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Reset osmostat syndrome

Louis J Imbriano, Joseph Mattana, James Drakakis, John K Maesaka
BACKGROUND: There is controversy over the prevalence of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) and cerebral or renal salt wasting (RSW), 2 syndromes with identical common clinical and laboratory parameters but different therapies. The traditional approach to the hyponatremic patient relies on volume assessment, but there are limitations to this method. METHODS: We used an algorithm that relies on fractional excretion of urate (FEurate) to evaluate patients with hyponatremia and present 4 illustrative cases...
October 2016: American Journal of the Medical Sciences
T D Filippatos, G Liamis, F Christopoulou, M S Elisaf
Hyponatremia is the most common electrolyte disorder in hospitalized patients associated with increased morbidity and mortality. On the other hand, inappropriate treatment of hyponatremia (under- or mainly overtreatment) may also lead to devastating consequences. The appropriate diagnosis of the causative factor is of paramount importance for the proper management and avoidance of treatment pitfalls. Herein, we describe the most common pitfalls in the evaluation of the hyponatremic patient, such as failure to exclude pseudohyponatremia or hypertonic hyponatremia (related to glucose, mannitol or glycine), to properly assess urine sodium concentration and other laboratory findings, to diagnose other causes of hyponatremia (cerebral salt wasting, reset osmostat, nephrogenic syndrome of inappropriate antidiuresis, prolonged strenuous exercise, drugs) as well as inability to measure urine osmolality or delineate the diagnosis and cause of the syndrome of inappropriate antidiuretic hormone secretion...
April 2016: European Journal of Internal Medicine
John K Maesaka, Louis Imbriano, Joseph Mattana, Dympna Gallagher, Naveen Bade, Sairah Sharif
Hyponatremia is the most common electrolyte abnormality. Its diagnostic and therapeutic approaches are in a state of flux. It is evident that hyponatremic patients are symptomatic with a potential for serious consequences at sodium levels that were once considered trivial. The recommendation to treat virtually all hyponatremics exposes the need to resolve the diagnostic and therapeutic dilemma of deciding whether to water restrict a patient with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) or administer salt and water to a renal salt waster...
December 8, 2014: Journal of Clinical Medicine
Beatriz Maia Vale, Sofia Morais, Joana Mesquita, Gabriela Mimoso
Neonatal hyponatraemia is common, and related to significant morbidity and mortality. We report a case of a preterm newborn (gestational age of 36 weeks) with hyponatraemia, and with a prenatal diagnosis of cleft lip and palate, with a normal fetal karyotype. On the seventh day of life, a biochemical evaluation for jaundice and mild signs of dehydration showed hyponatraemia of 124 mmol/L. Investigation showed normal adrenal and thyroid functions, plasma hyposmolality (258 mOsm/kg); high urinary sodium (73 mmol/L) and high urinary osmolality (165 mOsm/kg)...
2015: BMJ Case Reports
Kemoy Harris, Ravi Shankar, Karen Black, Burton Rochelson
The reset osmostat syndrome, a form of inappropriate antidiuretic hormone secretion (SIADH), occurs when the threshold for antidiuretic hormone secretion is moved downward. There is evidence to suggest a "reset osmostat phenomenon" in normal pregnancies, whereby the average plasma-osmolality is decreased by 5-10 mOsm/kg. We present a case of a non-physiologic reset osmostat in a pregnant patient, thought to be caused by large intracranial arteriovenous malformations and intraventricular hemorrhage. The presence of a reset osmostat should be suspected in any patient with apparent SIADH who has mild hyponatremia that is stable over many days despite variations in sodium and water intake...
March 2014: Journal of Maternal-fetal & Neonatal Medicine
Louis J Imbriano, Ekambaram Ilamathi, Nicole M Ali, Nobuyuki Miyawaki, John K Maesaka
BACKGROUND: Reset osmostat (RO) occurs in 36% of patients with syndrome of inappropriate antidiuretic hormone secretion (SIADH) and is not often considered when evaluating hyponatremic patients. Patients with RO are not usually treated, but recent awareness that symptoms are associated with mild hyponatremia creates a therapeutic dilemma. We encountered patients with hyponatremia, hypouricemia and high urine sodium concentration (UNa), who had normal fractional excretion (FE) of urate and excreted dilute urines that were consistent with RO...
September 2012: Journal of Nephrology
I Groeschl, S Kos, J Rutishauser
A 76-year-old patient was admitted with dizzy spells and fainting. Laboratory analysis indicated the syndrome of inappropriate antidiuresis, which was further characterized as type C ("reset osmostat"). Extended workup revealed a hormone - inactive pituitary macroadenoma. After complete transsphenoidal resection, serum sodium levels and plasma and urinary osmolality promptly normalized. Except for the gonadal axis, the anterior pituitary functions remained intact. There was no adenoma recurrence over a five-year follow-up, and repetitive testing on ad libitum fluid intake showed normal sodium concentrations...
May 2008: Experimental and Clinical Endocrinology & Diabetes
Guy Decaux, Wim Musch
Hyponatremia secondary to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a frequent cause of hypotonicity. Although the differential diagnosis with other causes of hypotonicity such as salt depletion is sometimes challenging, some simple and readily available biologic parameters can be helpful in the diagnosis of SIADH. In SIADH, urea is typically low; this is less specific for elderly patients, for whom lower clearance of urea accounts for higher values. Low levels of uric acid are more often seen in SIADH (70%) compared with salt-depleted patients (40%)...
July 2008: Clinical Journal of the American Society of Nephrology: CJASN
A G Rohana, A W Norasyikin, Z Suehazlyn, Wong Ming, S Norlela, M K Norazmi
We report a case of a 65 year old Malay lady with long-standing diabetes mellitus, who presented to our institution with a one month history of worsening neck pain and progressive upper and lower limb weakness. She was stable despite severe hyponatraemia which was initially treated as syndrome of inappropriate anti-diuretic hormone (SIADH). This was consistent with her underlying illness which was concluded as cervical tuberculosis (TB) with spinal cord compression. She underwent decompression and bone grafting...
December 2006: Medical Journal of Malaysia
Gary L Robertson
The syndrome of inappropriate antidiuresis (SIAD) is a disorder of sodium and water balance characterized by hypotonic hyponatremia and impaired water excretion in the absence of renal insufficiency, adrenal insufficiency, or any recognized stimulus for the antidiuretic hormone arginine vasopressin (AVP). Hyponatremia is primarily a result of excessive water retention caused by a combination of excessive intake and inappropriate antidiuresis. It is sometimes aggravated by a sodium deficiency caused by decreased intake and/or a secondary natriuresis triggered by and largely corrective of the increase in extracellular volume...
July 2006: American Journal of Medicine
Liang-Kung Chen, Ming-Hsien Lin, Shinn Jang Hwang, Tzen-Wen Chen
BACKGROUND: Hyponatremia is common in the institutionalized elderly, and syndrome of inappropriate antidiuretic hormone secretion was deemed the most important etiologic factor. The purpose of this study was to evaluate the prevalence and etiologic factors of hyponatremia among institutionalized elderly and to explore its association with nutritional status. METHODS: Subjects in 2 private long-term care facilities (LTCFs) participated in this study. Periodic nutritional evaluations, including anthropometric measurements and serial laboratory examinations, were performed every 6 months...
March 2006: Journal of the Chinese Medical Association: JCMA
Kian Peng Goh
Hyponatremia is an important electrolyte abnormality with the potential for significant morbidity and mortality. Common causes include medications and the syndrome of inappropriate antidiuretic hormone (SIADH) secretion. Hyponatremia can be classified according to the volume status of the patient as hypovolemic, hypervolemic, or euvolemic. Hypervolemic hyponatremia may be caused by congestive heart failure, liver cirrhosis, and renal disease. Differentiating between euvolemia and hypovolemia can be clinically difficult, but a useful investigative aid is measurement of plasma osmolality...
May 15, 2004: American Family Physician
D Jones, S K Biswas, D A Power, S Cannon, H R Brady, H Grimes, E C Mulkerrin
Hyponatremia (HN) is the commonest electrolyte abnormality in elderly patients. Its etiology in this setting is poorly understood. In this study, the authors aim to compare the hemodynamic and hormonal responses of a group of older patients with a predisposition to HN with a group of age-matched controls. We assessed hemodynamic and hormonal responses to postural challenge in 15 patients over age 65 with serum sodium concentrations of less than 130 mM (mean 128.7 mM) and 15 age-matched controls with normal sodium concentrations...
March 2002: Archives of Gerontology and Geriatrics
Peter H Baylis
The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the commonest form of normovolaemic or dilutional hyponatraemia. The diagnosis of SIADH should be considered if the five cardinal criteria are fulfilled (hypotonic hyponatraemia, natriuresis, urine osmolality in excess of plasma osmolality, absence of oedema and volume depletion, normal renal and adrenal function). The clinical features are principally neuro-muscular and gastro-intestinal, the severity of which is related to both the absolute serum sodium concentration and its rate of fall, particularly if greater than 0...
November 2003: International Journal of Biochemistry & Cell Biology
J H M van Steijn, R O B Gans
An 88-year-old man presented with nausea and vomiting. Recently a cutaneous B-cell lymphoma had been diagnosed on his right cheek. Laboratory investigation showed hyponatraemia. Fluid restriction was started, based on the diagnosis of the syndrome of inappropriate antidiuretic hormone secretion (SIADH). However the hyponatraemia persisted and a diagnosis of 'reset osmostat' was made. CT of the abdomen revealed slight bilateral adrenal enlargement, which was interpreted as adrenal incidentaloma. No other localisation of the lymphoma, besides that on the right cheek, was seen...
March 2, 2002: Nederlands Tijdschrift Voor Geneeskunde
J Leggott, D Almond
No abstract text is available yet for this article.
July 2001: Journal of the American Board of Family Practice
G L Liamis, H J Milionis, E C Rizos, K C Siamopoulos, M S Elisaf
Hyponatraemia is commonly reported in chronic alcoholic patients. However, the underlying pathogenetic mechanisms are not well delineated. In the current study, we analysed the possible pathophysiological mechanisms of hyponatraemia in a group of alcoholic patients (n = 127) admitted to our hospital for causes related to alcohol misuse. Hyponatraemia (serum sodium <134 mmol/l) was found in 22 patients (17.3%). The most common cause of hyponatraemia in our cohort was hypovolaemia (12 patients); pseudohyponatraemia was diagnosed in six patients with alcohol-induced severe hypertriglyceridaemia...
November 2000: Alcohol and Alcoholism: International Journal of the Medical Council on Alcoholism
P Ranieri, S Franzoni, R Rozzini, M Trabucchi
The presence of hyponatremia, especially in a frail and very old patient, is associated with a greater morbidity and mortality rate. We report the case of a depressed 79-year-old woman who was treated with venlafaxine, in whom a drug-induced hyponatremia occurred in the absence of other possible causes. The case is discussed in the context of the multipotential factors that induce hyponatremia, with particular attention to the geriatric patient.
April 1997: Journal of Geriatric Psychiatry and Neurology
M S Elisaf, A Konstantinides, K C Siamopoulos
A 62-year-old man with colon cancer who presented with hyponatremia is described. Volume depletion, renal failure, and cardiac, adrenal, hepatic, and thyroid diseases were excluded as causes of hyponatremia. The urine sodium concentration was repeatedly increased, suggesting the presence of the syndrome of inappropriate antidiuretic hormone secretion. An intact urinary diluting ability and the ability to maintain sodium balance without correcting hyponatremia when the sodium intake was high were consistent with the diagnosis of the reset osmostat variant of the syndrome of inappropriate antidiuresis...
1996: American Journal of Nephrology
M K Hariprasad, R P Eisinger, I M Nadler, C S Padmanabhan, B D Nidus
Twenty psychotic patients with psychogenic polydipsia had hyponatremia (98 to 124 mEq/L) lasting up to 28 months, with headache, hypertension, dementia, seizures, lethargy, and coma. Two deaths also may be attributed to this syndrome. Patients drank 7 to 43 L of water daily. Urine was dilute during this water load (37 to 95 mOsm/kg), and free water clearance ranged from 12 to 36 L/day, while plasma osmolality was 236 to 244 mOsm/kg. During fluid deprivation in seven such patients, urinary osmolality exceeded plasma osmolality when plasma concentration had risen to between 242 and 272 mOsm/kg, thus suggesting a "reset osmostat" or antidiuretic hormone response to nonosmotic stimuli...
December 1980: Archives of Internal Medicine
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