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U K Misra, J Kalita, M Kumar, A Tripathi
OBJECTIVE: To report atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) levels in patients with tuberculous meningitis (TBM) and acute encephalitis syndrome (AES), and evaluate their relationship with hyponatraemia. METHODS: Consecutive patients with TBM and AES were included in the study. Hyponatraemia was categorised as cerebral salt wasting (CSW), syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and a miscellaneous group based on clinical and laboratory criteria...
April 1, 2018: International Journal of Tuberculosis and Lung Disease
Peiwen Song, Cailiang Shen
No abstract text is available yet for this article.
March 20, 2018: Spinal Cord
Simon Mifsud, Emma Louise Schembri, Matthew Mercieca Balbi, Mark Gruppetta, James Clark
The authors report a case of a 68-year-old man who was diagnosed with an irreversible second-degree atrioventricular (AV) Mobitz II 2:1 block temporally associated with profound hyponatraemia. The cause of the hyponatraemia was beer potomania. The co-occurrence of reversible first, second and third-degree heart blocks and hyponatraemia has been described in a few published case reports. However, this case is noteworthy as the AV block persisted, despite correction of serum sodium concentration as opposed to other published cases, which meant that the patient required a permanent pacemaker...
March 14, 2018: BMJ Case Reports
Seosamh McCauley, Athinyaa Thiraviaraj
No abstract text is available yet for this article.
May 2017: Ulster Medical Journal
Joseph Fogarty, Clodagh Loughrey
Hyponatraemia is common and often a source of confusion for junior doctors. It is infrequently dangerous, but when it is, is a medical emergency and requires urgent treatment to avoid life-threatening cerebral oedema. Treatment of acute hyponatraemia is also potentially hazardous; it is therefore important to be able to recognise when urgent management is not indicated, and to investigate appropriately. This paper focuses on these issues, which are most likely to be the cause of consternation for the junior doctor...
May 2017: Ulster Medical Journal
Emmanuel Ademola Anigilaje
The survival of a child with severe volume depletion at the emergency department depends on the competency of the first responder to recognize and promptly treat hypovolemic shock. Although the basic principles on fluid and electrolytes therapy have been investigated for decades, the topic remains a challenge, as consensus on clinical management protocol is difficult to reach, and more adverse events are reported from fluid administration than for any other drug. While the old principles proposed by Holliday and Segar, and Finberg have stood the test of time, recent systematic reviews and meta-analyses have highlighted the risk of hyponatraemia, and hyponatraemic encephalopathy in some children treated with hypotonic fluids...
2018: Frontiers in Pediatrics
Ana Margarida Monteiro, Olinda Marques, Sofia Martins, Ana Antunes
The authors report a case of a 15-year-old girl with hypopituitarism due to pituitary stalk interruption syndrome diagnosed in the neonatal period. The patient was admitted to the emergency room with impaired consciousness and hypoglycaemia. The day before, she increased her water intake to about 1.5 L to perform a pelvic ultrasound. In the following hours, she developed vomiting and food refusal. Blood analysis revealed hypoglycaemia, hyponatraemia, decreased serum osmolality and normal urinary density. Hyponatraemia and adrenal crisis were managed with a gradual but slow resolution of consciousness and electrolytic balance...
March 9, 2018: BMJ Case Reports
Douglas Lewis, Andrew Blow, Jonathan Tye, Tamara Hew-Butler
Exercise-associated hyponatraemia (EAH) always involves a component of overhydration relative to available exchangeable sodium stores. In the majority of cases, this is purely due to excessive consumption of fluids during exercise. In a lesser number of cases, it is apparent that excessive sodium loss through sweat may play a role by decreasing the amount of acutely available exchangeable sodium. Two cases demonstrating the latter, one in an individual with cystic fibrosis (CF) and another in an endurance athlete without CF, demonstrate how elevated dermal sweat losses may contribute to a relative dilutional EAH along a pathophysiological continuum...
March 9, 2018: BMJ Case Reports
Nicholas Black, Hazim Hamada
An 80-year-old woman presented with a 5-week history of increasing confusion. Examination was remarkable only for deficits in short-term memory and paranoid thoughts. Blood tests revealed hyponatraemia, and further biochemical testing was consistent with syndrome of inappropriate antidiuretic hormone (SIADH). After an exhaustive diagnostic workup for causes of SIADH, the only abnormal finding was a mildly raised antivoltage-gated potassium channel (VGKC) titre of 185 pmol/L (0-69) consistent with possible anti-VGKC autoimmune limbic encephalitis...
March 7, 2018: BMJ Case Reports
Paul Torpiano, David Pace
BACKGROUND: Mediterranean Spotted Fever (MSF) is a tick-borne zoonosis caused by Rickettsia conorii which is endemic in Malta, an island in the South Mediterranean that is a popular tourist destination. Diagnosis is frequently based on clinical manifestations as laboratory results are often limited to a retrospective diagnosis. We describe the clinical presentation, diagnosis and treatment of children <16 years who presented with MSF from 2011 to 2016. METHOD: The demographics, clinical findings, laboratory results, management and outcome of all children hospitalised with suspected MSF based on the presence of fever and an eschar, were retrieved from their case notes...
February 17, 2018: Travel Medicine and Infectious Disease
Tzy Harn Chua, Matin Ly, Senthil Thillainadesan, Katie Wynne
Hyponatraemia is common following major head injury and is associated with significant morbidity and mortality. A 20-year-old man presented with reduced consciousness after head trauma and was found to have a fractured skull base with bilateral frontal contusions. On day 3 of his admission, he developed hyponatraemia with raised urine sodium and osmolality, despite receiving dexamethasone and intravenous fluid therapy. His hyponatraemia worsened after the treatment with fluid restriction and oral salt. He was in negative fluid balance suggesting possible renal salt wasting...
February 5, 2018: BMJ Case Reports
Sophie Chambers, Danielle Donoghue, Natalie Anscomb, Ruth A Griffin, Simon W Dubrey
No abstract text is available yet for this article.
February 2, 2018: British Journal of Hospital Medicine
Aaron C Tan, Gavin M Marx
We present a case of cisplatin-induced syndrome of inappropriate antidiuretic hormone (SIADH) in a patient with metastatic recurrent urothelial carcinoma. Cisplatin-induced SIADH is an uncommon but potentially life-threatening toxicity. Pharmacogenetic characteristics may result in different toxicity profiles in different populations. With such widespread use of cisplatin in a diverse range of cancers, prompt recognition is crucial to detect and prevent severe neurological sequelae.
January 31, 2018: BMJ Case Reports
Sandra P D'Angelo, Michelle R Mahoney, Brian A Van Tine, James Atkins, Mohammed M Milhem, Balkrishna N Jahagirdar, Cristina R Antonescu, Elise Horvath, William D Tap, Gary K Schwartz, Howard Streicher
BACKGROUND: Patients with metastatic sarcoma have limited treatment options. Nivolumab and ipilimumab are monoclonal antibodies targeting PD-1 and CTLA-4, respectively. We investigated the activity and safety of nivolumab alone or in combination with ipilimumab in patients with locally advanced, unresectable, or metastatic sarcoma. METHODS: We did a multicentre, open-label, non-comparative, randomised, phase 2 study that enrolled patients aged 18 years or older and had central pathology confirmation of sarcoma with at least one measurable lesion by Response Evaluation Criteria In Solid Tumors (RECIST) 1...
March 2018: Lancet Oncology
Ken Ohmachi, Kiyoshi Ando, Michinori Ogura, Toshiki Uchida, Kensei Tobinai, Dai Maruyama, Masayuki Namiki, Tadashi Nakanishi
E7777, a recombinant cytotoxic fusion protein comprising diphtheria toxin fragments A and B and human interleukin-2, shares an amino acid sequence with denileukin diftitox but has improved purity and an increased percentage of active protein monomer species. A phase 1 study was conducted to evaluate the tolerability, safety, pharmacokinetics and anti-tumour activity of E7777 in Japanese patients with relapsed/refractory peripheral and cutaneous T-cell lymphoma. E7777 (6, 12 and expanded 9 μg/kg/day) was administered to 13 patients via intravenous infusion on 5 consecutive days per 21-day cycle...
January 24, 2018: Cancer Science
Anan Shtaya, Debayan Dasgupta, John Millar, Owen Sparrow, Diederik Bulters, Jonathan Duffill
OBJECT: The outcomes of microsurgery of previously coiled aneurysms are poorly described and little is known about what factors predict poor outcome. Therefore, we set out studying our case series to identify predictors of poor outcome following microsurgery for previously coiled recurrent aneurysms. METHODS: A retrospective cohort study from a prospectively maintained vascular database reviewing presentations, recurrent aneurysms measurements, surgery and outcomes of microsurgical clipping of recurrent previously coiled intracranial aneurysms...
January 17, 2018: World Neurosurgery
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
Pulak Tosh, Sunil Rajan, Dilesh Kadapamannil, Nandhini Joseph, Lakshmi Kumar
Background and Aims: Hyponatraemia is frequent in post-operative patients and may be corrected with hypertonic saline (HTS). Oral tolvaptan is used to treat hypervolaemic or euvolaemic hyponatraemia. This study was performed to assess the efficacy of oral tolvaptan in correcting postoperative hyponatraemia compared to HTS. Methods: This prospective, randomised study was conducted in 40 symptomatic patients with serum sodium level ≤130 mEq/L. In Group H (n = 20), 3% HTS was infused at 20-30 mL/h aiming for correction of 6 mEq/L/day...
December 2017: Indian Journal of Anaesthesia
Tarun Dalia, Reza Masoomi, Kamal Kant Sahu, Kamal Gupta
Severe hyponatraemia in setting of cardiac tamponade is very rare and only few case reports have been reported so far. This case report highlights pericardial tamponade as a rare but easily treatable cause of severe hyponatraemia. Pertinent literature is also reviewed. A 70-year-old woman presented to the emergency department with altered mental status. She was tachycardic and hypotensive with cardiomegaly on a chest X-ray. Serum sodium was severely low at 109 mmol/L and was identified as the likely cause for her abnormal mentation...
January 3, 2018: BMJ Case Reports
Sudha Vidyasagar, Karthik Rao, Muralidhar Verma, Aswini Dutt Tripuraneni, Navin Patil, Dipanjan Bhattacharjee
Hyponatraemia is a well-established and potentially, a life-threatening adverse effect of selective serotonin receptor uptake inhibitors (SSRI). However, its occurrence secondary to syndrome of inappropriate antidiuretic hormone secretion (SIADH) with escitalopram, has been reported extremely sporadically. The reporting of such rare, but life-threatening adverse effects of escitalopram assumes immense significance in light of the fact that SSRIs presently form the mainstay of treatment of depressive disorders...
September 15, 2017: Psychopharmacology Bulletin
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