strachan, Lucy Francesca Morris
The presented case is one of severe dehydration and acute kidney injury with significant resultant complications that required considerable fluid and electrolyte replacement. Approaches to fluid resuscitation in the context of hypernatraemia and the hyperosmolar state were considered and then judiciously combined to manage a complex case with a successful outcome. Conflicting guidance in this domain is discussed with recommendations for a future management strategy that is tailored to individual patients.
August 2017: Journal of the Intensive Care Society
https://www.readbyqxmd.com/read/29101501/severe-hypernatraemic-dehydration-and-unconsciousness-in-a-care-dependent-inpatient-treated-with-empagliflozin
#8
Georg Gelbenegger, Nina Buchtele, Christian Schoergenhofer, Martin Roeggla, Michael Schwameis
A 66-year-old Caucasian male became unconscious 2 weeks after initiation of add-on therapy with empagliflozin for poorly controlled type 2 diabetes mellitus. The inpatient had recently suffered focal pontine stroke, rendering him bedridden and requiring increased nursing care, including assistance with drinking. The patient had received empagliflozin 10 mg once daily for glycaemic control. Investigations revealed hypernatraemia (164 mmol/l), a urine glucose level of 3935 mg/dl, and a creatinine level of 2...
November 3, 2017: Drug Safety—Case Reports
https://www.readbyqxmd.com/read/29051308/food-engorgement-in-35-dogs-2009-2013-compared-with-36-dogs-with-gastric-dilation-and-volvulus
#9
COMPARATIVE STUDY
Lisa Smart, Shona Reese, Giselle Hosgood
The clinical features and management of food engorgement (FE) in dogs have not been previously described. This retrospective observational study describes characteristics and outcome of 35 dogs with FE, and compares features on presentation to 36 dogs with gastric dilation and volvulus (GDV). Cases were retrospectively reviewed for history, clinical findings and outcome. Gastric distension was measured by caudal gastric margin (CGM), level with lumbar vertebrae, on a lateral abdominal radiograph. Frequent characteristics of dogs with FE included tachycardia, tachypnoea, hyperproteinaemia, increased base excess (BE), mild hypernatraemia and hyperlactataemia...
November 25, 2017: Veterinary Record
https://www.readbyqxmd.com/read/28975036/marked-paraneoplastic-basophilia-accompanying-eosinophilia-in-a-cat-with-alimentary-t-cell-lymphoma
#10
Maria Balan, Aimee Hope, Joseph Cassidy, Maureen McCullough, Peter J O'Brien
CASE SUMMARY: A 5-year-old male neutered domestic shorthair cat was referred with a history of persistent pyrexia, pica, soft faeces, inappetence, intermittent vomiting, mild-to-moderate granulocytosis and mild hypercalcaemia. No significant improvement was noted after antibiotic and corticosteroid treatment, except that the hypercalcaemia resolved. Physical examination, including thoracic auscultation, and abdominal and peripheral lymph node palpation, were unremarkable. On admission, haematology revealed moderate leukocytosis (36...
July 2017: JFMS open reports
https://www.readbyqxmd.com/read/28892994/life-threatening-severe-hypernatraemic-dehydration-in-neonates-a-report-of-two-cases
#11
Priyaja Paramasivam, Sujay Kumar Earan, Arulkumaran Arunagirinadhan, Shilpa Kantamneni
Hypernatraemic dehydration in neonates may lead to potentially lethal consequences like cerebral oedema, intracranial haemorrhage, hydrocephalus and gangrene. In the light of increase in the infants presenting with hypernatraemic dehydration, there is a definitive need to heighten the awareness and have a high degree of suspicion in diagnosis for this potentially lethal condition. We report two neonates of severe hypernatraemia with dehydration highlighting its diagnosis and management. Treatment of hypernatraemic dehydration involves correction of electrolyte imbalance by careful restoration of fluids and ensuring appropriate intake of calories...
July 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28859453/comparison-of-complications-trends-and-costs-in-endoscopic-vs-microscopic-pituitary-surgery-analysis-from-a-us-health-claims-database
#12
COMPARATIVE STUDY
Anthony O Asemota, Masaru Ishii, Henry Brem, Gary L Gallia
BACKGROUND: Microsurgical and endoscopic techniques are commonly utilized surgical approaches to pituitary pathologies. There are limited data comparing these 2 procedures. OBJECTIVE: To evaluate postoperative complications, associated costs, and national and regional trends of microscopic and endoscopic techniques in the United States employing a nationwide database. METHODS: The Truven MarketScan database 2010 to 2014 was queried and Current Procedural Terminology codes identified patients that underwent microscopic and/or endoscopic transsphenoidal pituitary surgery...
September 1, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28856224/an-analysis-of-the-relationship-between-serum-cortisol-and-serum-sodium-in-routine-clinical-patients
#13
Eleanor McLaughlan, Julian H Barth
OBJECTIVES: Adrenal insufficiency is an uncommon cause of hyponatraemia that should not be overlooked due to the severe consequences of an Addisonian crisis. Using the laboratory database of a large teaching hospital, we have explored the relationship between serum sodium and serum cortisol, and have estimated the frequency of hypoadrenalism in severely hyponatraemic patients. DESIGN AND METHODS: Data were gathered over a 23 month period from the Laboratory Information Management System at the Leeds Teaching Hospitals NHS Trust for instances where serum sodium and cortisol had been measured on a single sample...
August 2017: Practical laboratory medicine
https://www.readbyqxmd.com/read/28821524/the-association-between-intensive-care-unit-acquired-hypernatraemia-and-mortality-in-critically-ill-patients-with-cerebrovascular-diseases-a-single-centre-cohort-study-in-japan
#14
Takahiro Imaizumi, Masahiro Nakatochi, Yoshiro Fujita, Rie Nomura, Kenshi Watanabe, Michitaka Maekawa, Taishi Yamakawa, Takayuki Katsuno, Shoichi Maruyama
OBJECTIVES: Hypernatraemia is one of the major electrolyte disorders associated with mortality among critically ill patients in intensive care units (ICUs). It is unclear whether this applies to patients with cerebrovascular diseases in whom high sodium concentrations may be allowed in order to prevent cerebral oedema. This study aimed to examine the association between ICU-acquired hypernatraemia and the prognosis of patients with cerebrovascular diseases. DESIGN: A retrospective cohort study...
August 18, 2017: BMJ Open
https://www.readbyqxmd.com/read/28567198/biochemical-derangements-prior-to-emergency-laparotomy-at-queen-elizabeth-central-hospital-blantyre-malawi-a-cross-sectional-pilot-study
#15
Mark G Williams
BACKGROUND: The aim of this study was to examine biochemical investigations not routinely performed prior to emergency laparotomy in patients at Queen Elizabeth Central Hospital, a low-resource public hospital in Blantyre, Malawi. METHODS: A prospective cross-sectional study of adults (N = 15) needing emergency laparotomy over a 4-week period were studied at Queen Elizabeth Central Hospital. Biochemical investigations, not routinely performed for economic reasons, were performed preoperatively; these included sodium, potassium, chloride, carbon dioxide, urea, and calcium levels...
March 2017: Malawi Medical Journal: the Journal of Medical Association of Malawi
https://www.readbyqxmd.com/read/28473024/-prehospital-arterial-blood-gas-analysis-after-collapse-connected-to-triathlon-participation
#16
Asbjørn Ettrup-Christensen, Louise Amstrup-Hansen, Stine T Zwisler
Long-distance athletes are at risk of serious fluid and electrolyte disturbances, such as hypernatraemia (dehydration). Recently, cases of serious morbidity have been reported, due to acute exercise-associated hyponatraemia, which can advance to encephalopathy. An arterial blood gas analysis (ABG) was drawn from collapsed athletes at the championship of full-distance triathlon 2015, and different electrolyte imbalances were found. Our findings show that prehospital ABG can assist in differentiating the cause of collapse, and presumably, targeted treatment can be initiated already on scene...
May 1, 2017: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/28214374/a-systematic-review-of-known-interventions-for-the-treatment-of-chronic-nonhypovolaemic-hypotonic-hyponatraemia-and-a-meta-analysis-of-the-vaptans
#17
REVIEW
Sunil Bhandari, Alessandro Peri, Iain Cranston, Rachael McCool, Alison Shaw, Julie Glanville, Larisa Petrakova, Karl O'Reilly
International and national guidelines on the treatment of chronic nonhypovolaemic hypotonic hyponatraemia differ; therefore, we have undertaken this systematic review and meta-analysis to investigate the efficacy and safety of interventions for the treatment of chronic nonhypovolaemic hypotonic hyponatraemia. Following registration of the review protocol with PROSPERO, systematic literature searches were conducted to identify randomized and quasi-randomized controlled trials assessing any degree of fluid restriction or any drug treatment with the aim of increasing serum sodium concentration in patients with chronic nonhypovolaemic hypotonic hyponatraemia...
June 2017: Clinical Endocrinology
https://www.readbyqxmd.com/read/28074401/adipsic-diabetes-insipidus-in-adult-patients
#18
REVIEW
Martín Cuesta, Mark J Hannon, Christopher J Thompson
INTRODUCTION: Adipsic diabetes insipidus (ADI) is a very rare disorder, characterized by hypotonic polyuria due to arginine vasopressin (AVP) deficiency and failure to generate the sensation of thirst in response to hypernatraemia. As the sensation of thirst is the key homeostatic mechanism that prevents hypernatraemic dehydration in patients with untreated diabetes insipidus (DI), adipsia leads to failure to respond to aquaresis with appropriate fluid intake. This predisposes to the development of significant hypernatraemia, which is the typical biochemical manifestation of adipsic DI...
June 2017: Pituitary
https://www.readbyqxmd.com/read/27977657/delayed-recovery-of-adipsic-diabetes-insipidus-adi-caused-by-elective-clipping-of-anterior-communicating-artery-and-left-middle-cerebral-artery-aneurysms
#19
Jeffrey Tan, Samuel Ndoro, Uchenna Okafo, Aoife Garrahy, Amar Agha, Danny Rawluk
Adipsic diabetes insipidus (ADI) is an extremely rare complication following microsurgical clipping of anterior communicating artery aneurysm (ACoA) and left middle cerebral artery (MCA) aneurysm. It poses a significant challenge to manage due to an absent thirst response and the co-existence of cognitive impairment in our patient. Recovery from adipsic DI has hitherto been reported only once. A 52-year-old man with previous history of clipping of left posterior communicating artery aneurysm 20 years prior underwent microsurgical clipping of ACoA and left MCA aneurysms without any intraoperative complications...
December 16, 2016: New Zealand Medical Journal
https://www.readbyqxmd.com/read/27504377/wine-glass-sign-and-empty-delta-sign-a-rare-imaging-presentation-of-postpartum-encephalopathy-in-dehydration
#20
Chanabasappa V Chavadi, K Suprasanna, Anees Dudekula, Madhav Hegde, Swetha Kory
Rapid correction of hyponatremia is a well-known cause of central pontine and extrapontine myelinolysis. But uncommonly seen and rarely reported in Hypernatraemia. We report a rare case presenting as postpartum psychosis, wherein imaging revealed myelinolysis of corticospinal tracts in wine glass distribution and empty delta sign due to cortical venous thrombosis. At follow-up 3 months later, revealed significant neurological improvement. Concurrance occurrence of this dual pathology is not been described, which in our case was due to high serum sodium levels at presentation and dehydration...
June 2016: Journal of Clinical and Diagnostic Research: JCDR
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