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management of critical care hyponatremia

Timothy M Uyeki, Aneesh K Mehta, Richard T Davey, Allison M Liddell, Timo Wolf, Pauline Vetter, Stefan Schmiedel, Thomas Grünewald, Michael Jacobs, Jose R Arribas, Laura Evans, Angela L Hewlett, Arne B Brantsaeter, Giuseppe Ippolito, Christophe Rapp, Andy I M Hoepelman, Julie Gutman
BACKGROUND: Available data on the characteristics of patients with Ebola virus disease (EVD) and clinical management of EVD in settings outside West Africa, as well as the complications observed in those patients, are limited. METHODS: We reviewed available clinical, laboratory, and virologic data from all patients with laboratory-confirmed Ebola virus infection who received care in U.S. and European hospitals from August 2014 through December 2015. RESULTS: A total of 27 patients (median age, 36 years [range, 25 to 75]) with EVD received care; 19 patients (70%) were male, 9 of 26 patients (35%) had coexisting conditions, and 22 (81%) were health care personnel...
February 18, 2016: New England Journal of Medicine
Brian L Hendricks, Tasneem A Shikary, Lee A Zimmer
OBJECTIVE: The Affordable Care Act Readmissions Reduction Program introduced reimbursement policy changes resulting in penalties for hospitals with higher-than-average readmission rates among several categories, including elective surgical cases. We examined the rate of complications resulting in 30-day readmission following endoscopic transsphenoidal surgery. STUDY DESIGN: Case series with chart review. SETTING: Academic tertiary care center...
February 2016: Otolaryngology—Head and Neck Surgery
Cornelius Barlascini, Maria Grazia Piroddi, Alessandro Perazzo, Renata Senarega, Mario Santo, Antonello Nicolini
The ovarian hyperstimulation syndrome (OHSS) is a serious but rarely fatal complication of medical interventions that seek to induce fertility; it is typically encountered in women who undergo controlled ovarian hyperstimulation, but there are very rare patients who have genetic defects who present with OHSS. In recent years, its pathogenesis has been elucidated; this knowledge will decrease the frequency of this syndrome. Clinical signs may include any or all of the following: rapid weight gain, ascites, oliguria, hemoconcentration, leukocytosis, along with intravascular hypovolemia, hyponatremia, and hyperkalemia...
2015: Pneumologia: Revista Societății Române de Pneumologie
Kari Santoro Beer, Lori S Waddell
Obtaining and interpreting blood gas and electrolyte levels is essential in the management of perioperative veterinary patients. Metabolic and electrolyte alterations are common in critically ill surgical patients, and can lead to alterations in cardiovascular function, neurologic status, respiratory function, and even response to various drug therapies. Several common perioperative conditions are discussed in this article, including metabolic disturbances, electrolyte abnormalities (hyponatremia and hypernatremia, hyperkalemia), and respiratory abnormalities...
September 2015: Veterinary Clinics of North America. Small Animal Practice
T Eoin West, Amélie von Saint André-von Arnim
Clinicians caring for patients infected with Ebola virus must be familiar not only with screening and infection control measures but also with management of severe disease. By integrating experience from several Ebola epidemics with best practices for managing critical illness, this report focuses on the clinical presentation and management of severely ill infants, children, and adults with Ebola virus disease. Fever, fatigue, vomiting, diarrhea, and anorexia are the most common symptoms of the 2014 West African outbreak...
November 2014: Annals of the American Thoracic Society
Robin Guo, Marc Montecillo, Nader Kamangar
Critical Care Student/Resident Case Report Posters IIISESSION TYPE: Medical Student/Resident Case ReportPRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PMINTRODUCTION: Transurethral resection of the prostate (TURP) syndrome is a rare condition classically characterized by hyponatremia, altered mental status, and hypervolemia caused by large volume bladder irrigation with hypotonic glycine or cytal solution during TURP. Ionic solutions are not traditionally used because they dissipate the cutting power of monopolar instruments...
October 1, 2014: Chest
Avinash B Kumar, Yaping Shi, Matthew S Shotwell, Justin Richards, Jesse M Ehrenfeld
BACKGROUND: Hypertonic saline therapy is often used in critically ill subarachnoid hemorrhage (SAH) patients for indications ranging from control of intracranial hypertension to managing symptomatic hyponatremia. The risk factors for developing acute kidney injury (AKI) in this patient population are not well defined. SPECIFIC AIM: To study the role of serum sodium in developing AKI (based on the AKIN definition) in the SAH population admitted to a large academic neurocritical care unit...
April 2015: Neurocritical Care
Alexis A Topjian, Amber Stuart, Alyssa A Pabalan, Ashleigh Clair, Todd J Kilbaugh, Nicholas S Abend, Phillip B Storm, Robert A Berg, Jimmy W Huh, Stuart H Friess
OBJECTIVES: Dysnatremia is common in critically ill children due to disruption of hormonal homeostasis. Children with brain injury are at risk for syndrome of inappropriate antidiuretic hormone, cerebral salt wasting, and sodium losses due to externalized ventricular drain placement. We hypothesized that among PICU patients managed with an externalized ventricular drain, hyponatremia is common, hyponatremia is associated with seizures and in-hospital mortality, and greater sodium fluctuations are associated with in-hospital mortality...
November 2014: Pediatric Critical Care Medicine
Brian P Baur, Calvin J Meaney
Autosomal dominant polycystic kidney disease (ADPKD) is characterized by bilateral renal cysts, kidney pain, hypertension, and progressive loss of renal function. It is a leading cause of end-stage renal disease and the most common inherited kidney disease in the United States. Despite its prevalence, disease-modifying treatment options do not currently exist. Tolvaptan is an orally active, selective arginine vasopressin V2 receptor antagonist already in use for hyponatremia. Tolvaptan exhibits dose-proportional pharmacokinetics with a half-life of ~12 hours...
June 2014: Pharmacotherapy
Sudeep K Rajpoot, Carlos Maggi, Amrit Bhangoo
UNLABELLED: Neonatal hyperkalemia and hyponatremia are medical conditions that require an emergent diagnosis and treatment to avoid morbidity and mortality. Here, we describe the case of a 10-day-old female baby presenting with life-threatening hyperkalemia, hyponatremia, and metabolic acidosis diagnosed as autosomal dominant pseudohypoaldosteronism type 1 (PHA1). This report aims to recognize that PHA1 may present with a life-threatening arrhythmia due to severe hyperkalemia and describes the management of such cases in neonates...
2014: Endocrinology, Diabetes & Metabolism Case Reports
Isabelle Morard, Yvan Gasche, Mark Kneteman, Christian Toso, Ariane Mentha, Glenda Meeberg, Gilles Mentha, Norman Kneteman, Emiliano Giostra
BACKGROUND: Central pontine and extrapontine myelinolysis (CPEPM) is a rare but potentially fatal complication after orthotopic liver transplantation (OLT). The aim of this study was to identify risk factors for development of CPEPM after OLT and to assess patient outcome. METHODS: We reviewed the clinical data of 1,378 patients who underwent OLT between 1987 and 2009 in Geneva, Switzerland and Edmonton, Canada. Nineteen patients (1.4 %) developed CPEPM. We compared their characteristics with control patients, matched by age, gender, date of OLT, and MELD score...
April 2014: Neurocritical Care
Yuval Cavari, Alexander F Pitfield, Niranjan Kissoon
Intravenous maintenance fluid therapy aims to replace daily urinary and insensible losses for ill children in whom adequate enteric administration of fluids is contraindicated or infeasible. The traditional determination of fluid volumes and composition dates back to Holliday and Segar's seminal article from 1957, which describes the relationship between weight, energy expenditure, and physiologic losses in healthy children. Combined with estimates of daily electrolyte requirements, this information supports the use of the hypotonic maintenance fluids that were widely used in pediatric medicine...
November 2013: Pediatric Emergency Care
Richard H Sterns, John K Hix, Stephen M Silver
Hyponatremia is common in critical care units. Avoidance of neurologic injury requires a clear understanding of why the serum sodium (Na) concentration falls and why it rises, how the brain responds to a changing serum Na concentration, and what the goals of therapy should be. A 4 to 6 mEq/L increase in serum Na concentration is sufficient to treat life-threatening cerebral edema caused by acute hyponatremia. In chronic (> 48 h), severe (< 120 mEq/L) hyponatremia, correction by > 8 to 10 mEq/L/d risks iatrogenic osmotic demyelination syndrome (ODS); therefore, a 4 to 6 mEq/L daily increase in serum Na concentration should be the goal in most patients...
August 2013: Chest
John R Klinck, Lisa McNeill, David K Menon
Marked dysnatremia is associated with increased mortality in patients admitted to intensive care. However, new evidence suggests that even mild deviations from normal and simple variability of sodium values may also be significant. Should these findings prompt clinicians to re-evaluate the approach to fluid management in this setting? Sodium disorders, on one hand, are known to result from overzealous administration or restriction of free water or sodium ions. However, they are also associated with a range of co-morbidities and drug treatments that alter water loss and sodium handling in the nephron independently of prescribed fluid regimens...
2013: Critical Care: the Official Journal of the Critical Care Forum
Karen G Hirsch, S Andrew Josephson
Patients with kidney disease have increased rates of neurologic illness such as intracerebral hemorrhage and ischemic stroke. The acute care of patients with critical neurologic illness and concomitant kidney disease requires unique management considerations including attention to hyponatremia, renal replacement modalities in the setting of high intracranial pressure, reversal of coagulopathy, and seizure management to achieve good neurologic outcomes.
January 2013: Advances in Chronic Kidney Disease
Richa Vaishya, Jasbinder Kaur, Seema, Sunny Chopra, Shivani Jaswal
Hyponatraemia, one of the most common electrolyte abnormality when severe (<120 meq/l), has poor prognosis and fatal outcome. Published data on identification of mortality predictors in severe hyponatraemia is however insufficient. The aim of the study was to determine the characteristics, causes and outcome of severe hyponatraemia (<120 meq/l) in hospitalised patients and to identify the mortality predictors. A retrospective case note review of patients (n=175) admitted in emergency ward of a tertiary care hospital during a period of 12 months having severely hyponatraemic (<120 meq/l) were undertaken...
February 2012: Journal of the Indian Medical Association
Bruce Friedman, Joshua Cirulli
Hyponatremia is a common problem in critical care patients and is associated with increased duration of hospital stay and increased morbidity and mortality. The prevalence of hyponatremia in the intensive care unit (ICU) has been reported to be as high as 30% to 40%. Recent studies have found hyponatremia at ICU admission in up to 14% of patients in unselected groups; patients with hyponatremia were at elevated risk of mortality vs normonatremic patients. Most cases in the ICU are euvolemic or hypervolemic hyponatremia, with the syndrome of inappropriate secretion of antidiuretic hormone being a predominant cause...
April 2013: Journal of Critical Care
Tsae-Jyy Wang, Shu-Fang Vivienne Wu, Shu Yuan Liang, Heng-Hsin Tung, Yu-Ping Lin
Nutritional support provides critically ill patients with energy and nutrients required to face the demands of their illness and stress. For those unable to ingest orally, enteral feeding rather than parenteral feeding is recommended, as the former better preserves gut integrity, reduces risk of infection, and costs less. Early enteral feeding in critically ill patients is also associated with decreased disease severity, reduced complications, and shortened length of stay. Risks associated with enteral feeding include aspiration, diarrhea, vomiting, hyponatremia, and hyperglycemia...
August 2012: Hu Li za Zhi the Journal of Nursing
Cynthia Bautista
A cerebral aneurysm is an outpouching of a weakened arterial wall, usually at a bifurcation of one of the larger vessels of the Circle of Willis. When the outpouching ruptures, arterial pressure forces blood into the subarachnoid space. The annual incidence of aneurysmal subarachnoid hemorrhage is 8 to 10 per 100 000 in the United States. The outcome varies for this patient population. New management strategies have emerged; some practices are evidence based, whereas others are based on anecdotal experiences...
April 2012: AACN Advanced Critical Care
Alexander Fraser Pitfield, Allison B Carroll, Niranjan Kissoon
Primary neurological injury in children can be induced by diverse intrinsic and extrinsic factors including brain trauma, tumors, and intracranial infections. Regardless of etiology, increased intracranial pressure (ICP) as a result of the primary injury or delays in treatment may lead to secondary (preventable) brain injury. Therefore, early diagnosis and aggressive treatment of increased ICP is vital in preventing or limiting secondary brain injury in children with a neurological insult. Present management strategies to improve survival and neurological outcome focus on reducing ICP while optimizing cerebral perfusion and meeting cerebral metabolic demands...
February 2012: Pediatric Emergency Care
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