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Hypernatremia treatment

Vedha Sanghi, Aanchal Kapoor
Hypernatremia is a frequent cause of intensive care unit admission. The patient presented in this article had hypernatremia refractory to D5W (dextrose 5% water) therapy, which led to a complex investigation. Workup revealed central diabetes insipidus most likely secondary to flare up of neurosarcoidosis. The challenge in terms of diagnosis was a presentation with low urine output in the setting of hypernatremia resistant to treatment with desmopressin. This case unfolded the role of hypothyroidism causing secondary renal dysfunction and hence needed continued treatment with thyroxine in addition to treatment for hypernatremia...
July 2016: Journal of Investigative Medicine High Impact Case Reports
Feng Ma, Yirong Liu, Ming Bai, Yangping Li, Yan Yu, Meilan Zhou, Pengbo Wang, Lijie He, Chen Huang, Hanmin Wang, Shiren Sun
BACKGROUND: The excessive correction of acute hypernatremia is not known to be harmful. This study aimed to evaluate whether a reduction rate of serum sodium (RRSeNa) > 1mEq/L/hour in acute severe hypernatremia is an independent risk factor for mortality in critically ill patients undergoing continuous venovenous hemofiltration (CVVH) treatment. MATERIALS AND METHODS: For this retrospective study, we reviewed records of 75 critically ill patients undergoing CVVH treatment for acute severe hypernatremia between March 2011 and March 2015...
September 2016: American Journal of the Medical Sciences
Aliou Thiongane, Aliou Abdoulaye Ndongo, Idrissa Demba Ba, Djibril Boiro, Papa Moctar Faye, Younoussa Keita, Aïssatou Ba, Djeynaba Fafa Cissé, Idrissa Basse, Lamine Thiam, Indou Déme Ly, Babacar Niang, Abou Ba, Amadou Lamine Fall, Saliou Diouf, Ousmane Ndiaye, Mamadou Ba, Mamadou Sarr
Hemolytic-uremic syndrome (HUS) is a common cause of organic acute renal failure (ARF) in children. It is a progressive complication of acute gastroenteritis (AGE), especially caused by Escherichia coli in children. This study aimed to describe the clinical, therapeutic and evolutionary aspects of this affection in four children. We collected four cases of HUS. The average age was 10,5 months (5-15mois), exclusively boys. Clinical examination revealed a hemolytic anemia (pallor and jaundice), oligoanuria and edematous syndrome (2 cases), arterial hypertension (1 patient), AGE associated with severe dehydration and hypovolemic shock (2 patients), consciousness disorders...
2016: Pan African Medical Journal
Bei Hu, Qianpeng Han, Nashun Mengke, Kairan He, Yiqin Zhang, Zhiqiang Nie, Hongke Zeng
Many studies have indicated that hypernatremia is associated with increased mortality. In this study, we aimed to explore the relationship between intensive care unit (ICU)-acquired hypernatremia and the prognosis of critically neurological patients.Based on serum sodium level in the ICU, 450 patients were divided into 3 groups: 222 had normal serum sodium, 142 had mild hypernatremia, and 86 had severe hypernatremia. Kaplan-Meier and multivariable binary logistic regression analyses were performed to evaluate the prognostic value of hypernatremia in critically neurological patients...
August 2016: Medicine (Baltimore)
Kioomars Golshekan, Hamidreza Badeli, Mahboube Miri, Maryam Mirzaie, Afagh Hassanzadeh Rad, Fatemeh Salamat, Sepideh Abdi Tazeabadi, Nahid Bidar, Kobra Blouki-Moghaddam, Houman Hashemian
INTRODUCTION: Gastroenteritis (GE) is one of the most common pediatric diseases. Hyponatremia commonly occurs by administering hypotonic fluids to GE and hospitalized children. Yet, there is no consensus on the ideal method of treatment. OBJECTIVES: we aimed to assess suitable intravenous (IV) fluid for preventing dysnatremia in children with GE. PATIENTS AND METHODS: This is a double blind randomized clinical trial, which was conducted on infants of 6 months up to 14 years children with GE...
2016: Journal of Renal Injury Prevention
Ryoji Aoki, Tetsuji Morimoto, Yuno Takahashi, Hiroshi Saito, Tatsuo Fuchigami, Shori Takahashi
Extrapontine myelinolysis (EPM) is an uncommon disorder in children, with few pediatric cases reported to date. We report the first case of an infant with EPM without central pontine myelinolysis (CPM) presenting with severe hypernatremia. On admission, the infant had impaired consciousness, mild dehydration, and severe hypernatremia (190 mmol/L). The following day, the patient developed abnormal involuntary movements. Brain magnetic resonance imaging (MRI) confirmed EPM without CPM. He recovered without sequelae, and clinical examinations were within normal limits approximately 6 months after discharge...
September 2016: Pediatrics International: Official Journal of the Japan Pediatric Society
Tatsuhiro Fujii, Gabriela Moriel, Daniel R Kramer, Frank Attenello, Gabriel Zada
Over the past several decades, the rate of traumatic brain injury (TBI)-related emergency room visits in the United States has steadily increased, yet mortality in these patients has decreased. This improvement in outcome is largely due to advances in prehospital care, intensive care unit management, and the effectiveness of neurosurgical procedures, such as decompressive craniectomies. It is imperative to identify clinical factors predictive of patients who benefit from early mobilization of resources and operative treatment...
September 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Keita Hirai, Tatsuki Shimomura, Hideaki Moriwaki, Hidetoshi Ishii, Takayuki Shimoshikiryo, Daiki Tsuji, Kazuyuki Inoue, Toshihiko Kadoiri, Kunihiko Itoh
PURPOSE: The long-term efficacy of tolvaptan, a vasopressin V2 receptor antagonist, has been reported. However, the safety of long-term treatment remains to be fully elucidated. We assessed the safety profile of tolvaptan with respect to hypernatremia. METHODS: This retrospective study included 371 patients treated with tolvaptan. Risk factors for hypernatremia (serum sodium concentration ≥147 mEq/L) were determined. RESULTS: Hypernatremia occurred in 95 patients (25...
October 2016: European Journal of Clinical Pharmacology
Janice Milliere, Daryl Corriveau, Malvinder S Parmar
INTRODUCTION: Hypernatremia is common among hospitalized patients especially in the intensive care units and presents an independent risk factor for mortality. Mild hypernatremia is often asymptomatic but severe hypernatremia causes central nervous system dysfunction with initial non-specific symptoms of encephalopathy that may progress to seizures, coma and death, if left untreated. Severe hypernatremia is a medical emergency and requires emergent medical attention. MATERIALS AND METHODS: A haemodialysis patient who arrived for his scheduled haemodialysis treatment had monthly blood work drawn and was reported to have severe hypernatremia with serum sodium concentration of 183 mmol/L...
2016: Biochemia Medica: časopis Hrvatskoga Društva Medicinskih Biokemičara
Andrew Blake Tucker, Sean D Stocker
Changes in osmolality or extracellular NaCl concentrations are detected by specialized neurons in the hypothalamus to increase vasopressin (VP) and stimulate thirst. Recent in vitro evidence suggests this process is mediated by an NH2-terminal variant of the transient receptor potential vanilloid type 1 (TRPV1) channel expressed by osmosensitive neurons of the lamina terminalis and vasopressinergic neurons of the supraoptic nucleus. The present study tested this hypothesis in vivo by analysis of plasma VP levels during acute hypernatremia in awake control and TRPV1(-/-) rats...
September 1, 2016: American Journal of Physiology. Regulatory, Integrative and Comparative Physiology
Christian Arndt, Hinnerk Wulf
Hypernatremia is a common electrolyte disorder that reflects an imbalance in the water balance of the body, often resulting from an increased loss of free water compared to sodium excretion. It is rarely based on excessive sodium intake. The clinical presentation is often characterized by a central nervous system dysfunction (confusion, coma) and pronounced thirst (in awake patients). In addition to medical history, the volume status of the patient and the osmolality of urine are leading in the differential diagnosis...
May 2016: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
Saif A Muhsin, David B Mount
Hypernatremia is defined as a serum sodium level above 145 mmol/L. It is a frequently encountered electrolyte disturbance in the hospital setting, with an unappreciated high mortality. Understanding hypernatremia requires a comprehension of body fluid compartments, as well as concepts of the preservation of normal body water balance. The human body maintains a normal osmolality between 280 and 295 mOsm/kg via Arginine Vasopressin (AVP), thirst, and the renal response to AVP; dysfunction of all three of these factors can cause hypernatremia...
March 2016: Best Practice & Research. Clinical Endocrinology & Metabolism
Ken Yasuda, Makoto Sainouchi, Masahiro Goto, Nagako Murase, Ryo Ohtani, Michikazu Nakamura
A 61-year-old woman developed hearing difficulties and became thirsty after experiencing cold symptoms. A neurological examination revealed a loss of odor sensation, facial palsy, dysphasia, and dysarthria. Vocal cord palsy was observed during pharyngoscopy. Brain magnetic resonance imaging (MRI) showed a thickened pituitary stalk and swelling of the pituitary gland, but no high signal intensity regions were seen in the posterior portion of the pituitary gland. Gadolinium-enhanced MRI demonstrated a thickened dura mater over the anterior cranial fossa...
May 31, 2016: Rinshō Shinkeigaku, Clinical Neurology
Xiangyun Zhang, Mingyi Zhao, Wei Du, Dongni Zu, Yingwei Sun, Rongwu Xiang, Jingyu Yang
Hyponatremia, defined as a nonartifactual serum sodium level <135 mmol/L, is the most common fluid and electrolyte abnormality in clinical practice. Traditional managements (fluid restriction, hypertonic saline and loop diuretics, etc.) are difficult to maintain or ineffective. Recently, vasopressin receptor antagonists (VRAs) have shown promise for the treatment of hyponatremia. We aimed to conduct a meta-analysis to evaluate the efficacy and safety of VRAs in patients with euvolemic or hypervolemic hyponatremia...
April 2016: Medicine (Baltimore)
Mwanja Kakusa, Brown Kamanga, Owen Ngalamika, Soka Nyirenda
BACKGROUND: Diabetic ketoacidosis (DKA) is one of the commonly encountered diabetes mellitus emergencies. AIM: This study aimed at describing the clinical profiles and hospitalization outcomes of DKA patients at the University Teaching Hospital (UTH) in Lusaka, Zambia and to investigate the role of coma on mortality outcome. MATERIALS AND METHODS: This was a cross-sectional analytical study of hospitalized DKA patients at UTH. The data collected included clinical presentation, precipitating factors, laboratory profiles, complications, and hospitalization outcomes...
March 2016: Indian Journal of Endocrinology and Metabolism
Blanca Lizaola, Alan Bonder, Elliot B Tapper, Angela Mendez-Bocanegra, Andres Cardenas
Hyponatremia may occur in patients with cirrhosis and ascites mainly due to water retention and an inability of the kidney to excrete free water. The main reason for this abnormality is related to the fact that these patients have portal hypertension and this leads to systemic vasodilation that in turn activates sodium-retaining and water-retaining systems such as the renin-angiotensin-aldosterone system and arginine vasopressin (AVP). AVP increases solute-free water retention by acting on the V2 receptors of the kidney-collecting tubes...
June 2016: Current Treatment Options in Gastroenterology
Allison R Smego, Philippe Backeljauw, Iris Gutmark-Little
CONTEXT: The treatment of neurogenic diabetes insipidus (DI) in infancy is challenging and complicated by fluid overload and dehydration. Therapy with subcutaneous (SC), intranasal (IN), or oral tablet desmopressin acetate (1-desamino-8-D-arginine vasopressin [DDAVP]) remains difficult to titrate in infants. OBJECTIVE: Assess the efficacy and safety of buccally administered IN DDAVP for the management of infants with neurogenic DI. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTION: Retrospective review of clinical and laboratory data of 15 infants (mean age, 4...
May 2016: Journal of Clinical Endocrinology and Metabolism
Cecilie Morland, Mi Nguyen Pettersen, Bjørnar Hassel
Elevation of serum sodium, hypernatremia, which may occur during dehydration or treatment with sodium chloride, may cause brain dysfunction and damage, but toxic mechanisms are poorly understood. We found that exposure to excess NaCl, 10-100mmol/L, for 20h caused cell death in cultured cerebellar granule cells (neurons). Toxicity was due to Na(+), since substituting excess Na(+) with choline reduced cell death to control levels, whereas gluconate instead of excess Cl(-) did not. Prior to cell death from hyperosmolar NaCl, glucose consumption and lactate formation were reduced, and intracellular aspartate levels were elevated, consistent with reduced glycolysis or glucose uptake...
May 2016: Neurotoxicology
Annemieke Oude Lansink-Hartgring, Lara Hessels, Joachim Weigel, Anne Marie G A de Smet, Diederik Gommers, Prashant V Nannan Panday, Ewout J Hoorn, Maarten W Nijsten
BACKGROUND: Dysnatremia is associated with adverse outcome in critically ill patients. Changes in patients or treatment strategies may have affected the incidence of dysnatremia over time. We investigated long-term changes in the incidence of dysnatremia and analyzed its association with mortality. METHODS: Over a 21-year period (1992-2012), all serum sodium measurements were analyzed retrospectively in two university hospital ICUs, up to day 28 of ICU admission for the presence of dysnatremia...
December 2016: Annals of Intensive Care
Vicente E Torres, Eiji Higashihara, Olivier Devuyst, Arlene B Chapman, Ronald T Gansevoort, Jared J Grantham, Ronald D Perrone, John Ouyang, Jaime D Blais, Frank S Czerwiec
BACKGROUND: and objectives The Tolvaptan Efficacy and Safety in Management of Autosomal Dominant Polycystic Kidney Disease and Its Outcomes 3:4 study demonstrated a significant beneficial effect of the vasopressin V2 receptor antagonist tolvaptan on rates of kidney growth and eGFR decline in autosomal dominant polycystic kidney disease (ADPKD). This post hoc analysis was performed to reassess the primary and secondary efficacy endpoints by CKD stage at baseline. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In a phase 3, multicenter, double-blind, placebo-controlled, 3-year trial, 1445 patients with ADPKD (age 18-50 years), with total kidney volume (TKV) ≥750 ml and estimated creatinine clearance ≥60 ml/min, were randomly assigned 2:1 to split-dose tolvaptan (45/15, 60/30, or 90/30 mg daily as tolerated) or placebo...
May 6, 2016: Clinical Journal of the American Society of Nephrology: CJASN
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