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1.
Eur Heart J Acute Cardiovasc Care ; 11(1): 43-52, 2022 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-34897402

RESUMO

AIMS: Hypochloraemia is common in patients hospitalized with heart failure (HF) and associated with a high risk of adverse outcomes during admission and following discharge. We assessed the significance of changes in serum chloride concentrations in relation to serum sodium and bicarbonate concentrations during admission in a cohort of 1002 consecutive patients admitted with HF and enrolled into an observational study based at a single tertiary centre in the UK. METHODS AND RESULTS: Hypochloraemia (<96 mmol/L), hyponatraemia (<135 mmol/L), and metabolic alkalosis (bicarbonate >32 mmol/L) were defined by local laboratory reference ranges. Outcomes assessed were all-cause mortality, all-cause mortality or all-cause readmission, and all-cause mortality or HF readmission. Cox regression and Kaplan-Meier curves were used to investigate associations with outcome. During a median follow-up of 856 days (interquartile range 272-1416), discharge hypochloraemia, regardless of serum sodium, or bicarbonate levels was associated with greater all-cause mortality [hazard ratio (HR) 1.44, 95% confidence interval (CI) 1.15-1.79; P = 0.001], all-cause mortality or all-cause readmission (HR 1.26, 95% CI 1.04-1.53; P = 0.02), and all-cause mortality or HF readmission (HR 1.41, 95% CI 1.14-1.74; P = 0.002) after multivariable adjustment. Patients with concurrent hypochloraemia and natraemia had lower haemoglobin and haematocrit, suggesting congestion; those with hypochloraemia and normal sodium levels had more metabolic alkalosis, suggesting decongestion. CONCLUSION: Hypochloraemia is common at discharge after a hospitalization for HF and is associated with worse outcome subsequently. It is an easily measured clinical variables that is associated with morbidity or mortality of any cause.


Assuntos
Insuficiência Cardíaca , Hiponatremia , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/epidemiologia , Hospitalização , Hospitais , Humanos , Hiponatremia/epidemiologia , Hiponatremia/etiologia , Readmissão do Paciente , Prognóstico
2.
Acta Biomed ; 92(5): e2021474, 2021 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-34738553

RESUMO

Hyponatraemia is frequently encountered in adults with coronavirus disease 2019 (COVID-19) and is associated with poor prognosis. This review aims to describe for the first time the prevalence, aetiology, prognostic value, pathophysiology, and management of hyponatraemia in children and adolescents with COVID-19, taking into account all relevant studies published in PubMed and Cochrane Library studies until 26th September 2021. Literature search did not detect any studies evaluating the prevalence and prognostic value of sodium disorders in paediatric patients with COVID-19. A broader literature review showed a high prevalence of hyponatraemia in children with bacterial pneumonia, while some studies have reported that hyponatraemia is relatively common in Multisystem Inflammatory Syndrome in Children (MIS-C). In adults with COVID-19, an inverse association between sodium and interleukin-6 levels has been found, indicating that hyponatraemia could be used as a surrogate marker for the risk of cytokine storm and may facilitate the identification of patients who could benefit from immunomodulatory agents. Studies are urgently needed to evaluate the frequency and prognostic impact of electrolyte abnormalities in children with COVID-19. In the meantime, clinicians are urged to consider hyponatraemia in children with COVID-19 as a potential red flag, investigate the cause and administer fluids and other therapies accordingly.


Assuntos
COVID-19 , Hiponatremia , Adolescente , Adulto , COVID-19/complicações , Criança , Humanos , Hiponatremia/epidemiologia , Hiponatremia/etiologia , Hiponatremia/terapia , Prevalência , Prognóstico , SARS-CoV-2 , Síndrome de Resposta Inflamatória Sistêmica
3.
Artigo em Inglês | MEDLINE | ID: mdl-34769840

RESUMO

A case study involving a healthy trained male athlete who completed a 786 km multi-stage ultra-trail race. Several markers were analyzed in blood and urine samples: creatinine (SCR) for kidney damage, sodium ([Na+]) for hyponatremia, creatine kinase (CK) for exertional rhabdomyolysis, as well as other hematological values. Samples were taken before and after the race and during the recovery period (days 2 and 9 after the race). Results showed: SCR = 1.13 mg/dl, [Na+] =139 mmol/l and CK = 1.099 UI/l. Criteria for the determination of acute kidney damage were not met, and [Na+] concentration was above 135 mEq/L, indicating the absence of hyponatremia. Exertional rhabdomyolysis was suffered by the athlete (baseline CK increased fivefold), though this situation was reverted after 9 days of recovery. Ultra-trail races cause biochemical changes in athletes, which should be known about by healthcare professionals.


Assuntos
Injúria Renal Aguda , Hiponatremia , Corrida , Creatina Quinase , Humanos , Hiponatremia/etiologia , Masculino , Resistência Física , Sódio
4.
Medicine (Baltimore) ; 100(40): e27453, 2021 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-34622867

RESUMO

RATIONALE: Functional pancreatic neuroendocrine tumors (pNETs) rarely produce vasopressin. Here, we reported a case of pNET producing vasopressin in a 78-year-old man with hyponatremia. PATIENT CONCERNS: The patient presented with anorexia approximately 4 years ago, and the laboratory test results indicated hyponatremia. He was hospitalized 3 times subsequently due to anorexia in the past 4 years, during which laboratory tests consistently indicated severe hyponatremia. DIAGNOSIS: Upon admission, his serum osmolarity, urine osmolarity, urine sodium level, and 24-hour urine sodium level was 277 mOsm/kg H2O, 465 mOsm/kg H2O, 82.5 mmol/L, and 140.25 mmol, respectively. Gallium-68-labeled tetraazacyclododecanetetraacetic acid-Dphel-Tyr3-octreotate positron emission tomography-computed tomography showed a high uptake lesion measuring approximately 1 cm in diameter in the pancreatic body, and the possibility of pNET was considered. Besides, laboratory tests showed that adrenocorticotropic hormone, follicle-stimulating hormone, and luteinizing hormone released by the pituitary was insufficient in the case of low levels of cortisol, estradiol, progesterone, and testosterone. Thus, the diagnosis of the syndrome of inappropriate antidiuresis (SIAD) was considered along with hypopituitarism. INTERVENTIONS: The patient underwent surgery, and pNET was confirmed by pathology examination. The immunohistochemical study showed that the tumor cells were positive for somatostatin receptors 2 and vasopressin. OUTCOMES: In the last follow-up 17 months after surgery, the patient was in good condition, taking methylprednisolone 4 mg every other day, and had been free of anorexia or hyponatremia episodes. LESSONS: This case illustrated the potential ectopic production of vasopressin resulting in SIAD in pNETs, highlighting the adoption of gallium-68-labeled tetraazacyclododecanetetraacetic acid-Dphel-Tyr3-octreotate positron emission tomography-computed tomography and vasopressin immunohistochemical staining in the evaluation of the etiology of SIAD.


Assuntos
Síndrome de Secreção Inadequada de HAD/etiologia , Tumores Neuroendócrinos/complicações , Neoplasias Pancreáticas/complicações , Vasopressinas/biossíntese , Corticosteroides/uso terapêutico , Idoso , Anorexia/etiologia , Humanos , Hiponatremia/etiologia , Síndrome de Secreção Inadequada de HAD/complicações , Síndrome de Secreção Inadequada de HAD/tratamento farmacológico , Masculino , Tumores Neuroendócrinos/cirurgia , Neoplasias Pancreáticas/cirurgia
5.
Medicine (Baltimore) ; 100(39): e27390, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34596163

RESUMO

RATIONALE: Systemic lupus erythematosus (SLE) is an autoimmune disease that involves multiple organs and causes various clinical manifestations. Cases of rhabdomyolysis as the initial presentation of SLE are rare, and there are no reported cases of SLE presenting hyponatremia-associated rhabdomyolysis as the first manifestation. Herein, we report a case of SLE with lupus nephritis in a patient with acute hyponatremia-associated rhabdomyolysis. PATIENT CONCERNS: A 44-year-old woman was admitted with complaints of altered consciousness, myalgia, and red-brownish urine that first appeared three days prior. Peripheral blood tests revealed elevated creatine kinase (19,013 IU/L) and myoglobin (5099 U/L) levels and severe hyponatremia (111 mEq/L) with no azotemia. Urinalysis showed nephritic sediments. DIAGNOSIS: Whole-body bone scintigraphy showed increased uptake of radiotracer in the both upper and lower extremities. Serological evaluation revealed the presence of anti-nuclear (speckled pattern, 1:640), anti-double stranded DNA, and anti-Smith antibodies and absence of anti-Jo-1 antibody. A kidney biopsy demonstrated mesangial proliferative (class II) lupus nephritis. INTERVENTIONS: Fluid therapy, including intravenous administration of 3% NaCl, was initiated. After three consecutive days of intravenous methylprednisolone (1 g/d), oral prednisolone (1 mg/kg/d), mycophenolate mofetil, and hydroxychloroquine were administered. OUTCOMES: On day 28, the patient was discharged with marked resolution of SLE-associated symptoms and laboratory findings. Lupus reactivation was not present during the subsequent six-month follow-up. LESSONS: Hyponatremia-associated rhabdomyolysis can be the first manifestation of SLE. Moreover, prompt fluid therapy and timely administration of immunosuppressive agents in SLE patients presenting with hyponatremia and rhabdomyolysis can significantly help alleviate disease activity and improve clinical outcomes.


Assuntos
Hiponatremia/etiologia , Nefrite Lúpica/diagnóstico , Rabdomiólise/etiologia , Feminino , Hidratação/métodos , Humanos , Hiponatremia/sangue , Imunossupressores/uso terapêutico , Nefrite Lúpica/complicações , Nefrite Lúpica/tratamento farmacológico , Pessoa de Meia-Idade
6.
BMJ Case Rep ; 14(9)2021 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-34518176

RESUMO

Central pontine myelinolysis (CPM) is commonly associated with osmotic stress and rapid correction of hyponatraemia. It has rarely been reported in conjunction with malignancies. We report a case where CPM was not only associated with a new diagnosis of diffuse large B-cell lymphoma but was also a key presenting feature.


Assuntos
Hiponatremia , Linfoma Difuso de Grandes Células B , Mielinólise Central da Ponte , Idoso de 80 Anos ou mais , Humanos , Hiponatremia/etiologia , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/diagnóstico , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Imageamento por Ressonância Magnética , Masculino , Mielinólise Central da Ponte/diagnóstico por imagem , Mielinólise Central da Ponte/etiologia
7.
ASAIO J ; 67(9): 1012-1017, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34477570

RESUMO

Hyponatremia is associated with increased morbidity and mortality in heart failure (HF) patients. The implication of hyponatremia during left ventricular assist device (LVAD) therapy remains unknown. In this retrospective study, consecutive LVAD patients implanted between April 2014 and March 2018 were stratified by the presence of hyponatremia (serum sodium <135 mEq/L) at 30 days post-LVAD. Incidence of HF readmissions and survival during 1-year follow-up were compared between the groups. Of 204 patients identified, 170 were included. Serum sodium levels improved significantly from pre-LVAD to 1-year post-LVAD (136 [133, 139] mEq/L to 137 [135, 140] mEq/L, p < 0.001). At 30 days, 35 patients (21%) were in the hyponatremia group. No difference was observed for 1-year survival between groups (77% vs. 81%, p = 0.66). However, the incidence of HF readmissions was significantly higher in the hyponatremia group (44% vs. 15%, p = 0.001). Among the patients with pre-LVAD hyponatremia (N = 60), those with normalized serum sodium levels (N = 42) had a lower incidence of HF readmissions compared with those with persistent hyponatremia (12% vs. 44%, p = 0.008). Hyponatremia in LVAD patients is associated with a higher incidence of HF readmissions. Further studies are needed to elucidate whether therapies directed at hyponatremia (e.g., vasopressin antagonists) would improve outcomes in LVAD patients.


Assuntos
Insuficiência Cardíaca , Coração Auxiliar , Hiponatremia , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/terapia , Coração Auxiliar/efeitos adversos , Humanos , Hiponatremia/epidemiologia , Hiponatremia/etiologia , Estudos Retrospectivos , Resultado do Tratamento
8.
BMC Infect Dis ; 21(1): 1000, 2021 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-34560836

RESUMO

BACKGROUND: The Syndrome of Inappropriate Antidiuresis (SIADH) has been described to be associated with a multitude of conditions and medications, including the severe acute respiratory syndrome coronavirus 2. We describe the case of a patient with newly diagnosed and symptomatic SIADH after receiving the second COVID-19 vaccination not explained otherwise. CASE PRESENTATION: A 79-year-old male person was admitted to the emergency department due to a worsening of his general health state expressed by weakness, fatigue and anorexia. Vital signs and clinical findings were normal, in particular the patient was considered to be euvolemic. Laboratory investigations revealed a serum sodium of 117 mmol/L, a serum osmolality of 241 mosm/kg and a urea of 1.2 mmol/L with creatinine within normal range. Urine chemistry showed a urine osmolality of 412 mosm/kg and urine sodium of 110 mmol/L. TSH, C-reactive protein, and basal cortisol levels were normal. Under therapy with balanced crystalloid fluids, hyponatremia worsened and in absence of diuretic medications, diagnosis of SIADH was made. Since fluid restriction was not sufficiently effective, oral urea was administered. Under this therapy regimen hyponatremia resolved. CONCLUSIONS: Local as well as systemic reactions have been described for the new mRNA-based vaccines including pain and fever. Therefore, it is imaginable that the vaccine might trigger SIADH in some patients.


Assuntos
COVID-19 , Hiponatremia , Síndrome de Secreção Inadequada de HAD , Idoso , Vacinas contra COVID-19 , Humanos , Hiponatremia/etiologia , Síndrome de Secreção Inadequada de HAD/induzido quimicamente , Masculino , SARS-CoV-2 , Vacinação
9.
Eur J Endocrinol ; 185(4): R103-R111, 2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34370712

RESUMO

This review examines the prevalence, aetiology, pathophysiology, prognostic value, and investigation of dysnatraemia in hospitalised COVID-19 patients, taking into account all relevant studies published in PubMed and Cochrane Library studies until March 2021. Hyponatraemia is commonly observed in patients with bacterial pneumonia and is an independent predictor for excess mortality and morbidity. However, it remains unknown whether this association applies to coronavirus disease-2019 (COVID-19). Several studies reported a 20-35% prevalence for hyponatraemia and 2-5% for hypernatraemia in patients admitted with COVID-19. In addition, hyponatraemia on admission was a risk factor for progression to severe disease, being associated with an increased likelihood for the need for invasive mechanical ventilation, with an odds ratio (OR) of 1.83-3.30. Hyponatraemia seems to be an independent risk factor for mortality, with an OR of 1.40-1.50 compared to normonatraemia, while hypernatraemia is related to even worse outcomes than hyponatraemia. Furthermore, preliminary data show an inverse association between serum sodium and interleukin-6 levels, suggesting that hyponatraemia might be used as a surrogate marker for the risk of a cytokine storm and the need for treatment with interleukin antagonists. In conclusion, dysnatraemia is common and carries a poor prognosis in COVID-19 patients, indicating that it may play a future role in risk stratification and individualising therapy.


Assuntos
COVID-19 , Hipernatremia , Hiponatremia , COVID-19/complicações , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/terapia , Comorbidade , Hospitalização/estatística & dados numéricos , Humanos , Hipernatremia/diagnóstico , Hipernatremia/epidemiologia , Hipernatremia/etiologia , Hipernatremia/terapia , Hiponatremia/diagnóstico , Hiponatremia/epidemiologia , Hiponatremia/etiologia , Hiponatremia/terapia , Pandemias , Valor Preditivo dos Testes , Prevalência , Prognóstico , Fatores de Risco , Índice de Gravidade de Doença
10.
BMJ Case Rep ; 14(8)2021 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-34380688

RESUMO

The incidence of pituitary adenoma has been increasing these days. Majority of the cases are incidental findings on imaging; and these patients may be asymptomatic without any laboratory abnormalities. However, a non-functional sellar mass can initially present with hypopituitarism. The patient being described is an elderly female who presented with severe hyponatraemia. She has history of recurrent admissions for hyponatraemia in the past. Her biochemical evaluation revealed hypopituitarism and magnetic resonance imaging of brain showed pituitary microadenoma. Hyponatraemia as a presenting feature of hypopituitarism due to pituitary microadenoma is an uncommon scenario.


Assuntos
Adenoma , Hiponatremia , Hipopituitarismo , Neoplasias Hipofisárias , Adenoma/diagnóstico , Adenoma/diagnóstico por imagem , Idoso , Feminino , Humanos , Hiponatremia/etiologia , Hipopituitarismo/diagnóstico , Hipopituitarismo/etiologia , Imageamento por Ressonância Magnética , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/diagnóstico por imagem
11.
BMJ Case Rep ; 14(8)2021 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-34373242

RESUMO

Diabetic ketoacidosis (DKA) and hyponatraemia associated with beer potomania are severe diagnoses warranting intensive care level management. Our patient, a middle-aged man, with a history of chronic alcohol abuse and insulin non-compliance, presents with severe DKA and severe hyponatraemia. Correcting sodium and metabolic derangements in each disorder require significant attention to fluid and electrolyte levels. Combined they prove challenging and require an individualised approach to prevent the overcorrection of sodium. Furthermore, management of these conditions lends to the importance of understanding the pathophysiology behind their hormonal and osmotic basis.


Assuntos
Cetoacidose Diabética , Hiponatremia , Cerveja , Cetoacidose Diabética/complicações , Cetoacidose Diabética/diagnóstico , Humanos , Hiponatremia/diagnóstico , Hiponatremia/etiologia , Insulina , Masculino , Pessoa de Meia-Idade , Sódio
12.
BMJ Case Rep ; 14(8)2021 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-34373247

RESUMO

Hyponatraemia is the most common electrolyte disturbance observed in hospital inpatients. We report a 90-year-old woman admitted generally unwell following a fall with marked confusion. Examination revealed a tender suprapubic region, and investigations observed elevated inflammatory markers and bacteriuria. Admission investigations demonstrated a serum sodium of 110 mmol/L with associated serum osmolality 236 mmol/kg and urine osmolality 346 mmol/kg. She was treated for hyponatraemia secondary to syndrome of inappropriate antidiuretic hormone (SIADH) and urosepsis. However, her serum sodium failed to normalise despite fluid restriction, necessitating treatment with demeclocycline and hypertonic saline. Despite slow reversal of hyponatraemia over 1 month, the patient developed generalised seizures with pontine and thalamic changes on MRI consistent with osmotic demyelination syndrome (ODS). This case highlights the risk of ODS, a rare but devastating consequence of hyponatraemia treatment, despite cautious sodium correction.


Assuntos
Doenças Desmielinizantes , Hiponatremia , Síndrome de Secreção Inadequada de HAD , Idoso de 80 Anos ou mais , Doenças Desmielinizantes/complicações , Feminino , Humanos , Hiponatremia/etiologia , Hiponatremia/terapia , Síndrome de Secreção Inadequada de HAD/complicações , Solução Salina Hipertônica/uso terapêutico , Sódio
14.
BMJ Case Rep ; 14(8)2021 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-34353830

RESUMO

A 40-year-old woman presented to our emergency department in an altered state following a generalised tonic-clonic seizure. On regaining consciousness, she gave a history of bleeding tendencies and menorrhagia, fatigue, nausea, vomiting and appetite loss for a long time. She had received multiple blood transfusions in the last 10 years. Investigations revealed severe hyponatraemia, transaminitis and pancytopenia, which showed cyclical fluctuations in the hospital. Hyponatraemia was attributed to a central cause owing to secondary hypothyroidism and hypocortisolism on evaluation. A diagnosis of cyclical thrombocytopenia was made by logging the trends of blood cell lines and applying the Lomb-Scargle test. Liver biopsy showed features of transfusion hemosiderosis explaining transaminitis. All of the haematological abnormalities and clinical symptoms resolved on thyroxine and corticosteroid replacement, suggesting causal association hypopituitarism with cyclical thrombocytopenia.


Assuntos
Insuficiência Adrenal , Hiponatremia , Hipopituitarismo , Pancitopenia , Adulto , Feminino , Humanos , Hiponatremia/diagnóstico , Hiponatremia/etiologia , Hipopituitarismo/complicações , Hipopituitarismo/diagnóstico , Hipopituitarismo/tratamento farmacológico , Convulsões
15.
BMJ Case Rep ; 14(8)2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34404669

RESUMO

Pre-eclampsia is a common pregnancy complication with many associated maternal and fetal risks, yet its pathophysiology remains poorly understood. Hyponatraemia is a rarely described finding in pre-eclampsia that has been associated with both maternal and fetal complications and medically indicated delivery. We present a case of hyponatraemia in a patient admitted for induction of labour for gestational hypertension, which developed into pre-eclampsia with severe features requiring magnesium sulfate therapy for seizure prophylaxis. The patient's hyponatraemia resolved with delivery, fluid restriction and serial sodium monitoring. Adjustment to the components of the patient's magnesium sulfate infusion was made to reduce free water intake and avoid further exacerbation of her hyponatraemia. While there is currently no recommendation to routinely monitor sodium levels in hypertensive disorders of pregnancy, careful consideration of this potential finding in cases of pre-eclampsia should be given due to the overlap between symptoms of hyponatraemia and cerebral symptoms of pre-eclampsia.


Assuntos
Eclampsia , Hipertensão Induzida pela Gravidez , Hiponatremia , Pré-Eclâmpsia , Feminino , Humanos , Hiponatremia/etiologia , Hiponatremia/terapia , Sulfato de Magnésio/uso terapêutico , Gravidez , Sódio
16.
Medicine (Baltimore) ; 100(29): e26231, 2021 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-34398000

RESUMO

RATIONALE: Neuromyelitis optica spectrum disorders (NMOSD) is a rare autoimmune disease predominantly involving optic nerves and spinal cord, and possible comorbidities including syndrome of inappropriate antidiuretic hormone secretion or urinary complication. We reported a young girl diagnosed with NMOSD presented with refractory hyponatremia, acute urine retention, and general weakness. Clinical symptoms improved gradually after receiving intravenous immunoglobulin, high-dose methylprednisolone, and plasmapheresis. NMOSD should be kept in mind in adolescence with acute urine retention, intermittent fever, and hyponatremia. PATIENT CONCERNS: A 15-year-old girl admitted to our hospital due to no urination for 2 days. DIAGNOSIS: Aquaporin-4 antibodies were detected showing positive both in serum and cerebrospinal fluid. Long transverse myelitis in cervical and thoracic spinal cord and optic neuritis was revealed in magnetic resonance imaging. INTERVENTIONS: Intravenous immunoglobulin 2 g/kg was infused totally in 4 days, and methylprednisolone pulse therapy was subsequently followed in 5 days; followed by 5 courses of plasmapheresis a week later. OUTCOMES: Her muscle power, syndrome of inappropriate antidiuretic hormone secretion condition, and urinary function were all improved after immune-modulated treatment course; NMOSD relapsed twice within the first year after diagnosis, however no relapse of NMOSD in the subsequent 1 year. LESSONS: To the best of our knowledge, this was the first childhood case of NMO accompanied by refractory hyponatremia in the reported literature. In childhood cases presenting with refractory hyponatremia and limb weakness, NMO or NMOSD should be considered possible diagnoses despite their rarity in pediatric cases.


Assuntos
Hiponatremia/classificação , Neuromielite Óptica/complicações , Adolescente , Anuria/etiologia , Feminino , Humanos , Hiponatremia/etiologia , Imunoglobulinas Intravenosas/farmacologia , Imunoglobulinas Intravenosas/uso terapêutico , Pediatria
18.
Intern Med J ; 51(8): 1340-1343, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34423538

RESUMO

We present a case of severe hyponatraemia due to syndrome of inappropriate antidiuretic hormone (SIADH) in a patient with respiratory syncytial virus (RSV) infection. A retrospective analysis of all patients admitted to our hospital with RSV in the preceding 3-year period revealed hyponatraemia in 41 (28%) cases, of which 13 (8.9%) were moderate or severe. SIADH was explored and confirmed in five (3.4%) patients, raising this as an important, previously unrecognised, complication of RSV infection in adults. Physician awareness of SIADH as a potential complication of RSV will facilitate early diagnosis and treatment of this potentially fatal disorder.


Assuntos
Hiponatremia , Síndrome de Secreção Inadequada de HAD , Infecções por Vírus Respiratório Sincicial , Adulto , Humanos , Hiponatremia/diagnóstico , Hiponatremia/etiologia , Hiponatremia/terapia , Síndrome de Secreção Inadequada de HAD/complicações , Síndrome de Secreção Inadequada de HAD/diagnóstico , Infecções por Vírus Respiratório Sincicial/complicações , Infecções por Vírus Respiratório Sincicial/diagnóstico , Estudos Retrospectivos , Vasopressinas
20.
Sultan Qaboos Univ Med J ; 21(2): e312-e315, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34221482

RESUMO

Syndrome of inappropriate antidiuretic hormone (SIADH) secretion is a recognisable complication of acute porphyria. We report a nine-year-old female patient with hereditary tyrosinaemia type 1 and poor adherence to nitisinone therapy who presented with acute abdominal pain, vomiting and lethargy at Sultan Qaboos University Hospital, Muscat, Oman in 2016. She subsequently developed generalised tonic-clonic seizures attributable to severe hyponatremia that met the diagnostic criteria of SIADH. The acute porphyria screen also appeared positive. The patient responded well to fluid restriction and was discharged home without immediate neurological sequelae. Although acute porphyria is also a recognised complication of uncontrolled tyrosinaemia type 1, to the best of the authors' knowledge, no patient with tyrosinaemia type 1 has been reported to present with SIADH.


Assuntos
Hiponatremia , Síndrome de Secreção Inadequada de HAD , Tirosinemias , Criança , Feminino , Humanos , Hiponatremia/etiologia , Síndrome de Secreção Inadequada de HAD/complicações , Síndrome de Secreção Inadequada de HAD/diagnóstico , Omã , Tirosinemias/complicações , Tirosinemias/diagnóstico , Vasopressinas
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