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Sowmya Krishnan, Swapna Deshpande, Ashwini Mallappa, Gunda Divya, Pascale Lane, Anu Vishwanath, Rene Y McNall-Knapp
Chronic hyponatremia is very rare in children and is often seen in the setting of congestive heart failure or liver failure in adults. Here, we report an 8-year-old child with hypothalamic glioma who presented with severe hyponatremia. Initial management consisted of fluid restriction. This was very difficult for the child to follow and the child developed bizarre drinking habits requiring intervention from child psychiatry. So therapy was initiated with low dose V2 receptor antagonist under close inpatient monitoring...
2017: Case Reports in Pediatrics
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
Margarida Mendes, Julie Dubourg, Anne Blanchard, Damien Bergerot, Pierre-Yves Courand, Valentina Forni, Michael Frank, Guillaume Bobrie, Joel Menard, Michel Azizi
OBJECTIVES: The participation of vasopressin in the mechanisms of resistant hypertension is unclear. We compared plasma copeptin concentration, a surrogate marker for vasopressin secretion, between patients with resistant hypertension and those with controlled blood pressure (CBP), in a post hoc analysis of the Prise en charge de l'Hypertension Artérielle RESistante au traitement trial. METHODS: After 4-week treatment with irbesartan 300 mg/day, hydrochlorothiazide 12...
October 15, 2016: Journal of Hypertension
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)...
June 29, 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
S Latcha, M Lubetzky, A M Weinstein
BACKGROUND: Combined deficits in arginine vasopressin secretion (AVP) and thirst sensation can result in life threatening hyperosmolality and hypernatremia. Complications include seizures, profound volume contraction and renal failure. Fortunately, this is an uncommon clinical condition, with approximately 70 cases reported in the literature over the past 47 years [1]. Defects in AVP secretion and/or synthesis produce central diabetes insipidus (DI), polyuria with polydipsia, hypernatremia and hyperosmolality...
November 2011: Clinical Nephrology
Roza Benabdesselam, Abdoulaye Sene, Danièle Raison, Ouahiba Benmessaoud-Mesbah, Ghazi Ayad, Dominique Mornet, David Yaffe, Alvaro Rendon, Hélène Hardin-Pouzet, Latifa Dorbani-Mamine
Patients with Duchenne muscular dystrophy (DMD) and mdx mice, devoid of dystrophin proteins, show altered ionic homeostasis. To clarify dystrophin's involvement in the central control of osmotic stimuli, we investigated the effect of the disruption of Dp71, the major form of dystrophin in the brain, on the hypothalamoneurohypophysis system (HNHS) osmoregulatory response. Dp71 and Dp140 are the principal DMD gene products in the supraoptic nucleus (SON) and neurohypophysis (NH). They are present in astrocyte and pituicyte end-feet, suggesting involvement in both intrinsic osmosensitivity of the SON and vasopressin (AVP) release from the NH...
February 1, 2010: Journal of Neuroscience Research
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
Bhasker Bappal, Hala A Sheikh, Ajitha Radhakrishan, Waad-Allah S Mula-Abed
No abstract text is available yet for this article.
May 2006: Saudi Medical Journal
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
Jeremy L Freeman
The hypothalamus is involved in a variety of autonomic, endocrine, neurological and behavioural functions including temperature, osmostatic and autonomic nervous system regulation, pituitary, thyroid, adrenal and gonadal control, thirst, appetite and weight control, memory and emotional behaviour including aggression and laughter, and biological (circadian) rhythms. The functional anatomy of the hypothalamus and its major afferent and efferent neurological connections are described, with particular reference to hypothalamic hamartomas (HH), gelastic seizures, MRI of the hypothalamus, and potential effects of surgery for HH...
December 2003: Epileptic Disorders: International Epilepsy Journal with Videotape
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
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