Hiponatremia y traumatismo craneoencefálico, una asociación importante. Reporte de caso / Hyponatremia and traumatic brain injury, an important association. Case report

Introducción: La hiponatremia se encuentra asociada aproximadamente con el 10% de los pacientes con traumatismo craneoencefálico, su baja frecuencia y la intuición clínica de esta relación la hace importante en el presente informe de caso. Objetivo: Describir la asociación de la hiponatremia con el traumatismo craneoen-cefálico con la finalidad de mejorar la comprensión de esta relación en el personal de salud y promover la implementación de estrategias de diagnóstico y manejo más efectivas basadas en predicciones bioquímicas y anatómicas actualizadas. Presentación del caso: Paciente masculino, adulto joven, con antecedentes de dos traumatismos craneoencefálicos, con hiponatremia sérica severa y síntomas persistentes de mareo y cefalea, tratado con diuréticos de asa y cloruro de sodio vía oral, con mejoría posterior al vigésimo día de hospitalización. Discusión: Ciertas alteraciones neurológicas con manifestación clínica evidente, se presentan por bajos niveles de sodio sérico, o por causas anatómicas y fisioló-gicas diferentes. Se ha demostrado una relación causal con mecanismo fisiopato-lógico no bien descrito sobre la hiponatremia y el traumatismo craneoencefálico. Conclusión: Es crucial tener una vigilancia meticulosa en pacientes con hipona-tremia severa, aunque presenten pocos síntomas clínicos (considerando antece-dentes como el traumatismo craneoencefálico en la anamnesis inicial y de segui-miento) como en este caso. Además, se destaca la necesidad de investigar las vías metabólicas que podrían verse afectadas por traumatismos craneoencefálicos, y que podrían tener un impacto directo en los niveles de sodio en sangre.

Introduction: Hyponatremia is found to be associated with approximately 10% of patients with traumatic brain injury. Despite its low frequency, the clinical intuition regarding this relationship underscores its significance in this case report. Objective: Describe the association between hyponatremia and traumatic brain in-jury, aiming to enhance healthcare professionals' understanding of this correlation and to advocate for the implementation of more effective diagnostic and manage-ment strategies based on updated biochemical and anatomical predictions. Case Presentation: A young adult male patient with a history of two traumatic brain injuries, severe serum hyponatremia, and persistent symptoms of dizziness and headache, treated with loop diuretics and oral sodium chloride, exhibited improvement after twenty days of hospitalization. Discussion: Certain neurological alterations with evident clinical manifestation are characterized by low levels of serum sodium, possibly stemming from distinct ana-tomical and physiological causes. A causal relationship with a poorly described pathophysiological mechanism between hyponatremia and traumatic brain injury has been suggested. Conclusion: Meticulous monitoring is imperative for patients with severe hypona-tremia, even when clinical symptoms are minimal, as observed in this case. Fur-thermore, emphasis is placed on the need to investigate metabolic pathways that may be affected by traumatic brain injuries, potentially exerting a direct impact on blood sodium levels.

Osmotic demyelination as a complication of hyponatremia correction: a systematic review / Desmielinização osmótica como complicação da correção de hiponatremia: uma revisão sistemática

ABSTRACT Background: Rapid correction of hyponatremia, especially when severe and chronic, can result in osmotic demyelination. The latest guideline for diagnosis and treatment of hyponatremia (2014) recommends a correction limit of 10 mEq/L/day. Our aim was to summarize published cases of osmotic demyelination to assess the adequacy of this recommendation. Method: Systematic review of case reports of osmotic demyelination. We included cases confirmed by imaging or pathology exam, in people over 18 years of age, published between 1997 and 2019, in English or Portuguese. Results: We evaluated 96 cases of osmotic demyelination, 58.3% female, with a mean age of 48.2 ± 12.9 years. Median admission serum sodium was 105 mEq/L and > 90% of patients had severe hyponatremia (<120 mEq/L). Reports of gastrointestinal tract disorders (38.5%), alcoholism (31.3%) and use of diuretics (27%) were common. Correction of hyponatremia was performed mainly with isotonic (46.9%) or hypertonic (33.7%) saline solution. Correction of associated hypokalemia occurred in 18.8%. In 66.6% of cases there was correction of natremia above 10 mEq/L on the first day of hospitalization; the rate was not reported in 22.9% and in only 10.4% was it less than 10 mEq/L/day. Conclusion: The development of osmotic demyelination was predominant in women under 50 years of age, with severe hyponatremia and rapid correction. In 10.4% of cases, there was demyelination even with correction <10 mEq/L/day. These data reinforce the need for conservative targets for high-risk patients, such as 4-6 mEq/L/day, not exceeding the limit of 8 mEq/L/day.

RESUMO Antecedentes: A correção rápida da hiponatremia, principalmente quando grave e crônica, pode resultar em desmielinização osmótica. A última diretriz para diagnóstico e tratamento da hiponatremia (2014) recomenda um limite de correção de 10 mEq/L/dia. Nosso objetivo foi sumarizar os casos publicados de desmielinização osmótica para avaliar a adequação dessa recomendação. Método: Revisão sistemática de relatos de caso de desmielinização osmótica. Incluímos casos confirmados por imagem ou anatomia patológica, em maiores de 18 anos, publicados entre 1997 e 2019, nas línguas inglesa ou portuguesa. Resultados: Avaliamos 96 casos de desmielinização osmótica, sendo 58,3% do sexo feminino e com média de idade de 48,2 ± 12,9 anos. A mediana de sódio sérico admissional foi 105 mEq/L e > 90% dos pacientes apresentavam hiponatremia grave (<120 mEq/L). Foram comuns os relatos de distúrbios do trato gastrointestinal (38,5%), etilismo (31,3%) e uso de diuréticos (27%). A correção da hiponatremia foi feita principalmente com solução salina isotônica (46,9%) ou hipertônica (33,7%). Correção de hipocalemia associada ocorreu em 18,8%. Em 66,6% dos casos houve correção da natremia acima de 10 mEq/L no primeiro dia de internamento; a velocidade não foi relatada em 22,9% e em apenas 10,4% foi menor que 10 mEq/L/dia. Conclusão: O desenvolvimento da desmielinização osmótica foi predominante em mulheres, abaixo de 50 anos, com hiponatremia grave e correção rápida. Em 10,4% dos casos, houve desmielinização mesmo com correção <10 mEq/L/dia. Esses dados reforçam a necessidade de alvos conservadores para pacientes de alto risco, como 4-6 mEq/L/dia, não ultrapassando o limite de 8 mEq/L/dia.

Afferent baroreflex failure with hyponatremia:A case report / 北京大学学报(医学版)

Afferent baroreflex failure(ABF)is a rare disease.It refers to the clinical syndrome caused by the impairment of the afferent limb of the baroreflex or its central connections at the level of the medul-la.The recognized causes include trauma,surgery in related areas(radical neck tumor surgery,carotid endarterectomy),neck radiotherapy,brain stem stroke,tumor growth paraganglioma and hereditary diseases,among which the most common cause is extensive neck surgery or radiotherapy for neck cancer.The main manifestations are fluctuating hypertension,orthostatic hypotension,paroxysmal tachycardia and bradycardia.This case is a young man,whose main feature is blood pressure fluctuation,accom-panied by neurogenic orthostatic hypotension(nOH).After examination,the common causes of hyper-tension and nOH were ruled out.Combined with the previous neck radiotherapy and neck lymph node dissection,it was considered that the blood pressure regulation was abnormal due to the damage of carotid sinus baroreceptor after radiotherapy for nasopharyngeal carcinoma and neck lymph node dissection,which was called ABF.At the same time,the patient was complicated with chronic hyponatremia.Com-bined with clinical and laboratory examination,the final consideration was caused by syndrome of in-appropriate antidiuretic hormone(SIADH).Baroreceptors controlled the secretion of heart rate,blood pres-sure and antidiuretic hormone through the mandatory"inhibition"signal.We speculate that the carotid sinus baroreceptor was damaged after neck radiotherapy and surgery,which leads to abnormal blood pres-sure regulation and nOH,while the function of inhibiting ADH secretion was weakened,resulting in higher ADH than normal level and mild hyponatremia.The goal of treating ABF patients was to reduce the frequency and amplitude of sudden changes in blood pressure and heart rate,and to alleviate the on-set of symptomatic hypotension.At present,drug treatment is still controversial,and non-drug treatment may alleviate some patients'symptoms,but long-term effective treatment still needs further study.The incidence of ABF is not high,but it may lead to serious cardiovascular and cerebrovascular events,and the mechanism involved is extremely complicated,and there are few related studies.The reports of rele-vant medical records warn that patients undergoing neck radiotherapy or surgery should minimize the da-mage to the baroreceptor in the carotid sinus in order to reduce the adverse prognosis caused by complica-tions.

Boswellia serrata intoxication manifesting with syndrome of inappropriate antidiuretic hormone secretion, hyponatremia, seizure, and rhabdomyolysis / Intoxicação por Boswellia serrata manifestando-se com síndrome da secreção inapropriada de hormônio antidiurético, hiponatremia, convulsão e rabdomiólise

ABSTRACT Boswellia serrata is an herbal extract from the Boswellia serrata tree that has anti-inflammatory and analgesic properties and alleviates pain caused by rheumatoid arthritis, gout, osteoarthritis, and sciatica. Syndrome of inappropriate antidiuretic hormone secretion accompanied by hyponatremia, seizures, and rhabdomyolysis as a manifestation of Boswellia serrata intoxication has not been reported previously. A 38-year-old female suffered clinically isolated syndrome and has since been regularly taking B. serrata capsules (200mg/d) to strengthen her immune system. She experienced hypersensitivity to light, ocular pain, nausea, dizziness, and lower limb weakness four days after receiving her first BNT162b2 vaccine dose, and she increased the dosage of B. serrata to five capsules (1000mg/d) one week after vaccination. After taking B. serrata at a dosage of 1000mg/d for 3 weeks, she was admitted to the intensive care unit because of a first, unprovoked generalized tonic-clonic seizure. The patient's workup revealed syndrome of inappropriate antidiuretic hormone secretion, which resolved completely upon treatment and discontinuation of B. serrata. In summary, B. serrata potentially causes syndrome of inappropriate antidiuretic hormone secretion when it is taken at high doses. Patients should not self-medicate.

RESUMO Boswellia serrata é um extrato herbal da árvore Boswellia serrata que possui propriedades anti-inflamatórias e analgésicas e alivia a dor ciática e causada por artrite reumatoide, gota, osteoartrite. Não há relato na literatura de síndrome da secreção inapropriada do hormônio antidiurético, acompanhada por hiponatremia, convulsões e rabdomiólise, como manifestação de intoxicação por Boswellia serrata. Uma mulher de 38 anos diagnosticada com síndrome clinicamente isolada tomava regularmente cápsulas de B. serrata (200mg/dia) para fortalecer seu sistema imunológico. Ela desenvolveu hipersensibilidade à luz, dor ocular, náusea, tontura e fraqueza nos membros inferiores 4 dias após tomar a primeira dose da vacina BNT162b2 e aumentou a dose de B. serrata para 1.000mg/dia 1 semana após a vacinação. Após tomar B. serrata na dose de 1.000mg/dia por 3 semanas, ela foi internada na unidade de terapia intensiva devido à convulsão tônico-clônica generalizada não provocada. A investigação diagnóstica revelou síndrome da secreção inapropriada de hormônio antidiurético, que se resolveu completamente após tratamento e interrupção do uso de B. serrata. Em resumo, é possível que B. serrata cause síndrome da secreção inapropriada do hormônio antidiurético quando tomada em doses elevadas. Os pacientes não devem se automedicar.

Pontine myelinolysis with an uncommon manifestation of hallucination: a case report / Mielinólise pontina com manifestação incomum de alucinação: relato de caso

ABSTRACT This report aims to present an elderly woman with persistent delirium after hospitalization for lethargy secondary to hyponatremia. The diagnosis of pontine myelinolysis was made and there were no characteristic neurological manifestations such as pupillary changes or spastic tetraparesis. Hallucinations and personality changes were the clues to the diagnosis and should be considered an atypical manifestation of pontine myelinolysis.

RESUMO O objetivo deste relato é apresentar uma idosa que apresentou, após internação por letargia secundária à hiponatremia, delirium persistente depois da alta hospitalar. O diagnóstico de mielinólise pontina foi feito após a alta hospitalar e não houve manifestações neurológicas características, como alterações pupilares ou tetraparesia espástica. Alucinações e mudança de personalidade foram as pistas para o diagnóstico e devem ser consideradas como uma manifestação atípica de mielinólise pontina.

Reporte de caso: síndrome de absorción intravascular en histeroscopia, intoxicación por glicina / Case report: Intravascular absorption syndrome in hysteroscopy, glycine intoxication

El síndrome de absorción intravascular en histeroscopia se origina por la rápida absorción vascular de soluciones isotónicas e hipotónicas utilizadas en irrigación intrauterina, ocasionando hipervolemia y dilución de electrolitos, especialmente hiponatremia. Cuando este síndrome es debido a intoxicación por glicina al 1,5% causa acidosis severa y neurotoxicidad. La incidencia de este síndrome es baja pero puede aumentar por factores como: falta de control de altura de bolsas de irrigación, ausencia de equilibrio de fluidos de soluciones de irrigación, tejidos altamente vascularizados como miomas uterinos y uso de sistema de electrocirugía monopolar. Se reporta el caso de una paciente con miomas uterinos, programada para resección mediante histeroscopia que cursa con síndrome de absorción intravascular por glicina, el temprano diagnóstico y rápido tratamiento intraoperatorio y postoperatorio permitió una evolución favorable. El manejo se basó en el uso de diuréticos, restricción de fluidos y soluciones hipertónicas de sodio.

Intravascular absorption syndrome in hysteroscopy is caused by rapid vascular absorption of isotonic and hypotonic solutions used in intrauterine irrigation, causing hypervolemia and electrolyte dilution, especially hyponatremia. When this syndrome is due to 1.5% glycine toxicity, it causes severe acidosis and neurotoxicity. The incidence of this syndrome is low but may increase due to factors such as: lack of control of the height of irrigation bags, lack of fluid balance in irrigation solutions, highly vascularized tissues such as uterine myomas and use of a monopolar electrosurgery system. The case of a patient with uterine myomas, scheduled for resection by hysteroscopy, who presents with intravascular glycine absorption syndrome, is reported. Early diagnosis and rapid intraoperative and postoperative treatment allowed a favorable evolution. Management was based on the use of diuretics, fluid restriction, and hypertonic sodium solutions.

Urea como opción terapéutica en síndrome de antidiuresis inadecuada

El síndrome de antiduresis inadecuada (SADI) se produce por una alteración en el eje hipotálamo-neurohipófisis, por una falla en la respuesta regulatoria osmótica o por factores no osmóticos, con complicaciones en relación directa al grado de hiponatremia e impacto en la calidad de vida y mortalidad del paciente. El tratamiento consiste en la normalización de la natremia, y la búsqueda de la etiología. Presentamos el caso de un paciente adulto con el diagnóstico de SADI idiopático y trastorno neurocognitivo asociado, con respuesta favorable al tratamiento con urea.

Syndrome of Inappropriate Antidiuresis (SIAD), is produced by an alteration in the hypothalamus-neurohypophysis axis due to a failure in the osmotic regulatory response or non-osmotic factors, with complications directly related to the degree of hyponatremia and impact on quality of life and patient mortality. Management consists of normalization of natremia, and the search for the underlying etiology. We present the case of an adult patient diagnosed with idiopathic SIAD and associated neurocognitive disorder, with a favorable response to treatment with urea.

Hiponatremia severa por meningitis tuberculosa: complicación frecuente pero olvidada

Se presenta el caso de un paciente varón de 55 años que ingresó por alteración del estado de conciencia por una hiponatremia severa secundaria a una meningitis tuberculosa. No hubo mejoría de la hiponatremia al tratamiento con solución salina hipertónica, por lo cual se planteó el diagnóstico de síndrome de secreción inapropiada de hormona antidiurética (SIADH) y se evidenció mejoría con la restricción hídrica. El interés del presente caso es reportar una complicación frecuente pero olvidada de la meningitis tuberculosa.

We present the case of a 55-year-old male patient who was admitted due to an altered state of consciousness due to severe hyponatremia secondary to tuberculous meningitis. There was no improvement in hyponatremia after treatment with hypertonic saline solution, therefore the diagnosis of syndrome of inappropriate secretion of antidiuretic hormone (SIADH) was proposed, and improvement was evidenced with fluid restriction. The interest of this case is to report a common but forgotten complication of tuberculous meningitis.

Hypopituitarism in elderly � A case series

Hypopituitarism is found to be one of the under investigated disease in elderly as it produces non specific symptoms which can be easily attributed to ageing and related co morbidities. Unless the hypopituitarism is identified and proper therapy is instituted, the clinical consequences of the untreated patients will be fatal. Here we report three cases of hypopituitarism in elderly patients whose clinical presentation and etiology was completely different. The first patient was fifty year old lady who is a known asthmatic for the past thirty years on steroids and had iatrogenic Cushing抯. On tapering the steroids she developed hypotension and giddiness. On eliciting the history she was suspected to have Sheehan抯 syndrome and was confirmed with investigations. She was advised to continue the steroids with calcium supplements. The second patient is an 80 years old female who came with complaints of increased tiredness daily more in the morning while getting up and improves slowly in the afternoon time and getting tired again in the night. When she was examined she had hypotension of 90/50 mm of hg. She was evaluated for Partial hypopituitarism and investigation confirmed hypopituitarism and she was started on Hydrocortisone tablets and she improved. The third patient was a 65 year old lady who was diagnosed to have diabetes mellitus and hypothyroidism and was on oral hypoglycemic drugs and eltroxine supplementation respectively. She had multiple hypoglycemic symptoms unresolved in spite of tapering the oral hypoglycemic drugs and on evaluation found to have partial hypopituitarism and started on T. Hydrocortisone and she improved well. We report these three cases as hypopitiutarism has multifaceted clinical presentation and needs high level of suspicion to diagnose it in elderly

Clinical features of Guillain-Barré syndrome with positive anti sulfatide antibody in CSF and hyponatremia(report of one case) / 临床神经病学杂志

Objective To summarize the diagnosis and treatment experience of patients with Guillain-Barré syndrome(GBS)with positive anti sulfatide antibody in CSF.Methods The clinical data of a case of patient with GBS with positive anti sulfatide antibody in CSF in Department of Neurology,The Affiliated Brain Hospital of Nanjing Medical University in January,2023 were retrospectively analyzed,and the relevant literatures were reviewed.Results Two cases with GBS with positive anti sulfatide antibody in CSF from 2 literatures were retrieved,a total of 3 cases were retrieved.All cases were males.The onset duration was 4-6 d.Two patients with GBS with positive anti-sufatide antibody in CSF developed limb weakness,severe back and limb pain.Albuminocytologic dissociation in CSF and inefficacy of immunoglobin were found in the two cases.Severe hyponatremia secondary to intravenous immunoglobin was observed in our case.One patient presented with cranial nerve damage with mild elevation of CSF protein and improvement after immunoglobulin.Conclusion The plasmapheresis was recommended for the patients presenting with limb weakness with positive anti-sulfatide antibody in CSF in order to prevent inefficacy and severe hyponatremia secondary to intravenous immunoglobin.

Clinical and imaging characteristics of central pontine myelinolysis without hyponatremia / 中华神经医学杂志

Objective:To investigate the clinical and imaging characteristics of central pontine myelinolysis (CPM) without hyponatremia and explore its pathogenesis.Methods:A retrospective analysis was performed. Six CPM patients without hyponatremia, admitted to Department of Neurology, He'nan Provincial People's Hospital from March 2021 to March 2023 were chosen. Demographic information, causes, medical history, clinical presentations, and MRI features at onset, and 1 and 3 months after onset were analyzed. The prognoses were evaluated by modified Rankin Scale (mRS) scores 3 months after onset: mRS scores≤2 was classified as good prognosis, and mRS scores>2 as poor prognosis.Results:In these 6 CPM patients without hyponatremia, 4 were males and 2 females; 4 patients had dizziness, 3 headache, 4 limb weakness, 2 cognitive decline, and 2 slow reaction. Four CPM patients had a history of hypertension, 5 had a history of diabetes, and 1 had a history of alcoholic cirrhosis. Hormone therapy, nutritional support and symptomatic treatment were given; 5 patients had obvious improvement, and 1 had poor prognosis 3 months after onset. MRI showed asymmetrical abnormal signal in the basal pons and bilateral brachium pontis, with T1WI hypointensity, T2WI hyperintensity, T2-FLAIR hyperintensity, DWI hyperintensity and clear boundary, and without obvious mass effect or enhancement. DWI sequence enjoyed good diagnostic sensitivity in early stage of CPM: high signal changes could occur within 24 h of clinical symptoms, and isointensity 3 months after onset.Conclusion:Causes of CPM without hyponatremia are mostly hypokalemia, diabetes, malnutrition, and chronic alcoholism; its characteristic MRI manifestations are "pig nose sign", "bat wing sign" and "trident sign".

The association of hyponatremia with clinicopathological and prognostic characteristics of non-small cell lung cancer patients: A systematic review and meta-analysis / 中国胸心血管外科临床杂志

@#Objective    To explore the association of pretreatment hyponatremia with clinicopathological and prognostic characteristics of non-small cell lung cancer (NSCLC) patients. Methods    The PubMed, EMbase, Web of Science, VIP, CNKI and WanFang databases were searched from the inception to July 12, 2021 for relevant literatures. The quality of included studies was assessed by the Newcastle-Ottawa Scale (NOS) score. The relative risk (RR) and hazard ratio (HR) with 95% confidence interval (CI) were combined to assess the relationship between pretreatment hyponatremia and clinicopathological and prognostic characteristics. The prognostic indicators included the overall survival (OS) and progression-free survival (PFS). All statistical analysis was conducted by the STATA 15.0 software. Results    A total of 10 high-quality studies (NOS score≥6 points) involving 10 045 patients were enrolled and all participants were from Asian or European regions. The pooled results demonstrated that male [RR=1.18, 95%CI (1.02, 1.36), P=0.026], non-adenocarcinoma [RR=0.86, 95%CI (0.81, 0.91), P<0.001] and TNM Ⅲ-Ⅳ stage [RR=1.17, 95%CI (1.12, 1.21), P<0.001] patients were more likely to experience hyponatremia. Besides, pretreatment hyponatremia was significantly related to worse OS [HR=1.83, 95%CI (1.53, 2.19), P<0.001] and PFS [HR=1.54, 95%CI (1.02, 2.34), P=0.040]. Pretreatment hyponatremia was a risk factor for poor prognosis of NSCLC patients. Conclusion    Male, non-adenocarcinoma and advance stage NSCLC patients are more likely to experience hyponatremia. Meanwhile, the pretreatment sodium level can be applied as one of the prognostic evaluation indicators in NSCLC and patients with hyponatremia are more likely to have poor survival. However, more researches are still needed to verify above findings.

Encefalitis límbica asociada a secreción inadecuada de hormona antidiurética. Reporte de un caso y revisión de la literatura / Limbic encephalitis associated with inappropriate secretion of antidiuretic hormone. A case report and literature review / Encefalite límbica associada à secreção inapropriada de hormônio antidiurético. Relato de caso e revisão da literatura

La encefalitis límbica (EL) autoinmune es una afección neurológica infrecuente de curso subagudo con manifestaciones neuropsicológicas. Actualmente el tratamiento inmunoterápico agudo o de mantenimiento es dirigido según el anticuerpo neural acompañante y la presencia o ausencia de cáncer. Presentamos el caso de una mujer de 52 años con hipotiroidismo autoinmune, síndrome de secreción inadecuada de hormona antidiurética (SIADH) e hiponatremia (hipoNa) persistente, con evolución progresiva de perdida de la memoria y crisis distónicas faciobraquiales (DFBC) a quien se le realiza un diagnóstico oportuno de encefalitis límbica. Recibió tratamiento intravenoso combinado en base a corticoides e inmunoglobulina con buena respuesta y morbilidad mínima neuropsicológica. El reconocimiento de esta patología permite un diagnóstico y tratamiento temprano, imprescindible para mejorar el pronóstico de estos pacientes.

Autoimmune limbic encephalitis is a rather unusual neurological condition with subacute progression and neuropsychological symptoms. Currently, acute or maintenance treatment with immunotherapy is targeted depending on the accompanying neural specific antibody and the presence or absence of cancer. The study presents the case of a 52-year-old woman suffering from autoimmune hypothyroidism, syndrome of inappropriate secretion of anti-diuretic hormone (SIADH) and persistent hyponatremia, with progressive evolution which involved memory loss and faciobrachial dystonic seizures (FBDS). She was timely diagnosed with limbic encephalitis and was treated with intravenous combined corticosteroids and immunoglobulin therapy. Response was good, with minimum neuropsychological. Recognizing this condition allows for early diagnosis and treatment, what is key to improve the prognosis of these patients.

A encefalite límbica (LE) autoimune é uma condição neurológica rara de curso subagudo com manifestações neuropsiquiátrica. Atualmente, o tratamento com imunoterapia aguda ou de manutenção é orientado de acordo com o anticorpo neural e a presença ou ausência de câncer. Apresentamos o caso de uma mulher de 52 anos com hipotireoidismo autoimune, síndrome de secreção inapropriada de hormônio antidiurético e hiponatremia persistente, com evolução progressiva da perda de memória e crises distônicas faciobraquiais que foi diagnosticada oportunamente como encefalite límbica. Recebeu tratamento endovenoso combinado à base de corticoide e imunoglobulina com boa resposta e morbidade neuropsiquiátrica mínima. O reconhecimento desta patologia permite um diagnóstico e tratamento precoces, essenciais para melhorar o prognóstico desses pacientes.

Neonatal systemic pseudohypoaldosteronism type I / 中国当代儿科杂志

An 18-day-old male infant was admitted to the hospital due to recurrent hyperkalemia for more than 10 days. The neonate had milk refusal and dyspnea. The blood gas analysis revealed recurrent hyperkalemia, hyponatremia and metabolic acidosis. Adrenocortical hormone replacement therapy was ineffective. Additional tests showed a significant increase in aldosterone levels. Family whole exome sequencing revealed that the infant had compound heterozygous in the SCNNIA gene, inherited from both parents. The infant was diagnosed with neonatal systemic pseudohypoaldosteronism type I. The infant's electrolyte levels were stabilized through treatment with sodium polystyrene sulfonate and sodium supplement. The infant was discharged upon clinical recovery. This study provides a focused description of differential diagnosis of salt-losing syndrome in infants and introduces the multidisciplinary management of neonatal systemic pseudohypoaldosteronism type I.

SIADH associated with prostate cancer: a case report / 中华泌尿外科杂志

Prostate cancer with refractory hyponatremia is rare. A patient was admitted with urinary retention, who developed weakness, apathy, and altered mental status during hospitalization, and was diagnosed with severe hyponatremia. After multidisciplinary consultations with departments such as endocrinology and neurology, the patient was diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH). The patient received serum PSA test and prostate MRI examination, and was diagnosed with prostate cancer by prostate biopsy. Laparoscopic radical prostatectomy was successfully performed. Results: The patients took tolvaptan orally before operation to maintain normal serum sodium. One month after radical prostatectomy, the symptoms of fatigue and anorexia disappeared, and serum sodium returned to normal without tolvaptan taking and sodium supplementation. No tumor recurrence or hyponatremia relapse observed during the 6-month follow-up.

Relationship between serum sodium level and prognosis of severe craniocerebral injury / 国际外科学杂志

Objective:To explore the effect of different blood sodium levels on the condition and prognosis of patients with severe craniocerebral injury.Methods:A retrospective cohort study was conducted on 150 cases of severe craniocerebral injury admitted to Zhangye People′s Hospital Affiliated to Hexi University from January 2020 to October 2022. According to the five blood sodium values measured on the first day after admission and during the peak period of brain edema (2-4 days after injury) and 7 days after injury, 102 cases of blood sodium metabolic disorder, 43 cases of low sodium group: average blood sodium value<135 mmol/L, 59 cases of high sodium group: average blood sodium value>145 mmol/L. The characteristics of sodium ion metabolism imbalance and the relationship between serum sodium level and Glasgow coma score (GCS), Glasgow prognosis score (GOS) and APACHE Ⅱ score at 2 weeks after injury were analyzed. Measurement data with normal distribution were represented as mean±standard deviation ( ± s), and comparison between groups was conducted using the t-test. count data were expressed as cases or percentages(%), and comparison between groups was conducted using the Chi-square test. Results:The imbalance rate of sodium metabolism in the acute phase after injury was 68.00%(102/150), including 57.84%(59/102) of hypernatremia and 42.16%(43/102) of hyponatremia. The imbalance rate of sodium metabolism at 7 days after injury was significantly higher than that immediately after injury. Hypernatremia occurred earlier than hyponatremia and lasted longer than hyponatremia ( P<0.05). There was no correlation between the low sodium group and the scores of GCS ( R=0.523), GOS ( R=0.367), APACHE Ⅱ ( R=-0.453) ( P>0.05), but the scores of GCS ( R=-0.448) and GOS ( R=-0.486) were negatively correlated with the blood sodium level of the high sodium group ( P<0.05), and the high sodium group was positively correlated with the scores of APACHE Ⅱ ( R=0.477, P<0.05). Conclusions:Patients with severe craniocerebral injury are often accompanied by blood sodium disorder. Hyponatremia can be corrected in a short time and has no effect on the patient′s condition and prognosis. However, hypernatremia seriously affects the recovery of consciousness, prognosis and quality of life of the injured.

Efficacy and safety of tolvaptan for hyponatremia：an overview of systematic reviews/meta-analysis / 中国药房

OBJECTIVE To reevaluate systematic reviews/meta-analysis of efficacy and safety of tolvaptan for hyponatremia. METHODS Retrieved from CNKI， Wanfang Data， VIP， CBM， PubMed， Embase and the Cochrane Library database， systematic reviews/meta-analysis about tolvaptan for the treatment of hyponatremia were included from the inception to June 15， 2022. After screening literature and extracting data， the PRISMA statement， AMSTAR 2 scale and GRADE method were used to evaluate the reporting quality， methodological quality and evidence quality of the included literature， respectively. RESULTS A total of 6 articles were included， of which 1 was systematic review and 5 were meta-analysis， including 56 outcome indicators. All of the 6 studies had PRISMA scores ranging from 15.0 to 20.5， and the quality of them was moderate. Results of the AMSTAR 2 scale showed that the methodological quality of 5 literatures were very low， and the quality of 1 literature was low. The quality of GRADE evidence showed that there were 6 moderate-quality indicators， 13 low-quality indicators， 35 very low-quality indicators， and 2 indicators that could not be assessed due to missing data. The main factors causing degradation were limitations， inconsistency， imprecision and publication bias. In terms of efficacy， tolvaptan could effectively increase the level of serum sodium， increase urine volume， reduce body weight， reduce abdominal circumference， relieve edema， and reduce alaninetransaminase level. In terms of safety， the incidence of total adverse drug reaction induced by tolvaptan was controversial； it may increase the risk of dry mouth， thirst， frequent urination or excessive correction of serum sodium. CONCLUSIONS Tolvaptan has great efficacy in the treatment of hyponatremia， but serum sodium overcorrection should be avoided in terms of safety. Relevant systematic reviews/meta-analysis have shortcomings of low reporting quality， methodological quality and evidence quality， which may reduce the reliability of the results， so the results should be treated with caution.

Clinical Profile and Management of Hyponatremia among Patients Admitted to a Tertiary Care Hospital: A Cross-sectional Study

Background: Hyponatremia is one of the most common laboratory dispute which may occur in many clinical conditions. Hyponatremia complication may include significant co-morbidities like heart failure, liver cirrhosis, and nephrotic syndrome in addition to diuretic use.Material & Methods:This study was a retrospective cross-sectional study, conducted at the department of Medicine in Tairunnessa Memorial Medical College. The study was conducted during the period ofJanuary 2019- April 2022. The total sample size for this study was 94.Results:Most patients 24(25.5%) were aged between 41-50 years and followed by 5(5.3%) were aged 11-20 years. Most of the respondents 65(69%) were female and 29(31%) were male. Most of the respondents 49(52.1%) were housewife. Diarrhoea was seen in 50(53.2%) cases and followed by vomiting in 27(28.7%), nausea in 15(16%), general weakness in 10(10.6%), anorexia in 41(43.6%). HTN&BA, DM, CKD in 6(6.4%), severe pre eclampsia in 3(3.2%), chronic kidney disease in 2(2.1%), COPD in 2(2.1%). Hyponatremia was found mild in 68(72.3%) cases, moderate in 24(25.5%) cases and severe in 2(2.1%) cases and followed by Hypokalaemia (K+ <3.6 mmol/l) was found in 59(62.8%), normal K+ level in 31(33%) cases and mild-moderate hyperkalaemia in 3(3.2%) cases. Hypochloridaemia (Cl– <96 mmol/l) was found in 62(66%), normal Cl– level in 29(30.9%) cases andhyperchloridaemia in 3(3.2%) cases. Tab. Nacl was prescribed to 67(71.3%) patients, normal saline to 79(84%), Hypertonic saline (3% Nacl saline) to 5(5.3%), Cholera Saline to 3(3.2%) and others suggestion along with prescribed medicine was given to 94(100%) patients.Conclusions:Hyponatremia is one of the common electrolyte abnormalities which can be seen among hospitalized patients. It is mostly seen in elderly and critically ill patients who are admitted to the ICU.

Prevalence and outcome of hyponatremia in patients admitted with COVID-19

Background: Hyponatremia occurs in up to 30% of patients with pneumonia and is associated with increased morbidity and mortality. The prevalence of hyponatremia associated with coronavirus disease 2019 and the impact on outcome is unknown. We aimed to identify the prevalence, and outcome of patients having hyponatremia admitted with COVID-19. Methods: This was a retrospective observational study conducted among admitted adult patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Srinivas institute of medical sciences and research centre, Mukka, Surathkal.Results: This difference in hyponatremia was statistically significant with regard to age (p<0.001), respiratory rate (p=0.002), SpO2(p=0.029), total counts (p=0.03), CRP (p=0.005), and d-dimer (p=0.015).Conclusions: In patients with COVID-19, age, hypotension, respiratory rate, SpO2, total counts, CRP, and D-Dimer have significant correlation with hyponatremia. Also, patients with COVID-19 and hyponatremia have higher rates of mechanical ventilation and mortality

Dysnatremia in patients with chronic liver disease: a cross-sectional observational study

Background: The clinical significance of serum sodium levels and its association with a higher rate of complications in cirrhosis is debatable. This study was done to study the serum sodium levels in chronic liver disease (CLD) patients and establish its association with the severity of disease in such patients.Methods: In this cross-sectional study, we included adult patients diagnosed with CLD and assessed their serum electrolytes. The severity of liver disease was assessed using Child Pugh score (CPS) and model for end stage liver disease (MELD). Those with serum sodium levels less than 130 mEq/lwere classified as group A, 131 to 135 mEq/las normal group B and greater or equal to 136 mEq/las Group C.Results:In the present study, hepatic encephalopathy (p<0.01), hepatorenal syndrome (p<0.01) and coagulopathy (p<0.01) were found to occur significantly more common among patients from Group A, as compared to those in patients from group B or C. Mean MELD, CPS score and mortality was significantly higher among group A patients.Conclusions: Patients with lower serum salt levels had a substantially higher MELD score and CPS. Low blood sodium levels were linked to more severe liver disease, greater complications, and increased death. As a result, we urge that serum salt levels be checked on a frequent basis in patients with chronic liver disease.