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Adrogue Madias

Rik H G Olde Engberink, Nienke M G Rorije, Bert-Jan H van den Born, Liffert Vogt
The assumption that sodium accumulation in the human body is always accompanied by water retention has been challenged by data showing that sodium can be stored nonosmotically. Here we investigated the contribution of nonosmotic sodium storage to short-term sodium homeostasis after hypertonic saline infusion in healthy individuals on a low-sodium diet. During four hours after infusion, we compared the observed changes in plasma sodium concentration and urinary cation excretion with changes that were calculated with the Adrogue-Madias and Nguyen-Kurtz formula, formulations widely implemented to guide the treatment of dysnatremias...
March 2017: Kidney International
Horacio J Adrogué, Nicolaos E Madias
PURPOSE OF REVIEW: Primary hypertension is characterized by Na excess and K deficit in the body, which together are key to its pathogenesis. These derangements work jointly in the brain and the peripheral vascular wall to establish hypertension. In this review, we highlight recent evidence describing the central mechanisms through which Na surfeit and K deficit enhance sympathetic nerve activity, thereby raising peripheral vascular resistance and generating hypertension. RECENT FINDINGS: Animal studies point to a small increase in plasma and cerebrospinal fluid (CSF) [Na], a small decrease in CSF [K], and increased levels of circulating angiotensin II, aldosterone, and endogenous ouabain as the central signals evoking hypertension...
March 2017: Current Opinion in Nephrology and Hypertension
Horacio J Adrogué, Nicolaos E Madias
The physiologic approach has long been used in assessing acid-base status. This approach considers acids as hydrogen ion donors and bases as hydrogen ion acceptors and the acid-base status of the organism as reflecting the interaction of net hydrogen ion balance with body buffers. In the physiologic approach, the carbonic acid/bicarbonate buffer pair is used for assessing acid-base status and blood pH is determined by carbonic acid (ie, Paco2 ) and serum bicarbonate levels. More recently, the physicochemical approach was introduced, which has gained popularity, particularly among intensivists and anesthesiologists...
November 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Ramy Magdy Hanna, Wan-Ting Yang, Eduardo A Lopez, Joseph Nabil Riad, James Wilson
BACKGROUND: Improper correction of hyponatremia can cause severe complications, including osmotic demyelination syndrome (ODS). The Adrogué-Madias equation (AM), the Barsoum-Levine (BL) equation, the Electrolyte Free Water Clearance (EFWC) equation and the Nguyen-Kurtz (NK) equation are four derived equations based on the empirically derived Edelman equation for predicting sodium at a later time (Na2) from a known starting sodium (Na1), fluid/electrolyte composition and input and output volumes...
August 2016: Clinical Kidney Journal
Horacio J Adrogué, Nicolaos E Madias
The pathogenic role of sodium surfeit in primary hypertension is widely recognized but that of potassium deficiency usually has been ignored or at best assigned subsidiary status. Weighing the available evidence, we recently proposed that the chief environmental factor in the pathogenesis of primary hypertension and the associated cardiovascular risk is the interaction of the sodium surfeit and potassium deficiency in the body. Here, we present the major evidence highlighting the relationship between high-sodium intake and hypertension...
May 2014: Seminars in Nephrology
Horacio J Adrogué, Nicolaos E Madias
No abstract text is available yet for this article.
November 2014: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Horacio J Adrogué, Nicolaos E Madias
The pathogenic role of Na(+) in primary hypertension is widely recognized but that of K(+) remains unappreciated. Yet, extensive evidence indicates that together, the body's dominant cations constitute the chief environmental factor in the pathogenesis of hypertension and its cardiovascular sequelae. In this Review, we provide a synthesis of the determinants of Na(+) retention and K(+) loss developing in the body as the Na(+)-rich and K(+)-poor modern diet interacts with kidneys intrinsically poised to conserve Na(+) and excrete K(+); and the molecular pathways utilized by these disturbances in the central nervous system and the periphery to increase sympathetic tone and vascular resistance, and establish hypertension...
March 2014: Journal of the American Society of Hypertension: JASH
Ataru Okumura, Kota Ishikawa, Risako Watanabe, Taku Tsunekawa, Chikako Asai, Atsushi Kiyota, Minemori Watanabe, Yutaka Oiso
Although various formulas predicting plasma sodium level ([Na]) are proposed for correction of hyponatremia, it seems that an anticipated [Na] frequently exceeds or falls below the measured [Na], especially in syndrome of inappropriate antidiuretic hormone secretion (SIADH). The causative factors of the fluctuation have never been investigated clearly. The aim of this study was to identify the determining factors for accurate prediction of [Na] by comparing data from previously proposed formulas and a novel osmotic compartment model (O-C model)...
July 2013: Translational Research: the Journal of Laboratory and Clinical Medicine
Horacio J Adrogué, Nicolaos E Madias
Treatment of hypotonic hyponatremia often challenges clinicians on many counts. Despite similar serum sodium concentrations, clinical manifestations can range from mild to life threatening. Some patients require active management, whereas others recover without intervention. Therapeutic measures frequently yield safe correction, yet the same measures can result in osmotic demyelination. To address this challenge, we present a practical approach to managing hyponatremia that centers on two elements: a diagnostic evaluation directed at the pathogenesis and putative causes of hyponatremia, the case-specific clinical and laboratory features, and the associated clinical risk; and a management plan tailored to the diagnostic findings that incorporates quantitative projections of fluid therapy and fluid losses on the patient's serum sodium, balances potential benefits and risks, and emphasizes vigilant monitoring...
July 2012: Journal of the American Society of Nephrology: JASN
Luca Bettari, Mona Fiuzat, Gary M Felker, Christopher M O'Connor
Heart failure is one of the most common, costly, disabling and growing diseases (McMurray and Pfeffer in Lancet 365(9474):1877-1889, 2005). Hyponatremia, conventionally defined as a serum-sodium concentration equal or less than 135 mmol/l (American Heart Association in Heart disease and stroke statistics--2007 update. American Heart Association, Dallas, 2007; Stewart et al. in Eur J Heart Fail 4:361-371, 2002), is a common phenomenon in patients with heart failure, with an incidence of 20-25% (Krumholz et al...
January 2012: Heart Failure Reviews
Horacio J Adrogué, Nicolaos E Madias
Each of the four canonical acid-base disorders expresses as a primary change in carbon dioxide tension or plasma bicarbonate concentration followed by a secondary response in the countervailing variable. Quantified empirically, these secondary responses are directional and proportional to the primary changes, run a variable time course, and tend to minimize the impact on body acidity engendered by the primary changes. Absence of an appropriate secondary response denotes the coexistence of an additional acid-base disorder...
June 2010: Journal of the American Society of Nephrology: JASN
Horacio J Adrogué, F John Gennari, John H Galla, Nicolaos E Madias
Effective management of acid-base disorders depends on accurate diagnosis. Three distinct approaches are currently used in assessing acid-base disorders: the physiological approach, the base-excess approach, and the physicochemical approach. There are considerable differences among the three approaches. In this review, we first describe the conceptual framework of each approach, and comment on its attributes and drawbacks. We then highlight the application of each approach to patient care. We conclude with a brief synthesis and our recommendations for choosing an approach...
December 2009: Kidney International
Horacio J Adrogué, Nicolaos E Madias
No abstract text is available yet for this article.
October 2009: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Gregor Lindner, Christoph Schwarz, Nikolaus Kneidinger, Ludwig Kramer, Rainer Oberbauer, Wilfred Druml
BACKGROUND: Hypernatraemia is common in intensive care patients and may present an independent risk factor of mortality. Several formulae have been proposed to guide infusion therapy for correction of serum sodium. Unfortunately, these formulae have never been validated comparatively. We assessed the predictive potential of four different formulae (Adrogué-Madias, Barsoum-Levine, Kurtz-Nguyen and a simple formula based on electrolyte-free water clearance) in correction and maintenance of serum sodium in 66 hyper- and normonatraemic ICU patients...
November 2008: Nephrology, Dialysis, Transplantation
D M Snell, C Bartley
We report a case of a young male with adrenal hypoplasia who presented following water intoxication with severe hyponatraemia and seizures. He required a period of intensive care and over the initial 24 h his serum sodium corrected at average of 0.9 mmol x l(-1) h(-1). He subsequently developed osmotic demyelination syndrome. Following supportive treatment he made a full recovery. Severe hyponatraemia carries a risk of cerebral oedema with a significant mortality, yet correcting it too rapidly can result in osmotic demyelination syndrome, again with potentially disastrous consequences...
January 2008: Anaesthesia
Tomas Berl
No abstract text is available yet for this article.
November 2007: Clinical Journal of the American Society of Nephrology: CJASN
Hashim K Mohmand, Dany Issa, Zubair Ahmad, Joseph D Cappuccio, Ruth W Kouides, Richard H Sterns
BACKGROUND AND OBJECTIVES: Data regarding dosage-response relationships for using hypertonic saline in treatment of hyponatremia are extremely limited. Objectives of this study were to assess adherence to previously published guidelines (limiting correction to <12 mEq/L per d and <18 mEq/L per 48 h) in treating hyponatremia with hypertonic saline and to determine the predictive accuracy of the Adrogué-Madias formula. DESIGN, SETTING, PARTICIPANTS & MEASUREMENTS: A retrospective review was conducted of all 62 adult, hyponatremic patients who were treated with hypertonic saline during 5 yr at a 528-bed, acute care, teaching hospital...
November 2007: Clinical Journal of the American Society of Nephrology: CJASN
Horacio J Adrogué, Nicolaos E Madias
No abstract text is available yet for this article.
May 10, 2007: New England Journal of Medicine
Troels Ring
No abstract text is available yet for this article.
December 2006: Nature Clinical Practice. Nephrology
George Liamis, Michalis Kalogirou, Vasilios Saugos, Moses Elisaf
BACKGROUND: Rapid correction of dysnatraemias is frequently associated with increased morbidity and mortality. Therefore, it is important to estimate the proper volume and type of infusate required to change the serum sodium concentration predictably. The aim of this study is to evaluate the utility or/and the accuracy of the Adrogue-Madias formula in managing patients with hyponatraemia and hypernatraemia. METHODS: Among the 317 patients who either on admission to our internal medicine clinic or during their hospitalization were found to have hyponatraemia or hypernatraemia, we studied 189 patients (59...
June 2006: Nephrology, Dialysis, Transplantation
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