Hyponatremia physiopathology

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Widespread destruction of the skin induces a large necrotic mass and a break of the skin barrier. It also leads to an intense inflammatory reaction. This activates keratinocytes, endothelial cells and neutrophils. Certain mediators (e.g. endothelin, histamine, bradykinin, serotonin, catecholamines, vasopressin, prostaglandins, cytokines and nitrogen monoxide) are thus released in large quantities and act both at the site of the burns and at a distance. The abnormally high level of albumin in the capillary wall and the increased capacity of absorption of the interstitial areas around the burns are the main abnormalities observed...

This review updates some recent advances of a new and exciting developments in basic and clinical cardiology: a) the role, in the congestive heart failure (CHF), of the neurohumoral systems (NHS) which act to maintain circulatory homeostatic equilibrium, and b) the therapeutic implications of such a role. Six NHS, acting in CHF, have presently been identified: three of them induce vasoconstriction and sodium retention (sympathetic nervous systems, renin-angiotensin-aldosterone system and arginine-vasopressine system); the remaining three offset or balance the former ones, acting, therefore as "counterregulators" (prostaglandins--PGE2 and PGI2--, dopaminergic system and atrial natriuretic factor)...

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Hyponatremia in virtually all patients results from water retention due to an inability to excrete ingested water. In most cases, this defect represents the persistent secretion of ADH (such as in effective circulating volume depletion, and in the syndrome of inappropriate ADH secretion), although free water excretion can also be limited in disorders in which ADH levels may be appropriately suppressed (such as in advanced renal failure, and in primary polydipsia). The symptoms of hyponatremia primarily reflect neurologic dysfunction induced by cerebral edema and are related both to the severity and to the rapidity of reductions in the plasma sodium concentration...

Cerebral vasospasm following aneurysmal subarachnoid hemorrhage is one of the most important causes of cerebral ischemia, and is the leading cause of death and disability after aneurysmal rupture. The optimal treatment of vasospasm awaits development of agents for blocking or inactivating spasmogenic substances, or blocking arterial smooth muscle contraction. Rheological and/or hemodynamic manipulation using triple-H (hypertensive-hypervolemic-hemodilution) therapy to prevent or reverse ischemic consequences are relatively effective, but complicated and hazardous, and should be viewed principally as interim measures awaiting development of more specific therapies for arterial narrowing...

Unexpected severe electrolyte imbalance in the postoperative period. Report two cases. Two cases of inappropriate secretion of antidiuretic hormone are reported. In each patient, the physiopathology is reviewed. Differential diagnosis and treatment of hyponatremia is discussed.

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Hyponatraemia secondary to inappropriate secretion of antidiuretic hormone (SIADH) induces some biological modifications which are relatively characteristic of this condition. The disturbed acid-base equilibrium and the mechanism involved in the high urea and uric acid clearances observed in SIADH are discussed.

An eight-year-old black male with severe growth and mental retardation presented with massive myxedema, hyponatremia, and hypothermia. History of hypothyroidism was confirmed by laboratory investigation. The hypothyroidism appeared to be secondary to organic pituitary insufficiency due to diffuse brain damage. Appropriate therapeutic response was achieved initially only with intravenous thyroxine therapy. This case is reported to illustrate the unusual association of secondary hypothyroidism with severe myxedema and hyponatremia in the pediatric age group...

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Eight cases of hypothyroid coma observed between 1971 and 1981 are reported, and their main clinical, biological and therapeutic features described. Three out of the 8 patients died. Physiopathological and therapeutic comments are made with reference to these cases and previous reports, concerning the hypothermia, cardiac and respiratory function, hyponatraemia and the endocrine disturbances observed in hypothyroid coma.

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Another case of flexion contracture in a 60 year-old patient with hypopituitarism, chronic alcoholism and starvation is reported. The contracture, as in the other cases, involved the lower limbs, but in this particular patient it extended to the abdominal and extensor neck muscles and neurological signs were associated: cerebellar atrophy and peripheral neuropathy of the lower limbs probably due to alcoholism. As in the other reported cases, severe hyponatremia was observed (105 mmol/l) the physiopathology of which is discussed: starvation and glucocorticoid deficiency alone or associated with aldosterone deficiency...

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No abstract text is available yet for this article.

No abstract text is available yet for this article.