Diabetes Mellitus and Fluid Imbalance: The Need for Adequate Hydration.

The effect of hydration in modulating metabolic disease risk is a comparatively recent concept. Diabetic patients are at increased risk of dehydration due to osmotic diuresis. Undiagnosed or undertreated hyperglycemia may lead to electrolyte imbalance and elevated renal burden of glucose excretion, which may alter fluid reabsorption in the kidney. Also, the presence of one or more contributory factors, such as inadequate fluid intake, strenuous exercise, high temperatures, alcohol consumption, diarrhea, acute illnesses, fever, nausea, and vomiting, may put diabetic patients at increased risk of dehydration and electrolyte imbalance. Certain antidiabetic agents used by diabetic patients may cause fluid retention/deficits and/or electrolyte abnormalities in a few patients. Thus, drinking ample amounts of water and fluids with appropriate electrolyte composition is important to prevent dehydration. Successful management of dehydration in patients with diabetes is an unmet need and can best be accomplished by maintaining adequate hydration status.

Connecting the Dots: Hydration, Micronutrients, and Immunity.

Dehydration, often unnoticed, can occur in adults due to heat-related illnesses, viral infections, and upper respiratory tract infections, leading to deficits in fluids, electrolytes, and energy (FEE), even without diarrhea. This fluid deficit, in turn, impairs immunity at cellular and molecular levels. Physiologically, the immune system rapidly reacts to threats by adjusting its structural permeability, allowing water and small solutes to be passed, facilitated by proteins like aquaporins (AQPs). These AQPs are also essential for immune cell communication and adjustments of the cytoskeleton for functions like chemotaxis and phagocytosis. Apart from hydration, maintaining an optimal intake of essential micronutrients, including vitamins C and E, copper, zinc, and selenium, is also critical for supporting immune function and acting as antioxidants. Transient alterations in immune function caused by acute stressors or nondiarrheal conditions heighten vulnerability to coexisting illnesses, particularly cold and upper respiratory tract infections, while also elevating the likelihood of recurrent health issues. Supplementing fluids with known FEE content according to quality standards and enhanced taste is recommended during acute illness and until complete recovery. Thus, dehydration, caused by various acute conditions, can impair immunity and delay recovery. Prioritizing hydration and nutrition in healthcare and general settings is imperative, even when diarrhea is absent.

Effectiveness of ORSL® Variants as an Adjuvant along with Standard-of-care Treatment in the Restoration of Oral Fluid, Electrolytes, and Energy in Patients with Fever and/or General Weakness in Indian Patients in an Outpatient Setting.

BACKGROUND: Dehydration due to reduced intake or increased losses including insensible losses in patients with acute nondiarrheal diseases may lead to fluid, electrolytes, and energy (FEE) deficits. The impact of oral FEE supplementation adjuvant to standard of care (SOC) treatment on recovery in patients with acute nondiarrheal diseases is yet to be evaluated. AIM: To determine the effectiveness of ORSL® variants (ORSL® Apple Drink and ORSL® PLUS Orange Drink), fruit juice-based electrolyte drinks as an adjuvant along with SOC in the restoration of oral FEE in patients with acute nondiarrheal disease with fever and/or general weakness who attended an outpatient department (OPD). MATERIALS AND METHODS: This was a prospective, interventional, open-label, multicenter, real-world, study conducted at eight sites across India. Patients with fever and/or general weakness due to an acute nondiarrheal illness were given either ORSL® Apple Drink or ORSL® PLUS Orange Drink as an adjuvant along with SOC treatment per physician's discretion. The primary endpoint of the study was to assess improvement from baseline in energy or hydration levels after ORSL® variants consumption at 6, 24, and 48 hours measured by a new aided recovery scale (ARS). Secondary endpoints were to assess the improvement in energy and hydration levels at 20, 40, and 60 minutes, as well as energy levels and hydration levels at 20, 40, and 60 minutes, 6, 24, and 48 hours after the consumption of ORSL® Apple Drink or ORSL® PLUS Orange Drink. The patient's consumption of ORSL® variants and treatment experience, physician's experience of recommending ORSL® variants, and product safety were evaluated. RESULTS: In total, 612 patients were enrolled with mean age 38.3 years, of whom 62.9% were male. The mean baseline level of energy and hydration was 1.59 (range 1.0-2.0) on ARS. Statistically significant (p < 0.0001) improvements were observed in energy or hydration 6 hours after first consumption of ORSL formulations. Furthermore, improvement was observed from 40 minutes, and in levels of energy, hydration, and both energy and hydration from 60 minutes. Patients and physicians reported a positive experience with ORSL® variants. CONCLUSION: ORSL® Apple Drink and ORSL® PLUS Orange Drink are clinically proven to provide hydration and/or energy to patients with fever and/or general weakness.

Assessment of Hydration Status Using Conventional Method and Salivary Osmolarity as a Point-of-care Tool.

Dehydration is a well-known problem worldwide, and its assessment can be challenging due to confusing physical signs. The most effective way to assess hydration status is through the costly stable isotope methodology, but this approach has practical limitations. More commonly accepted and utilized indicators of hydration status are hematological and urinary parameters. However, hematological markers require invasive methods, and urinary markers have varying degrees of success in tracking hydration changes. While alterations in body weight can serve as a means of promptly evaluating hydration status, various factors such as food consumption, fluid intake, fecal losses, and urine production can impact these changes. Researchers have turned their attention to saliva as a potential marker and point-of-care (POC) testing to address the limitations of existing biomarkers. Saliva is appealing due to its easy collection process and similarities to extracellular fluid in terms of water and ion concentrations. Recent studies have shown that saliva flow rate, osmolarity/osmolality, and total protein concentration can effectively monitor changes in body mass during acute dehydration. Misdiagnosing dehydration can have severe clinical consequences, leading to morbidity and even mortality. This narrative review focuses on recognizing the significance of hydration assessment, monitoring, and the potential of salivary osmolarity (SOSM) as an assessment tool. Healthcare professionals can improve their practices and interventions to optimize hydration and promote overall wellness using such tools.

Association of Physicians of India Expert Recommendations on Oral Fluid, Electrolytes, and Energy Management during Transition Care and Discharge for Hospitalized Patients with Nondiarrheal Illnesses.

Acute nondiarrheal illnesses (NDIs) involve overt or subclinical dehydration, requiring rehydration and electrolyte repletion. Dehydration is frequently under-recognized and under-managed, both in outpatient departments (OPDs) and inpatient departments (IPDs). Postadmission dehydration is associated with longer hospital stays and higher inhospital mortality rates. Recognizing and understanding dehydration in hospitalized patients is necessary due to the adverse outcomes associated with this condition. In this article, we aimed to develop practical consensus recommendations on the role of oral fluid, electrolyte, and energy (FEE) management in hospitalized patients with FEE deficits in NDI. The modified Delphi consensus methodology was utilized to reach a consensus. A scientific committee comprising eight experts from India formed the panel. Relevant clinical questions within three major domains were formulated for presentation and discussion: (1) burden and factors contributing to dehydration in hospitalized patients; (2) assessment of fluid and electrolyte losses and increased energy requirements in hospitalized patients; and (3) management of FEE deficits in hospitalized patients [at admission, during intravenous (IV) therapy, IV to oral de-escalation, and discharge]. The consensus level was classified into agreement (mean score ≥4), no consensus (mean score <4), and exclusion (mean score <4 after the third round of discussion). The questions that lacked agreement were discussed during the virtual meeting. The experts agreed that the most common factors contributing to dehydration in patients with NDI hospitalized in IPDs include decreased oral fluid intake, increased fluid loss due to the illness, insensible fluid loss, and a lack of awareness among doctors about dehydration, which can result in poor fluid intake. Time constraints, discontinuity of care, lack of awareness of the principles of fluid balance, lack of formal procedures for enforcing hydration schemes, and lack of adequate training are most often barriers to the assessment of hydration status in hospital settings. Experts used hydration biomarkers, such as changes in body weight, serum, or plasma osmolality; fluid intake; and fluid balance charts; along with urine output, frequency, quantity, and color, to determine hydration status in hospital settings. Experts agreed that appropriate FEE supplementation in the form of ready-to-drink (RTD) fluids can restore FEE deficits and shorten the length of hospital stays in hospitalized patients at admission, during de-escalation from IV to oral therapy, and at discharge. RTD electrolyte solutions with known concentrations of electrolytes and energy are good choices to avoid taste fatigue and replenish FEE in hospitalized patients during transition care and at discharge.

Oral Fluid, Electrolytes, and Energy Management in Various Adult and Geriatric Illnesses beyond Diarrhea: An Indian Expert Panel Delphi Consensus Recommendation.

BACKGROUND: Dehydration is a highly prevalent clinical challenge in adults which can go undetected. Although dehydration is commonly associated with an increased risk of hospitalization and mortality, only a few international guidelines provide recommendations regarding oral fluids, electrolytes, and energy (FEE) management in adults/geriatrics with dehydration due to nondiarrheal causes. Currently, there is a lack of comprehensive recommendations on the role of oral FEE in nondiarrheal dehydration in adult and geriatric Indian patients. MATERIALS AND METHODS: A modified Delphi approach was designed using an online questionnaire-based survey followed by a virtual meeting, and another round of online surveys was used to develop this consensus recommendation. In round one, 130 statements, including 21 open-ended questions, were circulated among ten national experts who were asked to either strongly agree, agree, disagree, or strongly disagree with statements and provide responses to open-ended questions. The consensus was predefined at 75% agreement (pooling "strongly agree" and "agree" responses). Presentation of relevant literature was done during a virtual discussion, and some statements (the ones that did not achieve predefined agreement) were actively discussed and deliberately debated to arrive at conclusive statements. Those statements that did not reach consensus were revised and recirculated during round two. RESULTS: Consensus was achieved for 130/130 statements covering various domains such as assessment of dehydration, dehydration in geriatrics, energy requirement, impact of oral FEE on patient outcome, and fluid recommendations in acute and chronic nondiarrheal illness. However, one statement was not added as a recommendation in the final consensus (129/130) as further literature review did not find any supporting data. Oral FEE should be recommended as part of core treatment from day 1 of acute nondiarrheal illness and started at the earliest feasibility in chronic illnesses for improved patient outcomes. Appropriately formulated fluids with known electrolyte and energy content, quality standards, and improved palatability may further impact patient compliance and could be a good option. CONCLUSION: These consensus recommendations provide guidance for oral FEE recommendations in Indian adult/geriatric patients with various nondiarrheal illnesses.

Fluid Imbalance in Geriatrics: The Need for Optimal Hydration.

In the elderly, increased morbidity and mortality are often linked to fluid and electrolyte imbalances due to age-related physiological changes, hence monitoring and maintaining healthy hydration levels is important for the geriatric patient population. Patients recuperating from an illness at home maybe likely to neglect proper fluid intake and energy management, which hampers their timely recovery. In elderly patients with concurrent illnesses and therapies, dehydration is a common condition that often remains unnoticed despite persistent disease symptoms. Oral nutritional supplements such as scientifically formulated oral rehydration therapies (ORTs) have been recommended in such cases. These supplements can be further suggested by nutritional counseling, diet modification, nursing interventions, and educating the patients. The main aim of this review is to generate a greater understanding of the fluid intake requirements for the elderly, thus contributing to the prevention of the negative effects of dehydration. This review comprehensively highlights the need for treatment, recovery from illness to supportive care to address a patient's needs. Maintaining an optimal hydration level aids the efficacy of therapy in elderly patients. Hospitalized patients are considered to be at risk of dehydration, whereas patients at home completely ignore the need for fluid and energy management, leading to hospital readmissions and delayed recovery. Guidelines are available for treating, managing, and maintaining ideal hydration levels, these are considered to be imperative in managing elderly patients with chronic illnesses.

Knowledge, Attitudes, and Practices regarding Oral Fluid, Electrolyte, and Energy Management in Acute Nondiarrheal Illnesses among Physicians in India.

BACKGROUND: Fluid, electrolytes, and energy (FEE) management is important in the treatment of acute nondiarrheal illnesses. However, the use of FEE drinks in managing such illnesses is not well-documented. OBJECTIVE: This study aimed to understand physicians' knowledge, attitude, and practices (KAP) and perceived patient outcomes in treating FEE deficits in acute nondiarrheal illnesses using FEE drinks in India. MATERIALS AND METHODS: A cross-sectional respondent-blinded survey was designed and administered among practicing physicians across various specialties and prescribing statuses in India. KAP among groups of physicians was assessed, and the correlations between knowledge- attitudes, knowledge-practice, and knowledge-perceived outcomes were explored. RESULTS: A total of 494 physicians participated in the study from September to October 2021. Overall, knowledge scores were moderate. Prescribers had a higher average knowledge score and more proactive attitudes and practices as compared to nonprescribers. Most physicians agreed that FEE management recommendations could improve patients' recovery speed. There were significant positive correlations between knowledge scores and physicians' attitudes toward the importance of FEE management awareness, the importance of FEE management for patient recovery, and a physician's perception that FEE drinks improved patients' recovery time. There was no significant correlation between knowledge score and practices. CONCLUSION: There may be benefits from improving the knowledge of physicians in India in FEE management and developing guidelines for the use of FEE drinks in acute nondiarrheal illnesses. Further research exploring the knowledge-practice gap and evaluating the clinical benefit of FEE drinks in acute nondiarrheal illnesses should also be undertaken to develop such guidelines.

Comparing the Knowledge, Attitude, and Practices on Oral Fluids, Electrolytes, and Energy Management in Non-diarrheal Illnesses across Different Physician Specialties in India.

Background: The management of non-diarrheal illnesses requires careful attention to maintaining the proper balance of fluids, electrolytes, and energy (FEE). Nevertheless, there is a limited amount of information accessible regarding the utilization of oral FEE formulations in the treatment of these conditions. Objective: The objective of this study was to assess and contrast the levels of knowledge, attitude, and practices (KAP) among various medical specialties in India when it comes to addressing FEE imbalances in non-diarrheal illnesses through the use of oral FEE formulations, as well as to examine how these approaches influence perceived patient outcomes. We also present a subgroup analysis of KAP in healthcare personnels (HCPs) whose practices include 25% or more diabetic or geriatric patients. Materials and methods: A cross-sectional online assessment was created and conducted among physicians (n = 494) representing different medical specialties in India, which include general practitioners (GPs) (n = 128), MD physicians (n = 121), gynecologists (n = 122), and pediatricians (n = 123). Results: A total of 494 physicians across specialties, including GPs, MDs (MD internal medicine physicians), obstetrics and gynecologists (OB-GYN), and pediatricians, participated in the online assessment from September to October 2021. Knowledge scores were moderate across specialties, and there was no significant difference in knowledge level across specialties. More pediatricians and GPs than other HCPs consider FEE deficit to have a high impact on recovery. Further, pediatrician prescribers consider FEE management to be of high importance compared to other specialties. A significantly higher percentage of pediatricians assess all their patients (100%) for hydration levels, and significantly more gynecologists spend >5 minutes providing hydration advice to their patients. Among all specialties, MD and gynecologist prescribers are more likely to recommend oral FEE for patient recovery. HCPs with diabetes practices agree slightly more than HCPs with geriatric practices that oral FEE management recommendations facilitate the speed of the recovery process from non-diarrheal illnesses in their patients. However, only approximately 30% of them recommend FEE to 70% of their eligible patients, of which approximately 70% of these HCPs give formal (written/electronic) prescriptions of ready-to-drink (RTD) fluids to their patients. Conclusion: Enhancing the understanding of physicians across diverse specialties in India regarding oral FEE management and formulating recommendations for the utilization of oral FEE formulations in non-diarrheal conditions could lead to better outcomes. While knowledge and awareness of oral FEE management are similar across specialties, their practice behaviors vary. Additional research into this disparity and the assessment of the clinical advantages of oral FEE formulations in non-diarrheal illnesses among various specialties should be conducted. How to cite this article: Sathe P, Chakravarty P, Tesado C, et al. Comparing the Knowledge, Attitude, and Practices on Oral Fluids, Electrolytes, and Energy Management in Non-diarrheal Illnesses across Different Physician Specialties in India. J Assoc Physicians India 2023;71(10):19-30.

Nocturia - Symptom or a Disease?

Waking at night to void is known as nocturia and it is a common condition experienced by both men and women with profound impact on patient's health, quality of life, and economic condition. It is often perceived as a symptom of an organic disease, but the pathophysiology of nocturia is now well-understood, and it is considered as a disease itself. It is classified based on four different pathophysiologic mechanisms (24-hour polyuria, nocturnal polyuria, reduced bladder capacity, and sleep disorders). The association of nocturia with impaired quality of life, cardiovascular morbidity and all-cause mortality is well established. Various pharmacological agents are available, of which desmopressin is considered safe and effective in both short- and long-term studies for the treatment of nocturia in men and women, including the elderly. Combining desmopressin with other agents provides an effective treatment option for nocturia in patients with lower urinary tract symptoms, benign prostatic hypertrophy or overactive bladder syndrome. This review covers the various aspects of pathophysiology and impact of nocturia, as well as the treatment of nocturia. We present the novel concept of a "nocturia clinic", which is a comprehensive diagnostic and management center for patients with nocturia. This set-up may help bring about a positive change in the underreported and undertreated status of nocturia, and bring relief to sufferers of nocturia. Therefore nocturia though perceived as a symptom of many disorders; it itself has a defined pathophysiology and needs treatment.

Statin-induced rhabdomyolysis in patient with renal failure and underlying undiagnosed hypothyroidism.

Rhabdomyolysis is a syndrome characterized by muscle necrosis which causes the release of myoglobin into the bloodstream. The manifestations of this syndrome range from asymptomatic elevation of serum muscle enzymes to life-threatening cases associated with extremely high enzyme levels, electrolyte imbalance, and acute renal failure. Symptoms of rhabdomyolysis include dark urine, muscle weakness, and fatigue. Statins are commonly used drugs for the prevention and management of dyslipidemia. We present an interesting and critical case on statin-induced rhabdomyolysis with renal failure and previously undiagnosed idiopathic hypothyroidism.

Past, Present, and Likely Future of Nutraceuticals in India: Evolving Role of Pharmaceutical Physicians.

Nutraceuticals are gaining importance owing to the current pandemic situation and increasing focus on overall health. Nutraceuticals include products, which help in maintaining immunity and prevent diseases. It also includes products that support the optimal functioning of the human body. Poor nutrition plays an important role in lifestyle-related disorders as well. Various nutraceuticals have exhibited therapeutic potential, hence gaining popularity. Nutraceuticals are mainly categorized into dietary supplements and functional foods. With multiple factors contributing to the growth of nutraceutical industry in India, we are marching toward global leadership in nutraceuticals. Food Safety and Standards Authority of India (FSSAI) is solely responsible for regulating the approvals, promotions, and labeling standards for health supplements and nutraceuticals. As the understanding of these nutraceuticals is improving, the regulations are becoming stricter and there is a pressing need to monitor the usage of such products regularly and stringently. Nutrivigilance and phytovigilance are relatively new concepts in our country; however, regulatory authorities need to proactively observe the adverse effects and issues related to substandard and counterfeit nutraceutical products. Healthcare professionals including pharmaceutical physicians can play an important role in safeguarding the population by advocating the rational use of nutraceuticals, food supplements, and consumer health products.

Which LDL Value Should Clinicians Look at?

Objectives LDL cholesterol is routinely estimated by the Friedewald formula to guide the treatment of dyslipidemia. However, Friedewald equation has certain limitations, especially with high triglyceride levels. Direct methods are available for LDL estimation but have received relatively little scrutiny in the Indian setting. This study was aimed at comparing the calculative and direct methods of LDL estimation in Indian hyperlipidemic patients. Materials and Methods In this observational study, data from 380 consecutive lipid profiles of patients visiting a tertiary care hospital in Mumbai were analyzed retrospectively. CHOD PAP method was used to estimate total cholesterol. Enzymatic colorimetric method was used to estimate triglycerides. Enzyme selective protection method was used to estimate HDL. Direct LDL was estimated by homogenous enzymatic colorimetric assay and very low-density lipoprotein was calculated, whereas Friedewald's formula was used to derive calculated LDL. Results Total cholesterol values correlated positively with the LDL values measured by both methods. However, a statistically significant difference was noted between the correlation coefficients of both the methods. Triglyceride values correlated weakly with the LDL levels measured by both the methods. A weak negative correlation was observed with LDL by the calculated method, whereas a weak positive correlation existed between TG and LDL by the direct method. The difference between the correlation coefficients was statistically significant. Conclusion Both direct and calculated methods of LDL estimation have their limitations. A robust study with a larger sample size is needed to further investigate whether the differences in the different LDL estimation methods can translate to "clinical relevance" in the Indian setting.

Effects of two formulations containing Phyllanthus emblica and Tinospora cordifolia with and without Ocimum sanctum in immunocompromised mice.

BACKGROUND: Current pandemic has led us to explore the role of traditional system of medicine to look for formulations that enhance immunity. OBJECTIVE: The obejctive of this experimental study was to evaluate the immunomodulatory effects of two formulations, Tinospora cordifolia (Tc) and Phyllanthus emblica (Pe) with and without coating of Ocimum sanctum (Os). MATERIALS AND METHODS: After obtaining Institutional Animal Ethics Committee approval, present experimental study was conducted to evaluate the immunomodulatory effects of plant drug formulations against infection induced in mice subjected to major surgical stress. Hemisplenectomy was selected to induce major stress and the procedure for hemisplenectomy was standardized. A model of secondary fungal infection after hemisplenectomy was established followed by the treatment of mice with plant drugs and controls. They were subjected to hemisplenectomy or sham operation and 105 C. albicans were injected intravenously. The therapy continued for next 14 days. Kidneys were isolated to estimate fungal load. Fungal load of the kidneys was estimated on post-operative Day 15. RESULTS: The test formulations Tc + Pe and Tc + Pe + Os showed significant reduction in the fungal burden of kidneys as compared to hemisplenectomized control group. However, Tc alone exerted better degree of protection as compared to Tc + Pe and Tc + Pe + Os. CONCLUSION: The formulations, Tc + Pe and Tc + Pe + Os that were developed on the basis of theoretical concepts were not found to be superior to Tc. Though the individual ingredients have been shown to possess immunnostimulant activities, in combination, Pe and Os blunted the effects of Tc. The basis for this drug interaction needs further exploration. Thus, the current experimental study validates immunomodulatory role of Tc. However, the addition of Pe with bhavana of Os does not lead to any augmentation of immunomodulatory activity of Tc. This study also underlines the need to generate data on Ayurveda formulations to understand the rationality of the multi-ingredient Ayurvedic formulations.

Sports Pharmacology: A Medical Pharmacologist's Perspective.

Abuse of substances or methods to enhance the performance is becoming very common in the sports, which often destroys the spirit of competition. The regulatory bodies for sports have reported rates ranging from 5% to 31% for the use of performance-enhancing substances among athletes. Athletes can have serious injuries and morbidities, leading to poor health with the use of such substances. Commonly abused agents in sports include anabolic-androgenic steroids and its analogs, blood, erythropoietin, growth hormone and its derivatives, nutritional supplements, creatine, amphetamines, beta-hydroxy-beta-methylbutyrate (HMB), stimulants, and analgesics. Health-care professionals need to be careful while prescribing medicines to sportspersons. Knowledge of exercise physiology, pharmacology of the commonly used agents for sports-related injuries, and agents used for doping could help the sportspersons and health-care professionals to avoid the embarrassment arising because of misuse of these agents. Sports pharmacology includes study of the various aspects of the drug use and abuse in sports and treatment of sports-related injuries. Focusing on sports pharmacology in the medical curriculum can help the upcoming health-care professionals to support the sportspersons to improve the quality of their life by using various drugs and other substances within the standardized limits and avoid embarrassment of doping.

Exploring the ocean for new drug developments: Marine pharmacology.

Disease ailments are changing the patterns, and the new diseases are emerging due to changing environments. The enormous growth of world population has overburdened the existing resources for the drugs. And hence, the drug manufacturers are always on the lookout for new resources to develop effective and safe drugs for the increasing demands of the world population. Seventy-five percentage of earth's surface is covered by water but research into the pharmacology of marine organisms is limited, and most of it still remains unexplored. Marine environment represents countless and diverse resource for new drugs to combat major diseases such as cancer or malaria. It also offers an ecological resource comprising a variety of aquatic plants and animals. These aquatic organisms are screened for antibacterial, immunomodulator, anti-fungal, anti-inflammatory, anticancer, antimicrobial, neuroprotective, analgesic, and antimalarial properties. They are used for new drug developments extensively across the world. Marine pharmacology offers the scope for research on these drugs of marine origin. Few institutes in India offer such opportunities which can help us in the quest for new drugs. This is an extensive review of the drugs developed and the potential new drug candidates from marine origin along with the opportunities for research on marine derived products. It also gives the information about the institutes in India which offer marine pharmacology related courses.

Forensic pharmacology: An important and evolving subspecialty needs recognition in India.

With training in pharmacology, a pharmacologist has an expert knowledge as well as working experience in the subjects of therapeutics, pharmacokinetics, and toxicology along with exposure to subjects such as forensic medicine during the medical education. All these knowledge domains can be applied and act as an interface to the forensic situations. The skills and expertise of a forensic pharmacologist can be useful in a large and diverse number of legal cases. With an ever increasing incidence of criminal and civil cases in India, the development and inclusion of forensic pharmacologist in the judicial system of India are the need of the hour. The research in pharmacology has witnessed great technological advancement that allows it to expand its scope beyond the domain of therapeutics, thus enabling Indian pharmacologists to explore the niche area of Forensic Pharmacology. Differing pharmacokinetics and pharmacodynamics of drugs in living and dead, drug interactions, abuse of drugs, personal injury or death due to drug exposure leading to medico-legal issues, environmental exposure to chemicals, and doping and forensic pharmacovigilance are the diverse aspects of Forensic Pharmacology.

Diabetes insipidus: The other diabetes.

Diabetes insipidus (DI) is a hereditary or acquired condition which disrupts normal life of persons with the condition; disruption is due to increased thirst and passing of large volumes of urine, even at night. A systematic search of literature for DI was carried out using the PubMed database for the purpose of this review. Central DI due to impaired secretion of arginine vasopressin (AVP) could result from traumatic brain injury, surgery, or tumors whereas nephrogenic DI due to failure of the kidney to respond to AVP is usually inherited. The earliest treatment was posterior pituitary extracts containing vasopressin and oxytocin. The synthetic analog of vasopressin, desmopressin has several benefits over vasopressin. Desmopressin was initially available as intranasal preparation, but now the oral tablet and melt formulations have gained significance, with benefits such as ease of administration and stability at room temperature. Other molecules used for treatment include chlorpropamide, carbamazepine, thiazide diuretics, indapamide, clofibrate, indomethacin, and amiloride. However, desmopressin remains the most widely used drug for the treatment of DI. This review covers the physiology of water balance, causes of DI and various treatment modalities available, with a special focus on desmopressin.