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Hypernatremia treatment

Jonathan V Martin, David M Liberati, Lawrence N Diebel
BACKGROUND: Hypernatremia is a common problem affecting critically ill patients, whether due to underlying pathology or the subsequent result of hypertonic fluid resuscitation. Numerous studies have been published suggesting that hypernatremia may adversely affect the vascular endothelial glycocalyx. Our study aimed to evaluate if high sodium concentration would impair the endothelial and glycocalyx barrier function and if stress conditions that simulate the shock microenvironment would exacerbate any observed adverse effects of hypernatremia...
March 12, 2018: Journal of Trauma and Acute Care Surgery
Maria-Eleni Roumelioti, Todd S Ing, Helbert Rondon-Berrios, Robert H Glew, Zeid J Khitan, Yijuan Sun, Deepak Malhotra, Dominic S Raj, Emmanuel I Agaba, Glen H Murata, Joseph I Shapiro, Antonios H Tzamaloukas
Osmotic diuresis results from urine loss of large amounts of solutes distributed either in total body water or in the extracellular compartment. Replacement solutions should reflect the volume and monovalent cation (sodium and potassium) content of the fluid lost. Whereas the volume of the solutions used to replace losses that occurred prior to the diagnosis of osmotic diuresis is guided by the clinical picture, the composition of these solutions is predicated on serum sodium concentration and urinary sodium and potassium concentrations at presentation...
March 6, 2018: International Urology and Nephrology
Karina Miura Costa, Amulya Kumar Saxena
BACKGROUND: Postoperative chylothorax occurs due to trauma to lymphatic vessels and can occur after any thoracic procedure. This study reviewed recent literature to evaluate the management and outcomes of surgical chylothorax in neonates. METHODS: PubMed database was searched for articles in English, Portuguese and Spanish from 2000 to 2016. Data were collected for surgery, chylothorax management, complications, mortality and length of hospital stay (LOS). RESULTS: Twenty studies offered 107 neonates: congenital diaphragmatic hernia (CDH) (n = 76, 71%), cardiac malformations (n = 25, 23...
March 5, 2018: World Journal of Pediatrics: WJP
Robrecht J H Logjes, Maartje Haasnoot, Petra M A Lemmers, Mike F A Nicolaije, Marie-José H van den Boogaard, Aebele B Mink van der Molen, Corstiaan C Breugem
Although Robin sequence (RS) is a well-known phenomenon, it is still associated with considerable morbidity and even mortality. The purposes of this study were to gain greater insight into the mortality rate and identify risk factors associated with mortality in RS. We retrospectively reviewed all RS infants followed at the Wilhelmina Children's Hospital from 1995 to 2016. Outcome measurements were death and causes of death. The authors identified 103 consecutive RS infants with a median follow-up of 8.6 years (range 0...
February 28, 2018: European Journal of Pediatrics
Ramsis F Ghaly, Armen Haroutunian, Kenneth D Candido, Nebojsa Nick Knezevic
Background: Altered mental status describes impaired mental functioning ranging from confusion to coma and indicates an illness, either metabolic or structural in nature. Metabolic causes include hypothyroidism, hyperuremia, hypo/hyperglycemia, hypo/hypernatremia, and encephalopathy. The structural causes include tumors, brain hemorrhage, infection, and stroke. To our knowledge, this is the first case in which a patient presented with altered mental status from both metabolic (myxedema coma) and structural diseases (frontal meningioma) with vasogenic edema and midline shift...
2018: Surgical Neurology International
Akiko Nakamichi, Kazuki Ocho, Kosuke Oka, Miho Yasuda, Kou Hasegawa, Masaya Iwamuro, Mikako Obika, Kammei Rai, Fumio Otsuka
We herein report a case of central diabetes insipidus complicated with thyroid storm. A middle-aged woman who was receiving treatment for Graves' disease suddenly complained of polydipsia, polyuria and general fatigue. Laboratory tests showed hyperthyroidism, hypernatremia, hypoosmolar urine and a decreased plasma vasopressin level. The occurrence of central diabetes insipidus with hyperthyroidism was revealed on the basis of pituitary magnetic resonance imaging, a water deprivation test and a desmopressin test...
February 28, 2018: Internal Medicine
Halinder S Mangat
Traumatic brain injury (TBI) remains a major cause of mortality and disability. Post-traumatic intracranial hypertension (ICH) further complicates the care of patients. Hyperosmolar agents are recommended for the treatment of ICH, but no consensus or high-level data exist on the use of any particular agent or the route of administration. The two agents used commonly are hypertonic saline (HTS) and mannitol given as bolus therapy. Smaller studies suggest that HTS may be a superior agent in reducing the ICH burden, but neither agent has been shown to improve mortality or functional outcome...
February 20, 2018: Critical Care: the Official Journal of the Critical Care Forum
Julie Refardt, Mirjam Christ-Crain
Diabetes insipidus, characterized by polyuria and polydipsia, is a rare disease during pregnancy. Nevertheless, its recognition is important to avoid complications due to dehydration and hypernatremia. Its manifestation during pregnancy ranges from exacerbation of pre-existing central or nephrogenic diabetes insipidus to transient pregnancy-induced diabetes insipidus due to the increased metabolism of the antidiuretic hormone vasopressin by the placental vasopressinase. Diagnosis can be challenging, as urinary frequency is common during pregnancy and primary polydipsia also needs to be excluded...
February 19, 2018: Minerva Endocrinologica
Jian Liang Tan, Sudzilla Nordin, Alwi Muhd Besari
Introduction: Tuberculosis is the second leading cause of death under the category of infectious diseases, after the human immunodeficiency virus (HIV). Tuberculous meningitis (TBM) constitutes about 5% of all extrapulmonary disease worldwide. This report describes a case of Tuberculous meningitis with rare presentation in a 28-year-old woman, who was treated based on a collection of her social background, clinical findings and Multiplex PCR of tuberculosis. Case presentation: A 28-year-old Malay woman with no significant medical history presented to HUSM with one month history of on and off fever, two weeks history of generalised limbs weakness and one week history of dysphagia...
October 2017: Malaysian Journal of Medical Sciences: MJMS
Clara Pañella, Quim Castellví, Xavier Moll, Rita Quesada, Alberto Villanueva, Mar Iglesias, Dolores Naranjo, Patricia Sánchez-Velázquez, Anna Andaluz, Luís Grande, Antoni Ivorra, Fernando Burdío
Background: Spread hepatic tumours are not suitable for treatment either by surgery or conventional ablation methods. The aim of this study was to evaluate feasibility and safety of selectively increasing the healthy hepatic conductivity by the hypersaline infusion (HI) through the portal vein. We hypothesize this will allow simultaneous safe treatment of all nodules by irreversible electroporation (IRE) when applied in a transhepatic fashion. Material and methods: Sprague Dawley (Group A, n = 10) and Athymic rats with implanted hepatic tumour (Group B, n = 8) were employed...
December 2017: Radiology and Oncology
Eike Blohm, Amy Goldberg, Ann Salerno, Carole Jenny, Edward Boyer, Kavita Babu
OBJECTIVES: Immediate recognition of salt toxicity and aggressive resuscitative measures are critical in the treatment of this lethal poisoning. Despite heroic measures, pediatric deaths due to salt toxicity still occur from irreversible neurological damage. The objective of this article is to review the relevant literature and offer a therapeutic algorithm for the management of pediatric patients presenting with salt toxicity. METHODS: A literature search for cases of salt toxicity was conducted...
October 31, 2017: Pediatric Emergency Care
Marie de Tersant, Thérésa Kwon, Marie-Alice Macher, Anne Maisin, Georges Deschênes, Olivier Niel
BACKGROUND: Acute pancreatitis can be a life-threatening complication in patients with chronic kidney disease (CKD), especially in kidney transplant recipients. CASE DIAGNOSIS/TREATMENT: The patient was 7 years old when he received renal transplantation for CKD secondary to posterior urethral valves. Two years later, he presented with severe necrotizing pancreatitis (Ranson's score 5, Balthazar's score 8). Viral and genetic testing came back negative; pancreatitis was attributed to the patient's treatments (prednisone, trimethoprim-sulfamethoxazole, and everolimus)...
October 24, 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Akari Nakamura-Utsunomiya, Takeshi Y Hiyama, Satoshi Okada, Masaharu Noda, Masao Kobayashi
Adipsic hypernatremia is a rare disease presenting as persistent hypernatremia with disturbance of thirst regulation and hypothalamic dysfunction. As a result of congenital disease, tumors, or inflammation, most cases are accompanied by structural abnormalities in the hypothalamic-pituitary area. While cases with no hypothalamic-pituitary structural lesion have been reported, their etiology has not been elucidated. Recently, we reported three patients with adipsic hypernatremia whose serum-derived immunoglobulin (Ig) specifically reacted with mouse subfornical organ (SFO) tissue...
2017: Clinical Pediatric Endocrinology: Case Reports and Clinical Investigations: Official Journal of the Japanese Society for Pediatric Endocrinology
Manish Kumar Arya, Sheikh Minhaj Ahmed, Krishnakumar N Shah, Uma S Ali
A 4-year-old girl admitted with altered mental status, new-onset diabetes mellitus, and diabetic ketoacidosis (DKA) had a rapid rise in serum sodium from 158 mEq/L (corrected sodium 165 mEq/L) at the admission to 204 mEq/L within 18 hours of admission despite standard fluid and insulin therapy recommended for the treatment of DKA. During her illness, she developed arterial and deep vein thrombosis (DVT), bloodstream infection with Candida species, and extensive skin blistering and denudation. The child needed mechanical ventilation, insulin infusion, careful fluid titration to bring down the sodium gradually, and low-molecular weight heparin for her DVT...
September 2017: Indian Journal of Critical Care Medicine
Rujun Zeng, Renhua Wu, Qingguo Lv, Nanwei Tong, Yuwei Zhang
RATIONALE: Hypernatremia is a rare but fatal complication of hypertonic saline (HS) irrigation in hepatic hydatid disease. It needs careful monitoring and treatment. PATIENT CONCERNS: A 28-year-old woman with hepatic hydatid cysts who received operation treatment developed electrolyte disturbances. We also conducted a retrospective study about influence of HS application on electrolytes in patients with hepatic hydatid disease receiving surgery. DIAGNOSES: Hypernatremia, developed after HS irrigation...
September 2017: Medicine (Baltimore)
H Rana, N Ferguson, P V Dicpinigaitis
WHAT IS KNOWN AND OBJECTIVE: Despite widespread use of vasopressin for the treatment of septic shock, few cases of diabetes insipidus (DI) following its discontinuation have been reported. CASE SUMMARY: A 54-year-old man presented with pneumonia progressing to septic shock, requiring norepinephrine and vasopressin for refractory hypotension. After clinical improvement, the patient on 3 separate occasions developed polyuria and severe hypernatremia upon discontinuation of vasopressin, with prompt recovery upon its resumption...
September 11, 2017: Journal of Clinical Pharmacy and Therapeutics
Florian M Trefz, Ingrid Lorenz, Annette Lorch, Peter D Constable
Profound acidemia impairs cellular and organ function and consequently should be associated with an increased risk of mortality in critically ill humans and animals. Neonatal diarrhea in calves can result in potentially serious metabolic derangements including profound acidemia due to strong ion (metabolic) acidosis, hyper-D-lactatemia, hyper-L-lactatemia, azotemia, hypoglycemia, hyperkalemia and hyponatremia. The aim of this retrospective study was to assess the prognostic relevance of clinical and laboratory findings in 1,400 critically ill neonatal calves with diarrhea admitted to a veterinary teaching hospital...
2017: PloS One
Jennifer Fuchs, Sarah T Adams, Julie Byerley
BACKGROUND: Fluid and electrolyte therapy is an important component in the care of the hospitalized child. Previous pediatric guidelines have followed the Holliday-Segar method of calculating and delivering maintenance IV fluids, using hypotonic fluids in maintenance therapy. However, research demonstrates that hypotonic fluids can lead to iatrogenic hyponatremia and that isotonic fluid is a safer alternative. OBJECTIVE: To provide the ideal approach to intravenous (IV) fluid use in the hospitalized child and determine the safety and effectiveness of isotonic maintenance fluid therapy...
2017: Reviews on Recent Clinical Trials
Michael M Braun, Megan Mahowald
Sodium disorders (ie, hyponatremia, hypernatremia) are common electrolyte disturbances in clinical medicine and are associated with increased rates of morbidity and mortality. Etiologies of hyponatremia are classified into four categories. The first is pseudohyponatremia, in which the sodium level is low due to hyperproteinemia, hyperlipidemia, or hyperglycemia. The other three categories are based on overall patient fluid status and include hypovolemic (commonly due to fluid loss), hypervolemic (commonly due to fluid retention from heart failure, cirrhosis, or renal failure), and euvolemic (most often because of syndrome of inappropriate secretion of antidiuretic hormone)...
August 2017: FP Essentials
Hamid Mohammadi Kojidi, Morteza Rahbar Taramsari, Alireza Badsar, Mirsaeed Attarchi
A 51-year-old man committed suicide by swallowing the contents of a fire extinguisher. A few hours after his suicide attempt, he was referred to the medical center for poisoning. At the time of admission, the patient was conscious with stable vital signs. The patient complained of burning lips and mouth, mentioning diarrhea. Initial treatments included gastric lavage with activated charcoal, while paraclinical measures were requested. The patient had undergone hypernatremia (Na: 152 mEq/l) and metabolic alkalosis...
May 2017: Acta Medica Iranica
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