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1.
Medicine (Baltimore) ; 100(9): e24604, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655925

RESUMO

ABSTRACT: Mortality of critically ill patients with coronavirus disease 2019 (COVID-19) was high. Aims to examine whether time from symptoms onset to intensive care unit (ICU) admission affects incidence of extra-pulmonary complications and prognosis in order to provide a new insight for reducing the mortality. A single-centered, retrospective, observational study investigated 45 critically ill patients with COVID-19 hospitalized in ICU of The Third People's Hospital of Yichang from January 17 to March 29, 2020. Patients were divided into 2 groups according to time from symptoms onset to ICU admission (>7 and ≤7 days) and into 2 groups according to prognosis (survivors and non-survivors). Epidemiological, clinical, laboratory, radiological characteristics and treatment data were studied. Compared with patients who admitted to the ICU since symptoms onset ≤7 days (55.6%), patients who admitted to the ICU since symptoms onset >7 days (44.4%) were more likely to have extra-pulmonary complications (19 [95.0%] vs 16 [64.0%], P = .034), including acute kidney injury, cardiac injury, acute heart failure, liver dysfunction, gastrointestinal hemorrhage, hyperamylasemia, and hypernatremia. The incidence rates of acute respiratory distress syndrome, pneumothorax, and hospital-acquired pneumonia had no difference between the 2 groups. Except activated partial thromboplastin and Na+ concentration, the laboratory findings were worse in group of time from symptoms onset to ICU admission >7 days. There was no difference in mortality between the 2 groups. Of the 45 cases in the ICU, 19 (42.2%) were non-survivors, and 16 (35.6%) were with hospital-acquired pneumonia. Among these non-survivors, hospital-acquired pneumonia was up to 12 (63.2%) besides higher incidence of extra-pulmonary complications. However, hospital-acquired pneumonia occurred in only 4 (15.4%) survivors. Critically ill patients with COVID-19 who admitted to ICU at once might get benefit from intensive care via lower rate of extra-pulmonary complications.


Assuntos
Cuidados Críticos , Estado Terminal , Avaliação de Sintomas , Tempo para o Tratamento/estatística & dados numéricos , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/etiologia , /diagnóstico , /fisiopatologia , China/epidemiologia , Cuidados Críticos/métodos , Cuidados Críticos/estatística & dados numéricos , Estado Terminal/mortalidade , Estado Terminal/terapia , Doenças do Sistema Digestório/diagnóstico , Doenças do Sistema Digestório/etiologia , Feminino , Pneumonia Associada a Assistência à Saúde/diagnóstico , Pneumonia Associada a Assistência à Saúde/mortalidade , Cardiopatias/diagnóstico , Humanos , Hiperamilassemia/diagnóstico , Hiperamilassemia/etiologia , Hipernatremia/diagnóstico , Hipernatremia/etiologia , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Prognóstico , Análise de Sobrevida , Avaliação de Sintomas/métodos , Avaliação de Sintomas/estatística & dados numéricos
2.
Eur J Endocrinol ; 184(3): 413-422, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33449918

RESUMO

Objective: The pandemic of coronavirus disease (COVID-19) has rapidly spread globally and infected millions of people. The prevalence and prognostic impact of dysnatremia in COVID-19 is inconclusive. Therefore, we investigated the prevalence and outcome of dysnatremia in COVID-19. Design: The prospective, observational, cohort study included consecutive patients with clinical suspicion of COVID-19 triaged to a Swiss Emergency Department between March and July 2020. Methods: Collected data included clinical, laboratory and disease severity scoring parameters on admission. COVID-19 cases were identified based on a positive nasopharyngeal swab test for SARS-CoV-2, patients with a negative swab test served as controls. The primary analysis was to assess the prognostic impact of dysnatremia on 30-day mortality using a cox proportional hazard model. Results: 172 (17%) cases with COVID-19 and 849 (83%) controls were included. Patients with COVID-19 showed a higher prevalence of hyponatremia compared to controls (28.1% vs 17.5%, P < 0.001); while comparable for hypernatremia (2.9% vs 2.1%, P = 0.34). In COVID-19 but not in controls, hyponatremia was associated with a higher 30-day mortality (HR: 1.4, 95% CI: 1.10-16.62, P = 0.05). In both groups, hypernatremia on admission was associated with higher 30-day mortality (COVID-19 - HR: 11.5, 95% CI: 5.00-26.43, P < 0.001; controls - HR: 5.3, 95% CI: 1.60-17.64, P = 0.006). In both groups, hyponatremia and hypernatremia were significantly associated with adverse outcome, for example, intensive care unit admission, longer hospitalization and mechanical ventilation. Conclusion: Our results underline the importance of dysnatremia as predictive marker in COVID-19. Treating physicians should be aware of appropriate treatment measures to be taken for patients with COVID-19 and dysnatremia.


Assuntos
/diagnóstico , Hipernatremia/diagnóstico , Hipernatremia/epidemiologia , Hiponatremia/diagnóstico , Hiponatremia/epidemiologia , Adulto , Idoso , /terapia , Estudos de Casos e Controles , Estudos de Coortes , Cuidados Críticos/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Humanos , Hipernatremia/complicações , Hipernatremia/terapia , Hiponatremia/complicações , Hiponatremia/terapia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Mortalidade , Pandemias , Prevalência , Prognóstico , Estudos Prospectivos , Suíça/epidemiologia , Triagem
3.
Am J Emerg Med ; 38(8): 1700.e1-1700.e3, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32386806

RESUMO

We report the case of a 21-year-old female presenting with severe hypernatremia and a gastric outlet obstruction due to chronic purging behavior with salt water flushes. She presented obtunded following emesis and a witnessed seizure. She was found to have a corrected sodium level of 177 mmol/L. Following initial intubation and resuscitation, her CT imaging showed massive gastric dilation with high-density material in the gastric lumen. After orogastric flushing was unsuccessful and the patient's abdominal distention worsened, she was managed surgically and found to have a salt bezoar leading to bowel ischemia and perforation. This case details the complications and management of acute hypernatremia and gastric outlet obstruction in an otherwise healthy, young female. In a society where eating disorders are pervasive, Emergency Medicine physicians should be familiar with dangerous dietary behaviors as well as the management of their rare, but potentially life-threatening, complications.


Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos/complicações , Dilatação Gástrica/etiologia , Hipernatremia/etiologia , Sódio na Dieta/envenenamento , Feminino , Dilatação Gástrica/diagnóstico por imagem , Humanos , Hipernatremia/diagnóstico , Hipernatremia/terapia , Sódio na Dieta/administração & dosagem , Tomografia Computadorizada por Raios X , Adulto Jovem
6.
Am J Kidney Dis ; 75(2): 272-286, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31606238

RESUMO

Overall body fluid concentration is regulated within a narrow range by the concerted action of the hypothalamic-pituitary axis to influence water intake through thirst and water excretion via the effect of vasopressin, or antidiuretic hormone, on renal collecting duct water permeability. Sodium is the principal extracellular cation; abnormalities in overall effective body fluid concentration, or tonicity, manifest as disturbances in serum sodium concentration. Depending on its severity and chronicity, hyponatremia can lead to significant symptoms, primarily related to central nervous system function. Failure to correct hyponatremia can lead to permanent neurologic damage, as can over rapid correction. It is thus essential to stay within specific limits for correction, particularly for chronic hyponatremia. Hypernatremia also leads to central nervous system dysfunction, although goals for its correction rate are less well established. This Core Curriculum article discusses the normal regulation of tonicity and serum sodium concentration and the diagnosis and management of hypo- and hypernatremia.


Assuntos
Currículo , Gerenciamento Clínico , Hipernatremia/diagnóstico , Hiponatremia/diagnóstico , Sódio/sangue , Humanos , Hipernatremia/sangue , Hipernatremia/terapia , Hiponatremia/sangue , Hiponatremia/terapia , Desequilíbrio Hidroeletrolítico
7.
Eur J Med Genet ; 63(2): 103641, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30894326

RESUMO

Holoprosencephaly is the most common brain malformation in humans and it is a complex genetic disorder. We report on a patient with holoprosencephaly caused by a rare ZIC2 mutation presenting a bifid nose associated with a nasal fistula and an epidermal cyst, besides hypernatremia. The patient was a 1 year and 4 months old girl that developed an important neuropsychomotor delay. Currently, she uses a wheelchair to move around and only emits sounds. Computed tomography (CT) scan revealed a semilobar holoprosencephaly and a Dandy-Walker variant. Head magnetic resonance imaging also disclosed corpus callosum agenesis and prefrontal subarachnoid space enlargement. On physical examination at 1 year and 4 months of age, we verified growth retardation, microcephaly, bilateral epicantic fold, upslanting palpebral fissures, bifid nose, and limbs spasticity secondary to hypertonia. Later, she began to present hypernatremia; however, its precise cause was not identified. At 6 years and 10 months of age, a nasal fistula was suspected. Facial CT scan showed an epidermal cyst at cartilaginous portion of the nasal septum. High resolution GTG-Banding karyotype was normal. However, molecular analysis through direct sequencing technique showed a mutation at regulatory region of the ZIC2 gene: c.1599*954T > A, a genetic variation previously described only in a Brazilian patient. Our patient presented findings still not reported in literature among patients with holoprosencephaly, including those with ZIC2 mutations. Thus, the spectrum of abnormalities associated to ZIC2 mutations may be broader and include other defects as those observed in our patient.


Assuntos
Cisto Epidérmico/genética , Holoprosencefalia/genética , Hipernatremia/genética , Proteínas Nucleares/genética , Mutação Puntual , Fístula do Sistema Respiratório/genética , Fatores de Transcrição/genética , Encéfalo/anormalidades , Encéfalo/diagnóstico por imagem , Cisto Epidérmico/diagnóstico , Facies , Feminino , Holoprosencefalia/diagnóstico , Humanos , Hipernatremia/diagnóstico , Lactente , Imagem por Ressonância Magnética , Fenótipo , Fístula do Sistema Respiratório/diagnóstico , Síndrome , Tomografia Computadorizada por Raios X
8.
J. pediatr. (Rio J.) ; 95(6): 689-695, Nov.-Dec. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1056654

RESUMO

ABSTRACT Objective: The literature indicates a single universal cut-off point for weight loss after birth for the risk of hypernatremia, without considering other factors. The aim of this study was to construct and internally validate cut-off points for the percentage weight loss associated with the risk of hypernatremia, taking into account risk factors. Methods: A prospective study with a three-day follow-up was conducted in 165 neonates with a gestational age ≥35 weeks. The main outcome variable was mild or moderate hypernatremia (serum sodium ≥ 145 mmol/L). Secondary variables (risk factors) were maternal and infant variables. A multivariate logistic regression model was constructed to predict hypernatremia, obtaining its probability and the optimal discriminant cut-off point for hypernatremia (receiver operating characteristic analysis). Based on this point, threshold weight loss values were obtained according to the other variables. These values were internally validated by bootstrapping. Results: There were 51 cases (30.9%) of hypernatremia. The mean percentage weight loss for hypernatremic infants was 8.6% and 6.0% for the rest. Associated variables in the multivariate model included greater weight loss, male gender, higher education level, multiparity, and cesarean delivery. The model had an area under the receiver operating characteristic curve of 0.84 (sensitivity = 77.6%; specificity = 73.2%). Similar values were obtained in the bootstrapping validation. The lowest percentage weight loss was 4.77%, for cesarean delivery in male infants of mothers with a higher education level. Conclusions: The weight loss percentage values depended on the type of delivery, parity, newborn gender, and level of maternal education. External studies are required to validate these values.


RESUMO Objetivo: A literatura indica um único ponto de corte universal na perda de peso após o nascimento para risco de hipernatremia, sem considerar outros fatores. Nosso objetivo foi criar e validar internamente pontos de corte para o percentual de perda de peso associado ao risco de hipernatremia considerando fatores de risco. Métodos: Foi feito um estudo prospectivo que incluiu 165 neonatos com idade gestacional ≥ 35 semanas, acompanhados por três dias. A principal variável de resultado foi hipernatremia leve ou moderada (sódio sérico ≥ 145 mmol/L). As variáveis secundárias (fatores de risco) foram variáveis maternas e dos neonatos. Um modelo multivariado de regressão logística foi criado para diagnosticar hipernatremia, obteve sua probabilidade e o ponto de corte discriminativo ideal para hipernatremia (análise da Característica de Operação do Receptor). Com base nesse ponto, obtivemos então os valores limites de perda de peso de acordo com as outras variáveis. Esses valores foram internamente validados por. Resultados: Há 51 casos (30,9%) de hipernatremia. O percentual de perda de peso para neonatos hipernatrêmicos foi 8,6% e 6,0% para o restante. As variáveis associadas no modelo multivariado incluíram maior perda de peso, sexo masculino, maior nível de escolaridade, multiparidade e cesárea. O modelo apresentou uma área sob a curva da Característica de Operação do Receptor de 0,84 (sensibilidade = 77,6%; especificidade = 73,2%). Valores semelhantes foram obtidos na validação da bootstrapping. O menor percentual de perda de peso foi 4,77% para cesárea em neonatos do sexo masculino de mães com maior nível de escolaridade. Conclusões: Os valores percentuais de perda de peso dependem do tipo de parto, paridade, sexo do recém-nascido e nível de escolaridade materna. São necessários estudos externos para validar esses valores.


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Perda de Peso , Desidratação/diagnóstico , Hipernatremia/diagnóstico , Aleitamento Materno , Análise Multivariada , Estudos Prospectivos , Fatores de Risco , Idade Gestacional , Desidratação/etiologia , Desidratação/prevenção & controle , Hipernatremia/etiologia , Hipernatremia/prevenção & controle
9.
Med Sci Monit ; 25: 8438-8446, 2019 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-31705647

RESUMO

BACKGROUND Hypernatremia is associated with poor outcomes in critically ill patients, and an accurate assessment of water volume is important to determine appropriate fluid hydration. Bioelectrical impedance analysis (BIA) is a new, noninvasive, and relatively easy method for measuring hydration status. This study aimed to investigate whether bioelectrical impedance measurements of body water could reduce the frequency of blood sampling for fluid replacement in patients with hypernatremia. MATERIAL AND METHODS Fifty-one hospitalized patients were studied with hypernatremia, defined as a serum sodium ≥150 mmol/L determined by laboratory testing. Laboratory and BIA measurements were compared, and water deficiency was calculated with a conventional formula (sodium-corrected Watson formula) and measured by BIA. RESULTS The value of the absolute fluid overload (AFO) equivalent to the overhydration (OH) value, determined using BIA, did not accurately represent water deficit in patients with hypernatremia (r=0.137, P=0.347). Although the total body water (TBW) measured by BIA showed a significant correlation with that determined by the conventional formula (r=0.861, P<0.001), there was a proportional bias (r=0.617, P<0.001). The intracellular water (ICW) measured by BIA underestimated the TBW level calculated by the conventional formula by about 14.06±4.0 L in the Bland-Altman analysis. CONCLUSIONS It is not currently possible to replace blood testing with BIA for assessing volume status in hypernatremic patients. However, ICW value measured by BIA might represent plasma sodium level more accurately than extracellular water (ECW) or TBW value in patients with hypernatremia.


Assuntos
Hipernatremia/diagnóstico , Hipernatremia/metabolismo , Estado de Hidratação do Organismo/fisiologia , Adulto , Composição Corporal , Água Corporal/fisiologia , Desidratação/diagnóstico , Impedância Elétrica , Espaço Extracelular , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Água
10.
J Clin Endocrinol Metab ; 104(11): 5427-5430, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31373657

RESUMO

CONTEXT: Psychogenic adipsic hypernatremia is an exceedingly rare and life-threatening condition, occurring in those with severe psychiatric disorders. Its diagnosis requires exclusion of congenital or acquired hypothalamic pathologic entities. We present the case of a patient who experienced transient severe hypernatremia without evidence of brain pathologic features or known psychiatric disease. In our patient, the transient adipsic hypernatremia had resulted from an episode of mild depression that resolved spontaneously. CASE DESCRIPTION: A 46-year-old healthy woman who had had three recurrent admissions within 1 month had presented for evaluation of intractable nausea and vomiting with a history of a recent episode of a depressive mood change. Each admission had shown substantial hypernatremia (maximum plasma sodium, 166 mEq/L) accompanied by a strong aversion to consuming water. The findings from the diagnostic evaluation showed elevated serum osmolality and lower than expected urine osmolality (urine osmolality range, 474-501 mOsm/kg). This finding, along with an MRI scan showing the presence of a normal posterior pituitary bright spot, suggested that the osmoregulation of her thirst and arginine vasopressin (AVP) secretion were both defective during the attack. The patient was evaluated by psychiatry. Mild depression was diagnosed, and the patient started treatment with mirtazapine, which she only took for a few days. The patient's hypernatremia had completely recovered with resolution of her depression within 2 months. CONCLUSION: A mild mood disorder can cause transient dysregulation of the thirst mechanism and AVP secretion through not yet identified mechanisms.


Assuntos
Transtorno Depressivo/complicações , Hipernatremia/etiologia , Sede/fisiologia , Antidepressivos/uso terapêutico , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/fisiopatologia , Feminino , Humanos , Hipernatremia/diagnóstico , Hipernatremia/fisiopatologia , Pessoa de Meia-Idade , Mirtazapina/uso terapêutico , Concentração Osmolar , Resultado do Tratamento
11.
Eur J Endocrinol ; 181(2): 193-199, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31167167

RESUMO

Background: Diagnosis and treatment of dysnatremia is challenging and further complicated by the pitfalls of different sodium measurement methods. Routinely used sodium measurements are the indirect (plasma/serum) and direct (whole blood) ion-selective electrode (ISE) method, showing discrepant results especially in the setting of acute illness. Few clinicians are aware of the differences between the methods in clinically stable patients or healthy volunteers. Methods: Data of 140 patients and 91 healthy volunteers undergoing osmotic stimulation with hypertonic saline infusion were analyzed. Sodium levels were measured simultaneously by indirect and direct ISE method before and at different time points during osmotic stimulation up to a sodium threshold of ≥150 mmol/L. The primary outcome was the difference in sodium levels between the indirect and direct ISE method. Results: 878 sodium measurements were analyzed. Mean (s.d.) sodium levels ranged from 141 mmol/L (2.9) to 151 mmol/L (2.1) by the indirect ISE compared to 140 mmol/L (3) to 149 mmol/L (2.8) by the direct ISE method. The interclass correlation coefficient between the two methods was 0.844 (95% CI: 0.823-0.863). On average, measurements by the indirect ISE were 1.9 mmol/L (95% CI limits: -3.2 to 6.9) higher than those by the direct ISE method (P < 0.001). The tendency of the indirect ISE method resulting in higher levels increased with increasing sodium levels. Conclusion: Intra-individual sodium levels differ significantly between the indirect and direct ISE method also in the absence of acute illness. It is therefore crucial to adhere to the same method in critical situations to avoid false decisions due to measurement differences.


Assuntos
Diabetes Insípido/sangue , Eletrodos Íon-Seletivos/normas , Polidipsia/sangue , Solução Salina Hipertônica/administração & dosagem , Sódio/sangue , Diabetes Insípido/diagnóstico , Humanos , Hipernatremia/sangue , Hipernatremia/induzido quimicamente , Hipernatremia/diagnóstico , Hiponatremia/sangue , Hiponatremia/diagnóstico , Polidipsia/diagnóstico , Estudos Prospectivos
12.
Pediatr Ann ; 48(5): e197-e200, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31067335

RESUMO

Hypernatremic dehydration in exclusively breast-fed neonates is associated with a free water deficit secondary to inadequate fluid intake. It is a common but underrecognized problem in the primary care setting, as the degree of dehydration can be underestimated due to fluid shifts. Neonates of primiparous mothers and those who experience greater weight loss in the first week of life are at higher risk of developing hypernatremic dehydration and most often present for care between 6 and 10 days of life. No consensus treatment guidelines exist, but most experts recommend a goal reduction rate of serum sodium levels of 0.5 mEq/L per hour with correction over 48 hours. Serum sodium level greater than 160 mEq/L is a risk factor for morbidity and mortality. Complications of hypernatremic dehydration, with seizure being most common, usually occur during improper correction. Several small studies have documented varying degrees of neurodevelopmental delay on long-term follow-up of patients admitted for hypernatremic dehydration treatment as a neonate. [Pediatr Ann. 2019;48(5):e197-e200.].


Assuntos
Desidratação , Hipernatremia , Aleitamento Materno , Desidratação/diagnóstico , Desidratação/etiologia , Desidratação/fisiopatologia , Desidratação/terapia , Humanos , Hipernatremia/diagnóstico , Hipernatremia/etiologia , Hipernatremia/fisiopatologia , Hipernatremia/terapia , Recém-Nascido , Masculino , Fatores de Risco
14.
Clin Endocrinol (Oxf) ; 91(1): 22-32, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31004513

RESUMO

Copeptin is secreted in an equimolar amount to arginine vasopressin (AVP) but can easily be measured in plasma or serum with a sandwich immunoassay. The main stimuli for copeptin are similar to AVP, that is an increase in osmolality and a decrease in arterial blood volume and pressure. A high correlation between copeptin and AVP has been shown. Accordingly, copeptin mirrors the amount of AVP in the circulation. Copeptin has, therefore, been evaluated as diagnostic biomarker in vasopressin-dependent disorders of body fluid homeostasis. Disorders of body fluid homeostasis are common and can be divided into hyper- and hypoosmolar circumstances: the classical hyperosmolar disorder is diabetes insipidus, while the most common hypoosmolar disorder is the syndrome of inappropriate antidiuresis (SIAD). Copeptin measurement has led to a "revival" of the direct test in the differential diagnosis of diabetes insipidus. Baseline copeptin levels, without prior thirsting, unequivocally identify patients with nephrogenic diabetes insipidus. In contrast, for the difficult differentiation between central diabetes insipidus and primary polydipsia, a stimulated copeptin level of 4.9 pmol/L upon hypertonic saline infusion differentiates these two entities with a high diagnostic accuracy and is clearly superior to the classical water deprivation test. On the contrary, in the SIAD, copeptin measurement is of only little diagnostic value. Copeptin levels widely overlap in patients with hyponatraemia and emphasize the heterogeneity of the disease. Additionally, a variety of factors lead to unspecific copeptin elevations in the acute setting further complicating its interpretation. The broad use of copeptin as diagnostic marker in hyponatraemia and specifically to detect cancer-related disease in SIADH patients can, therefore, not be recommended.


Assuntos
Diabetes Insípido/diagnóstico , Glicopeptídeos/sangue , Diabetes Insípido/sangue , Humanos , Hipernatremia/sangue , Hipernatremia/diagnóstico , Hiponatremia/sangue , Hiponatremia/diagnóstico , Polidipsia Psicogênica/sangue , Polidipsia Psicogênica/diagnóstico
15.
Crit Care Clin ; 35(2): 187-200, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30784603

RESUMO

Diabetes insipidus and the syndrome of inappropriate antidiuretic hormone secretion lie at opposite ends of the spectrum of disordered renal handling of water. Whereas renal retention of water insidiously causes hypotonic hyponatremia in syndrome of inappropriate antidiuretic hormone secretion, diabetes insipidus may lead to free water loss, hypernatremia, and volume depletion. Hypernatremia and hyponatremia are associated with worse outcomes and longer intensive care stays. Moreover, pathologies causing polyuria and hyponatremia in patients in intensive care may be multiple, making diagnosis challenging. We provide an approach to the diagnosis and management of these conditions in intensive care patients.


Assuntos
Antidiuréticos/uso terapêutico , Cuidados Críticos/normas , Desamino Arginina Vasopressina/uso terapêutico , Diabetes Insípido/tratamento farmacológico , Hipernatremia/tratamento farmacológico , Hiponatremia/tratamento farmacológico , Síndrome de Secreção Inadequada de HAD/tratamento farmacológico , Diabetes Insípido/diagnóstico , Diabetes Insípido/fisiopatologia , Feminino , Humanos , Hipernatremia/diagnóstico , Hiponatremia/diagnóstico , Síndrome de Secreção Inadequada de HAD/diagnóstico , Síndrome de Secreção Inadequada de HAD/fisiopatologia , Masculino , Guias de Prática Clínica como Assunto , Equilíbrio Hidroeletrolítico/efeitos dos fármacos
17.
Clin Toxicol (Phila) ; 57(5): 303-311, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30689457

RESUMO

INTRODUCTION: Sodium hypochlorite is used as a bleaching and disinfecting agent and is commonly found in household bleach. OBJECTIVE: The objective is to review critically the epidemiology, mechanisms of toxicity, clinical features, diagnosis, and management of hypochlorite poisoning. METHODS: PubMed was searched from January 1950 to June 2018 using the terms "Hypochlorite", "Sodium Hypochlorite", "Sodium Oxychloride", "Hypochlorous Acid", "Bleach", "Chlorine Bleach", in combination with the keywords "poisoning", "poison", "toxicity", "ingestion", "adverse effects", "overdose", and "intoxication". In addition, bibliographies of identified articles were screened for additional relevant studies including non-indexed reports. Non-peer-reviewed sources were also included. These searches produced 110 citations which were considered relevant. EPIDEMIOLOGY: There is limited information regarding statistical trends on world-wide poisoning from sodium hypochlorite. In the United States of America, poison control center data have shown that enquiries regarding hypochlorite bleaches have ranged from 43,000 to 46,000 per year over the period 2012-2016. Mechanisms of toxicity: Hypochlorite's potential to cause toxicity is related to its oxidizing capacity and the pH of the solution. Toxicity arises from its corrosive activity upon contact with mucous membranes and skin. Features following ingestion: While small accidental ingestions are very unlikely to cause clinically significant toxicity, large ingestions may cause corrosive gastrointestinal injury and systemic effects, including metabolic acidosis, hypernatremia, and hyperchloremia. Features following dental exposure: Hypochlorite is used extensively by dentists for cleaning root canals and is safe if the solution remains within the root canal. Extrusions into the periapical area can result in severe pain with localized large and diffuse swelling and hemorrhage. Features following skin exposure: Prolonged or extensive exposure may cause skin irritation and damage to the skin or dermal hypersensitivity. Such exposures can result in either immediate or delayed-type skin reactions. High concentration solutions have caused severe chemical skin burns. Features following inhalation: Although there are only limited data, inhalation of hypochlorite alone is likely to lead to no more than mild irritation of the upper airways. Features following ocular exposure: Corneal injuries from ocular exposure are generally mild with burning discomfort and superficial disturbance of the corneal epithelium with recovery within 1 or 2 days. With higher concentration solutions, severe eye irritation can occur. DIAGNOSIS: The diagnosis can typically be made on the basis of a careful history, including details of the specific product used, its hypochlorite concentration, and the amount involved. As hypochlorite bleach produces a characteristic smell of chlorine, this may provide a diagnostic clue. In severe cases, corrosive injury is suggested on presentation because of hypersalivation, difficulty swallowing, retrosternal pain or hematemesis. MANAGEMENT: Symptom-directed supportive care is the mainstay of management. Gastrointestinal decontamination is not beneficial. Local corrosive injury is the major focus of treatment in severe cases. Fiberoptic endoscopy and CT thorax/abdomen are complimentary and have been shown to be useful in corrosive injuries in assessing the severity of injury, risk of mortality and risk of subsequent stricture formation and should be performed as soon as possible after ingestion. Dental periapical extrusion injuries should be left open for some minutes to allow bleeding through the tooth and to limit hematoma development in tissue spaces. Once the bleeding has ceased, the canal can be dressed with non-setting calcium hydroxide and sealed coronally. CONCLUSIONS: Accidental ingestion of household bleach is not normally of clinical significance. However, those who ingest a large amount of a dilute formulation or a high concentration preparation can develop severe, and rarely fatal, corrosive injury so prompt supportive care is essential as there is no specific antidote. Treatment primarily consists of symptom-directed supportive care.


Assuntos
Desinfetantes/envenenamento , Oxidantes/envenenamento , Envenenamento , Hipoclorito de Sódio/envenenamento , Clareadores Dentários/envenenamento , Acidose/induzido quimicamente , Acidose/epidemiologia , Animais , Desinfetantes/química , Oftalmopatias/induzido quimicamente , Oftalmopatias/epidemiologia , Humanos , Hipernatremia/induzido quimicamente , Hipernatremia/diagnóstico , Hipernatremia/epidemiologia , Exposição por Inalação/efeitos adversos , Oxidantes/química , Envenenamento/diagnóstico , Envenenamento/epidemiologia , Envenenamento/terapia , Prognóstico , Doenças Respiratórias/induzido quimicamente , Doenças Respiratórias/epidemiologia , Medição de Risco , Dermatopatias/induzido quimicamente , Dermatopatias/epidemiologia , Hipoclorito de Sódio/química , Clareadores Dentários/química
18.
Free Radic Biol Med ; 134: 343-349, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30695690

RESUMO

BACKGROUND: The extra-renal effects of aldosterone on left ventricular (LV) structure and function are exacerbated by increased dietary sodium in persons with hypertension. Previous studies demonstrated endothelial dysfunction and increased oxidative stress with high salt diet in normotensive salt-resistant subjects. We hypothesized that increased xanthine oxidase (XO), a product of endothelial cells, is related to 24-h urinary sodium and to LV hypertrophy and function in patients with resistant hypertension (RHTN). METHODS: The study group included persons with RHTN (n = 91), defined as a blood pressure > 140/90 mmHg on ≥ 3 medications at pharmacologically effective doses. Plasma XO activity and 24-h urine were collected, and cardiac magnetic resonance imaging (MRI) was performed to assess LV function and morphology. Sixty-seven normotensive persons on no cardiovascular medications served as controls. A subset of RHTN (n = 19) received spironolactone without salt restriction for six months with follow-up XO activity measurements and MRI analyses. RESULTS: XO activity was increased two-fold in RHTN vs. normal and was positively correlated with LV mass, LV diastolic function, and 24-h urinary sodium. In RHTN patients receiving spironolactone without salt restriction, LV mass decreased, but LV diastolic function and XO activity did not improve. Baseline urinary sodium was positively associated with rate of change of LV mass to volume ratio and the LV E/A ratio. CONCLUSIONS: These results demonstrate a potential role of endothelium-derived oxidative stress and excess dietary salt in the pathophysiology of LV hypertrophy and diastolic dysfunction in persons with RHTN unaffected by the addition of spironolactone.


Assuntos
Hipernatremia/diagnóstico , Hipertensão/complicações , Hipertrofia Ventricular Esquerda/diagnóstico , Sódio/metabolismo , Xantina Oxidase/sangue , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Hipernatremia/sangue , Hipernatremia/enzimologia , Hipernatremia/etiologia , Hipertrofia Ventricular Esquerda/sangue , Hipertrofia Ventricular Esquerda/enzimologia , Hipertrofia Ventricular Esquerda/etiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
19.
Acta Clin Belg ; 74(1): 7-20, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30311550

RESUMO

The differential diagnosis between hypertonic, isotonic and hypotonic hyponatremia are presented. The help of some usual serum (urea, uric acid and TCO2) and urine parameters (mainly osmolality and sodium concentration) are discussed and help to determine the best treatment. Morbidity associated with untreated hyponatremia and with the different treatment available is also discussed. Who to prevent and treat ODS (osmotic demyelating syndrome) is recalled. The pathophysiology and treatment of hypernatremia are also discussed.


Assuntos
Hiponatremia/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Hipernatremia/sangue , Hipernatremia/diagnóstico , Hipernatremia/terapia , Hipernatremia/urina , Hiponatremia/sangue , Hiponatremia/terapia , Hiponatremia/urina , Masculino , Sódio/sangue
20.
J Pediatr (Rio J) ; 95(6): 689-695, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30030986

RESUMO

OBJECTIVE: The literature indicates a single universal cut-off point for weight loss after birth for the risk of hypernatremia, without considering other factors. The aim of this study was to construct and internally validate cut-off points for the percentage weight loss associated with the risk of hypernatremia, taking into account risk factors. METHODS: A prospective study with a three-day follow-up was conducted in 165 neonates with a gestational age ≥35 weeks. The main outcome variable was mild or moderate hypernatremia (serum sodium≥145mmol/L). Secondary variables (risk factors) were maternal and infant variables. A multivariate logistic regression model was constructed to predict hypernatremia, obtaining its probability and the optimal discriminant cut-off point for hypernatremia (receiver operating characteristic analysis). Based on this point, threshold weight loss values were obtained according to the other variables. These values were internally validated by bootstrapping. RESULTS: There were 51 cases (30.9%) of hypernatremia. The mean percentage weight loss for hypernatremic infants was 8.6% and 6.0% for the rest. Associated variables in the multivariate model included greater weight loss, male gender, higher education level, multiparity, and cesarean delivery. The model had an area under the receiver operating characteristic curve of 0.84 (sensitivity=77.6%; specificity=73.2%). Similar values were obtained in the bootstrapping validation. The lowest percentage weight loss was 4.77%, for cesarean delivery in male infants of mothers with a higher education level. CONCLUSIONS: The weight loss percentage values depended on the type of delivery, parity, newborn gender, and level of maternal education. External studies are required to validate these values.


Assuntos
Desidratação/diagnóstico , Hipernatremia/diagnóstico , Perda de Peso , Aleitamento Materno , Desidratação/etiologia , Desidratação/prevenção & controle , Feminino , Idade Gestacional , Humanos , Hipernatremia/etiologia , Hipernatremia/prevenção & controle , Recém-Nascido , Masculino , Análise Multivariada , Estudos Prospectivos , Fatores de Risco
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