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https://www.readbyqxmd.com/read/29326859/severe-hyponatremia-presenting-with-minimal-symptoms
#1
Anita Lwanga, Amira Mohamed, Mayank Patel, Andres Serrano
Hyponatremia is a common electrolyte abnormality, however, encountering a patient with serum sodium level below 100 mEq/L and minimal symptoms is unusual. We present the case of an 86-year-old woman who was found to have serum sodium levels of 99 mEq/L. Her only complaint was difficulty in walking. On admission, and throughout her hospital stay, she did not have altered mental status, focal neurological deficits, or adverse outcomes. Her history, blood work, and urine studies pointed towards a diagnosis of thiazide-associated hyponatremia...
November 8, 2017: Curēus
https://www.readbyqxmd.com/read/29321043/what-is-in-your-wallet-a-cluster-randomized-trial-of-the-effects-of-showing-comparative-patient-out-of-pocket-costs-on-primary-care-prescribing-for-uncomplicated-hypertension
#2
Robyn Tamblyn, Nancy Winslade, Christina J Qian, Teresa Moraga, Allen Huang
BACKGROUND: Drug expenditures are responsible for an increasing proportion of health costs, accounting for $1.1 trillion in annual expenditure worldwide. As hundreds of billions of dollars are being spent each year on overtreatment with prescribed medications that are either unnecessary or are in excess of lowest cost-effective therapy, programs are needed that optimize fiscally appropriate use. We evaluated whether providing physicians with information on the patient out-of-pocket payment consequences of prescribing decisions that were in excess of lowest cost-effective therapy would alter prescribing decisions using the treatment of uncomplicated hypertension as an exemplar...
January 10, 2018: Implementation Science: IS
https://www.readbyqxmd.com/read/29318728/diagnosis-and-management-of-hyponatraemia-in-the-older-patient
#3
REVIEW
Michael Woodward, Peter Gonski, Mathis Grossmann, John Obeid, Ron Scholes, Duncan J Topliss
Hyponatraemia (serum sodium concentration below 135 mmol/L) is the most common electrolyte disturbance and occurs commonly in older people. The causes can be complex to diagnose and treat and many published guidelines do not focus on the issues in an older patient group. Here, we are principally concerned with diagnosis and management of euvolaemic and hypervolaemic hyponatraemia in hospitalised patients over 70 years old. We also aim to increase awareness of hyponatraemia in residential aged care facilities and the community...
January 2018: Internal Medicine Journal
https://www.readbyqxmd.com/read/29310825/potassium-intake-modulates-the-thiazide-sensitive-sodium-chloride-cotransporter-ncc-activity-via-the-kir4-1-potassium-channel
#4
Ming-Xiao Wang, Catherina A Cuevas, Xiao-Tong Su, Peng Wu, Zhong-Xiuzi Gao, Dao-Hong Lin, James A McCormick, Chao-Ling Yang, Wen-Hui Wang, David H Ellison
Kir4.1 in the distal convoluted tubule plays a key role in sensing plasma potassium and in modulating the thiazide-sensitive sodium-chloride cotransporter (NCC). Here we tested whether dietary potassium intake modulates Kir4.1 and whether this is essential for mediating the effect of potassium diet on NCC. High potassium intake inhibited the basolateral 40 pS potassium channel (a Kir4.1/5.1 heterotetramer) in the distal convoluted tubule, decreased basolateral potassium conductance, and depolarized the distal convoluted tubule membrane in Kcnj10flox/flox mice, herein referred to as control mice...
January 6, 2018: Kidney International
https://www.readbyqxmd.com/read/29307229/vascular-legacy-beyond-blood-pressure-control-benefits-of-perindopril-indapamide-combination-in-hypertensive-patients-with-diabetes
#5
Bernard I Lévy, Stefano Taddei
OBJECTIVES: Much of the chronic care of patients with type 2 diabetes mellitus and hypertension involves the prevention of diabetic complications. Renin-angiotensin system inhibitors are recommended as first-line therapies because of their nephroprotective properties. Their combination with metabolically neutral diuretics is recommended to reduce blood pressure, morbidity, and mortality. Our objective was to review the mechanisms by which the combination of the angiotensin-converting enzyme inhibitor, perindopril, and metabolically neutral thiazide-like diuretic, indapamide, targets the pathways involved in microvascular and macrovascular diabetic complications...
January 8, 2018: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/29303829/sex-differences-in-antihypertensive-treatment-in-france-among-17%C3%A2-856-patients-in-a-tertiary-hypertension-unit
#6
Thérèse Deborde, Laurence Amar, Guillaume Bobrie, Nicolas Postel-Vinay, Christiane Battaglia, Amokrane Tache, Antoine Chedid, Mohamed-Malek Dhib, Gilles Chatellier, Pierre-François Plouin, Anita Burgun, Michel Azizi, Anne-Sophie Jannot
BACKGROUND: Sex differences in antihypertensive treatment have often been highlighted, but whether there is truly a difference or whether this difference is mediated by confounding factors has yet to be deciphered. PATIENTS AND METHODS: We performed a cross-sectional study on the first consultation in the Georges Pompidou Hospital Tertiary Hypertension Unit between July 2000 and June 2015 to explore sex differences in both patient and treatment characteristics over this period...
January 4, 2018: Journal of Hypertension
https://www.readbyqxmd.com/read/29288159/sphingolipid-metabolic-pathway-impacts-thiazide-diuretics-blood-pressure-response-insights-from-genomics-metabolomics-and-lipidomics
#7
Mohamed H Shahin, Yan Gong, Reginald F Frye, Daniel M Rotroff, Amber L Beitelshees, Rebecca A Baillie, Arlene B Chapman, John G Gums, Stephen T Turner, Eric Boerwinkle, Alison Motsinger-Reif, Oliver Fiehn, Rhonda M Cooper-DeHoff, Xianlin Han, Rima Kaddurah-Daouk, Julie A Johnson
BACKGROUND: Although hydrochlorothiazide (HCTZ) is a well-established first-line antihypertensive in the United States, <50% of HCTZ treated patients achieve blood pressure (BP) control. Thus, identifying biomarkers that could predict the BP response to HCTZ is critically important. In this study, we utilized metabolomics, genomics, and lipidomics to identify novel pathways and biomarkers associated with HCTZ BP response. METHODS AND RESULTS: First, we conducted a pathway analysis for 13 metabolites we recently identified to be significantly associated with HCTZ BP response...
December 29, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29283974/the-role-of-distal-tubule-and-collecting-duct-sodium-reabsorption-in-sunitinib-induced-hypertension
#8
Jeannine Witte, Josephine Lampe, Anna Koenen, Ines Urbaneck, Antje Steinbach, Rainer Rettig, Olaf Grisk
OBJECTIVE: Antiangiogenic receptor tyrosine kinase inhibitors (RTKI) induce arterial hypertension which may limit their use. Renal fractional sodium excretion (FENa) is reduced in early RTKI-induced hypertension, whereas fractional lithium excretion is unaltered. Therefore, we tested the hypothesis that activated distal tubule and collecting duct sodium reabsorption contributes to RTKI-induced hypertension. METHODS: Amiloride-sensitive and hydrochlorothiazide (HCTZ)-sensitive fractional sodium reabsorption (FRNa) and renal epithelial sodium channel (ENaC) as well as sodium chloride cotransporter (NCC) abundances were determined in sunitinib-treated and control rats...
December 27, 2017: Journal of Hypertension
https://www.readbyqxmd.com/read/29279076/symptomatic-hyponatremia-after-bowel-preparation-report-of-two-cases-and-literature-review
#9
Juliana Moura Costa, João Bruno Soares
INTRODUCTION: Bowel preparation for colonoscopy and/or colorectal surgery can cause electrolyte imbalances. The risk of electrolyte imbalances seems to be related to the type of bowel cleansing solution, age of patients and comorbidities. CASE REPORT: We report two cases of symptomatic hyponatremia (focal neurological signs and coma) after bowel preparation with sodium picosulfate/magnesium citrate for colonoscopy. In both cases, symptoms related to hyponatremia rapidly disappeared after sodium level correction with intravenous administration of hypertonic saline (3% NaCl)...
November 29, 2017: Acta Médica Portuguesa
https://www.readbyqxmd.com/read/29276921/-indapamide-sr-amlodipine-fixed-dose-combination-novel-approach-to-effective-control-of-systolic-arterial-pressure
#10
O N Tkachyeva, Y V Kotovskaya, E N Dudinskaya
Effective control of arterial pressure (AP) is achieved only in ⅓ of patients with arterial hypertension. It is especially difficult to achieve control of systolic (S) AP in elderly patients in whom SAP is the strongest prognostic factor of cardiovascular complications. Thiazide and thiazide-like diuretics and calcium antagonists are effective for lowering of elevated SAP and pulse (P) AP including aortic PAP elevation of which is associated with high stiffness of arterial wall and is typical for elderly people...
November 2017: Kardiologiia
https://www.readbyqxmd.com/read/29251761/single-pill-combinations-spcs-and-treatment-of-arterial-hypertension-in-poland-expert-consensus-statement-of-the-polish-society-of-hypertension-and-polish-cardiac-society-working-group-on-cardiovascular-pharmacotherapy
#11
Andrzej Tykarski, Krystyna Widecka, Krzysztof Narkiewicz, Beata Wożakowska-Kapłon, Zbigniew Gaciong, Stefan Grajek, Tomasz Grodzicki, Andrzej Januszewicz, Jacek Wolf, Aleksander Prejbisz, Katarzyna Kostka-Jeziorny, Krzysztof J Filipiak
The reasons for the publication of current expert consensus statement after 4 years from the previous one are: the growing number of evidence on the benefits of the use of single-pill combinations (SPCs) in hypertension (also with concomitant dyslipidaemia), the extension of indications for their use in the hypertension management algorithm and the emergence in recent years after the publication of Polish Society of Hypertension experts' position statement in 2013 of new types of SPCs available to doctors in Poland, including triple-drug combinations of antihypertensives and the so-called "hybrids" SPCs containing not only antihypertensive drugs but also statins...
2017: Kardiologia Polska
https://www.readbyqxmd.com/read/29212860/reference-values-of-renal-tubular-function-tests-are-dependent-on-age-and-kidney-function
#12
Anneke P Bech, Jack F M Wetzels, Tom Nijenhuis
Electrolyte disorders due to tubular disorders are rare, and knowledge about validated clinical diagnostic tools such as tubular function tests is sparse. Reference values for tubular function tests are based on studies with small sample size in young healthy volunteers. Patients with tubular disorders, however, frequently are older and can have a compromised renal function. We therefore evaluated four tubular function tests in individuals with different ages and renal function. We performed furosemide, thiazide, furosemide-fludrocortisone, and desmopressin tests in healthy individuals aged 18-50 years, healthy individuals aged more than 50 years and individuals with compromised renal function...
December 2017: Physiological Reports
https://www.readbyqxmd.com/read/29188803/activation-of-human-smooth-muscle-bk-channels-by-hydrochlorothiazide-requires-cell-integrity-and-the-presence-of-bk-%C3%AE-1-subunit
#13
Pedro Martín, Melisa Moncada, Guruprasad Kuntamallappanavar, Alex M Dopico, Verónica Milesi
Thiazide-like diuretics are the most commonly used drugs to treat arterial hypertension, with their efficacy being linked to their chronic vasodilatory effect. Previous studies suggest that activation of the large conductance voltage- and Ca2+-dependent K+ (BK) channel (Slo 1, MaxiK channel) is responsible for the thiazide-induced vasodilatory effect. But the direct electrophysiological evidence supporting this claim is lacking. BK channels can be associated with one small accessory β-subunit (β1-β4) that confers specific biophysical and pharmacological characteristics to the current phenotype...
November 30, 2017: Acta Pharmacologica Sinica
https://www.readbyqxmd.com/read/29180859/hyponatremia-in-the-elderly-challenges-and-solutions
#14
REVIEW
Theodosios D Filippatos, Andromachi Makri, Moses S Elisaf, George Liamis
Decreased serum sodium concentration is a rather frequent electrolyte disorder in the elderly population because of the presence of factors contributing to increased antidiuretic hormone, the frequent prescription of drugs associated with hyponatremia and also because of other mechanisms such as the "tea and toast" syndrome. The aim of this review is to present certain challenges in the evaluation and treatment of hyponatremia in the elderly population and provide practical solutions. Hyponatremia in elderly subjects is mainly caused by drugs (more frequently thiazides and antidepressants), the syndrome of inappropriate antidiuretic hormone secretion (SIAD) or endocrinopathies; however, hyponatremia is multifactorial in a significant proportion of patients...
2017: Clinical Interventions in Aging
https://www.readbyqxmd.com/read/29167564/whole-transcriptome-sequencing-analyses-reveal-molecular-markers-of-blood-pressure-response-to-thiazide-diuretics
#15
Ana Caroline C Sá, Amy Webb, Yan Gong, Caitrin W McDonough, Somnath Datta, Taimour Y Langaee, Stephen T Turner, Amber L Beitelshees, Arlene B Chapman, Eric Boerwinkle, John G Gums, Steven E Scherer, Rhonda M Cooper-DeHoff, Wolfgang Sadee, Julie A Johnson
Thiazide diuretics (TD) are commonly prescribed anti-hypertensives worldwide. However, <40% of patients treated with thiazide monotherapy achieve BP control. This study uses whole transcriptome sequencing to identify novel molecular markers associated with BP response to TD. We assessed global RNA expression levels in whole blood samples from 150 participants, representing patients in the upper and lower quartile of BP response to TD from the Pharmacogenomic Evaluation of Antihypertensive Responses (PEAR) (50 whites) and from PEAR-2 (50 whites and 50 blacks)...
November 22, 2017: Scientific Reports
https://www.readbyqxmd.com/read/29165723/the-impact-of-hyperosmolarity-on-long-term-outcome-in-patients-presenting-with-severe-hyperglycemic-crisis-a-population-based-study
#16
Ivan Kruljac, Miroslav Ćaćić, Petra Ćaćić, Lora Stanka Kirigin Biloš, Davor Kust, Božidar Perić, Maja Filipović-Grčić, Gorana Mirošević, Vedran Ostojić, Mario Štefanović, Milan Vrkljan
Aims We compared characteristics of patients with hyperglycemic hyperosmolar state (HHS) and patients with severe hyperglycemia without the signs of hyperosmolarity and ketoacidosis; analyzed long-term all-cause mortality and potential prognostic factors. Methods The studied population included 261 749 adults. HHS was diagnosed in patients with plasma glucose >33.0 mmol/L, ketonuria <1+, and serum osmolarity >320 mmol/L. Patients with plasma glucose >33.0 mmol/L, ketonuria <1+ and serum osmolarity <320 mmol/L were considered as controls (nHHS)...
November 17, 2017: Experimental and Clinical Endocrinology & Diabetes
https://www.readbyqxmd.com/read/29162216/treatment-regimens-by-pediatric-nephrologists-in-children-with-congenital-nephrogenic-diabetes-insipidus-a-mwpnc-study%C3%A2
#17
Cynthia D'Alessandri-Silva, Melinda Carpenter, John D Mahan
BACKGROUND: Congenital nephrogenic diabetes insipidus (NDI) is a rare genetic disorder affecting urinary concentration. Clinicians have varied medication regimens as well as nutritional plan approaches for these children. MATERIALS AND METHODS: An electronic survey was distributed to member pediatric nephrologists of the Midwest Pediatric Nephrology Consortium via email (n = 179). Questions included types of drugs prescribed, factors contributing to drug choice, common drug combinations given, and dietary/failure to thrive interventions used...
November 22, 2017: Clinical Nephrology
https://www.readbyqxmd.com/read/29153114/cost-effectiveness-analyses-of-antihypertensive-medicines-a-systematic-review
#18
REVIEW
Chanhyun Park, Guijing Wang, Jefferey M Durthaler, Jing Fang
CONTEXT: Hypertension affects one third of the U.S. adult population. Although cost-effectiveness analyses of antihypertensive medicines have been published, a comprehensive systematic review across medicine classes is not available. EVIDENCE ACQUISITION: PubMed, Embase, Cochrane Library, and Health Technology Assessment were searched to identify original cost-effectiveness analyses published from 1990 through August 2016. Results were summarized by medicine class: angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), thiazide-type diuretics, β-blockers, and others...
December 2017: American Journal of Preventive Medicine
https://www.readbyqxmd.com/read/29152588/the-delivery-science-rapid-analysis-program-a-research-and-operational-partnership-at-kaiser-permanente-northern-california
#19
Julie A Schmittdiel, Rick Dlott, Joseph D Young, Michael B Rothmann, Wendy Dyer, Alyce S Adams
Introduction: Health care researchers and delivery system leaders share a common mission to improve health care quality and outcomes. However, differing timelines, incentives, and priorities are often a barrier to research and operational partnerships. In addition, few funding mechanisms exist to generate and solicit analytic questions that are of interest to both research and to operations within health care settings, and provide rapid results that can be used to improve practice and outcomes...
October 2017: Learning Health Systems
https://www.readbyqxmd.com/read/29152298/medullary-nephrocalcinosis-in-idiopathic-hypercalciuria
#20
Abhilash Koratala, Vikrampal Bhatti
Idiopathic hypercalciuria is a metabolic abnormality characterized by excessive calcium excretion in the urine with normal serum calcium levels and is a common risk factor for formation of kidney stones and/or nephrocalcinosis. These patients benefit from a normal-calcium, reduced-animal protein, and low-salt diet, along with a thiazide diuretic.
November 2017: Clinical Case Reports
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