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1.
Internist (Berl) ; 61(1): 91-95, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31673730

RESUMO

This article reports the case of a 43-year-old woman who presented to the emergency room with headache and paresthesia after a fall on the head while skiing. She had clinical signs of volume depletion and blood test showed severe hyponatremia. Cerebral imaging was unremarkable. The diagnosis of cerebral salt-wasting syndrome (CSWS) was made, which is defined by the presence of extracellular volume depletion due to a tubular defect in renal sodium transport in patients with normal adrenal and thyroid function. The disease is mostly secondary to a neurological disease or head trauma. The patient rapidly improved after volume therapy and treatment with mineralocorticoids. The differentiation of CSWS from the syndrome of inappropriate antidiuretic hormone (SIADH) secretion can be challenging but the distinction is important because treatment options are very different.


Assuntos
Traumatismos Craniocerebrais/complicações , Hiponatremia/etiologia , Síndrome de Secreção Inadequada de HAD/diagnóstico , Esqui/lesões , Acidentes , Adulto , Feminino , Humanos
2.
Zhonghua Nei Ke Za Zhi ; 59(1): 29-34, 2020 Jan 01.
Artigo em Chinês | MEDLINE | ID: mdl-31887833

RESUMO

Objective: The study was aimed to investigate the prevalence and causes of hyponatremia in hospitalized patients, and to analyze the relationship between hyponatremia and mortality. Methods: A retrospective analysis was carried out in 525 patients with hyponatremia, who were older than 14 years old and hospitalized in the Zhoushan Hospital from Jan. 2014 to Apr. 2014. Based on the severity of the hyponatremia the patients were divided into three groups: the mild, moderate and severe hyponatremia groups. The underlying causes of hyponatremia were analyzed, and the association between hyponatremia and mortality was explored using logistic regression analyses. Results: (1) The prevalence of hyponatremia was 5.26% in whole hospitalized patients (n=9 989) during the study period. It was 6.1% in the elderly population (≥60 years old). (2) Malignant tumors and infectious diseases were the main primary diseases of hyponatremia in all three groups. Among them, lung cancer was the most common malignant tumor, and pneumonia was the most common infectious disease associated with hyponatremia. Cerebral hemorrhage was common in patients with moderate and severe hyponatremia, in which subarachnoid hemorrhage was the major primary disease associated with moderate to severe hyponatremia. In the subgroup of elderly patients, malignant tumor and infectious diseases were the major basic diseases. (3) Among the 525 cases, 13.7% and 3.8% of them were diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH) and cerebral salt-wasting syndrome (CSWS), respectively. The proportions of SIADH and CSWS increased to 17.4% and 4.2%, respectively, in the elderly hyponatremic patients (n=264). (4) More patients were prescribed with sodium-excretion drugs in the moderate and severe hyponatremia groups than those in the mild one(42.2% vs.21.4%, 43.2% vs.21.4%, all P<0.05). (5) Patients with moderate or severe hyponatremia had a higher mortality compared to those with mild hyponatremia (moderate vs. mild group: OR 6.92, 95%CI 2.53-18.92, P<0.001; severe vs. mild group: OR 4.54, 95%CI 1.05-19.58, P=0.043). Conclusions: Hyponatremia was common in hospitalized patients. The major primary diseases were malignant tumor (lung cancer), infectious diseases (pneumonia) and cerebral hemorrhage complicated with SIADH and CSWS. Use of sodium-excretion drugs increased the risk of moderate to severe hyponatremia. Patients with moderate to severe hyponatremia had a higher risk of death in hospitals.


Assuntos
Hiponatremia/epidemiologia , Adolescente , Distribuição por Idade , Idoso , China/epidemiologia , Mortalidade Hospitalar , Humanos , Hiponatremia/etiologia , Hiponatremia/mortalidade , Síndrome de Secreção Inadequada de HAD , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Sódio
3.
Clin Nephrol ; 93(1): 42-46, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31670650

RESUMO

BACKGROUND: Various studies have demonstrated that interleukin-6 (IL-6) activates the central magnocellular arginine vasopressin (AVP)-secreting neurons in the brain to produce non-osmotic, non-volume-mediated increases in AVP. The most common toxicity of CD19+ chimeric antigen receptor (CAR) T-cells is cytokine release syndrome, which is related to increased levels of IL-6. This study will evaluate the correlation of IL-6 levels with hyponatremia in patients receiving CD19+ CAR T-cells. MATERIALS AND METHODS: This is a single-center retrospective analysis of adult patients who received CD19+ CAR T-cells for the treatment of relapsed/refractory acute lymphoblastic leukemia (ALL). RESULTS: Hyponatremia, defined as a serum sodium (Na) ≤ 135 mEq/L, occurred in 31 (61%) patients. A change in Na > 7 mEq occurred in 32 (63%) patients, and the median lowest Na was 133 mEq/L (interquartile range (IQR): 131 - 136)). There was an inverse linear relationship between IL-6 levels and lowest Na (p = 0.001). Overall, per 10-fold increase in IL-6, Na decreased by an average of 2.68 mEq/L. CONCLUSION: Hyponatremia is common in patients who received CD19+ CAR T-cells. There is an inverse linear relationship between IL-6 levels and nadir Na (p = 0.001). Further studies will be needed to confirm a causative relationship between IL-6 levels and hyponatremia following CD19+ CAR T-cell infusion.


Assuntos
Hiponatremia/sangue , Hiponatremia/etiologia , Imunoterapia Adotiva/efeitos adversos , Interleucina-6/sangue , Sódio/sangue , Adulto , Idoso , Antígenos CD19/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Receptores de Antígenos Quiméricos , Estudos Retrospectivos , Linfócitos T/metabolismo , Adulto Jovem
4.
Medicine (Baltimore) ; 98(47): e17982, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764808

RESUMO

RATIONALE: Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is an infection-associated encephalitis/encephalopathy syndrome that is predominately caused by a virus. MERS has no direct association with central nervous system (CNS) infections or inflammation. Non-CNS infections may cause reversible lesion in the splenium of corpus callosum. Recently, there have been reports of many patients with hyponatremia related MERS. Interleukin-6 (IL-6) was also found elevated in serum and in cerebrospinal fluid (CSF) in patients with MERS. The role of IL-6 in the non-osmotic release of vasopressin is crucial. Persistent hyponatremia may be linked to this effect. The following is a case report of MERS secondary to encephalitis, complicated by hyponatremia. We will summarize the latest research and progress regarding MERS. PATIENT CONCERNS: A 31-year-old man was admitted to our department with a 5-day history of fever and headache. His initial diagnosis was encephalitis and hyponatremia; during this period the patient also developed MERS secondary to the encephalitis. DIAGNOSES: Encephalitis was diagnosed by reviewing the history of fever, headache, neck rigidity and Kerning sign (+) on clinical examination. Lab tests revealed: serum VCA IgG (+), EBNA-1 IgG (-), EBV IgM (-), and inflammation in the analysis of CSF. Cranial MRI+C showed that the blood vessels on the surface of the brain were obviously increasing and thickening and diffuse slow waves were detected on the electroencephalogram (EEG). The patient's hyponatremia aggravated on the third day of hospitalization. On the fourth day of hospitalization, the patient was somnolent, apathetic, and slow. Magnetic resonance imaging (MRI) of the brain, with a T2-weighted fluid attenuated inversion recovery image, showed high-signal intensity in the splenium of the corpus callosum (SCC) on the fifth day of hospitalization. Diffusion-weighted imaging (DWI) showed splenial hyperintensity as a "boomerang sign" and reduced diffusion on apparent diffusion coefficient (ADC) maps. Cranial MRI findings returned to normal after 1 month. The diagnosis of MERS was confirmed. INTERVENTIONS: We administered an intravenous drip infusion of acyclovir and prescribed oral sodium supplementation. OUTCOMES: The patient's neurological symptoms gradually improved. The MRI lesion in the SCC disappeared on the 30th day. LESSONS: In patients with encephalitis accompanied by hyponatremia, elevated IL-6 or urinary ß2-microglobulin (ß2MG), and exacerbations such as sudden somnolence, delirium, confusion, and seizures, the possibility of secondary MERS should be investigated, in addition to the progression of encephalitis.


Assuntos
Corpo Caloso/patologia , Encefalite/complicações , Hiponatremia/etiologia , Adulto , Encefalite/diagnóstico , Humanos , Masculino , Índice de Gravidade de Doença
6.
Neurosurg Clin N Am ; 30(4): 515-524, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31471059

RESUMO

Sodium perturbations are a common complication after pituitary surgery, with hyponatremia being the most frequent. Postoperative assessments should be tailored to the early and late periods, and monitoring sodium perturbations is recommended. Cerebral salt wasting is rare after pituitary surgery, and diagnosis and management can be challenging. Providing patient counseling and close postoperative follow-up is important to effectively manage diabetes insipidus and reduce hospital readmissions due to sodium perturbations.


Assuntos
Adenoma/complicações , Adenoma/cirurgia , Hipernatremia/etiologia , Hiponatremia/etiologia , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/cirurgia , Diabetes Insípido/etiologia , Homeostase , Humanos , Hipernatremia/prevenção & controle , Hiponatremia/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Sódio/metabolismo
7.
Mymensingh Med J ; 28(3): 716-718, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31391452

RESUMO

Bronchiolitis is the leading cause of lower respiratory tract infection (LRTI) in infants. Respiratory syncitial virus (RSV) is the most common cause of bronchiolitis in infants and young children. Hyponatremia is a commonly overlooked important extrapulmonary manifestation of bronchiolitis. It is now known that the syndrome of inappropriate anti diuretic hormone secretion (SIADH) occurs frequently in several pulmonary conditions including bronchiolitis which may lead to hyponatremia. In many studies,a good number of patients admitted with bronchiolitis were found to have hyponatremia e.g. Wilson et al. A high index of suspicion with prompt diagnosis and treatment can save life and prevent handicaps. Serum electrolyte level should be measured in all children hospitalized for bronchiolitis. Neurological complications may occur in hyponatremia and fluid therapy in vulnerable infants should be appropriately planned to reduce this risk.


Assuntos
Bronquiolite , Hiponatremia , Infecções por Vírus Respiratório Sincicial , Sódio/sangue , Bronquiolite/complicações , Criança , Pré-Escolar , Hospitalização , Humanos , Hiponatremia/etiologia , Lactente , Infecções por Vírus Respiratório Sincicial/complicações
9.
Transplant Proc ; 51(6): 1880-1886, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31399172

RESUMO

BACKGROUND: Both hyponatremia and portal vein thrombosis (PVT) reflect the severity of liver dysfunction and are independently associated with increased morbidity in cirrhotic patients. In this study, we analyzed effects of hyponatremia on PVT development. METHODS: Data on adult liver transplants (LTs) in the Model for End-Stage Liver Disease era through September 2016 were obtained. Receiver operating curves and multivariable logistic regression models were constructed to evaluate the association between serum sodium level and PVT. Based on the receiver operating curves, hyponatremia was defined as a sodium level below 125 mEq/L. RESULTS: Of the 49,155 recipients included, 16% had hyponatremia (n = 7828) and 9% had PVT (n = 4414) at transplant. Subjects with hyponatremia had lower rates of PVT at the time of LT (4.4% vs 10.1%, P < .001), incidence of nonalcoholic steatohepatitis (10.8% vs 16.5%, P < .001), diabetes (19.7% vs 24.3%, P < .001), and need for dialysis (8.8% vs 16.0%, P < .001) as well as higher rates of chronic hepatitis C and B (37.6% vs 29.1%, P < .001 and 2.9% vs 1.7%, P < .001). Multivariable regression analysis confirmed that hyponatremia was independently associated with a decreased likelihood of PVT (odds ratio [OR], 0.44, P < .001). African American patients had a lower incidence of PVT (OR, 0.70; P < .001). Variables associated with a higher incidence of PVT were: nonalcoholic steatohepatitis (OR, 1.15; P = .005), moderate-to-severe ascites (OR, 1.10; P = .008), and Hispanic ethnicity (OR, 1.2; P < .001). CONCLUSION: Hyponatremia is associated with a lower rate of PVT independent of severity of liver disease and other thrombotic risk factors. This protective effect should be taken into consideration during the perioperative management of hyponatremia in patients undergoing LT.


Assuntos
Hiponatremia/etiologia , Transplante de Fígado/efeitos adversos , Veia Porta , Complicações Pós-Operatórias/etiologia , Trombose Venosa/etiologia , Adulto , Idoso , Feminino , Humanos , Hiponatremia/epidemiologia , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Complicações Pós-Operatórias/epidemiologia , Diálise Renal , Estudos Retrospectivos , Fatores de Risco , Trombose Venosa/epidemiologia
10.
BMJ Case Rep ; 12(8)2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31420419

RESUMO

Addison's disease is a common endocrinopathy often diagnosed in patients presenting with hyponatraemia. Cerebellar ataxia as a presentation of hyponatraemia is extremely rare. A 42-year-old man presented with vomiting, fever, ataxic gait and scanning type of dysarthria. Clinical examination revealed signs suggestive of isolated cerebellar involvement. Patient was found to have severe hyponatraemia and serum cortisol was found to be extremely low while MRI brain was found to be normal. Corticosteroid therapy was initiated and cerebellar ataxia was resolved following normalisation of sodium levels.


Assuntos
Doença de Addison/diagnóstico , Ataxia Cerebelar/diagnóstico , Hiponatremia/diagnóstico , Doença de Addison/complicações , Adulto , Ataxia Cerebelar/complicações , Diagnóstico Diferencial , Humanos , Hiponatremia/etiologia , Masculino
11.
Medicina (Kaunas) ; 55(9)2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31455034

RESUMO

Exercise-associated hyponatremia (EAH) is defined as a plasma sodium concentration of <135 mmol/L during or after endurance and ultra-endurance performance and was first described by Timothy Noakes when observed in ultra-marathoners competing in the Comrades Marathon in South Africa in the mid-1980s. It is well-established that a decrease in plasma sodium concentration <135 mmol/L occurs with excessive fluid intake. Clinically, a mild hyponatremia will lead to no or very unspecific symptoms. A pronounced hyponatremia (<120 mmol/L) will lead to central nervous symptoms due to cerebral edema, and respiratory failure can lead to death when plasma sodium concentration reaches values of <110-115 mmol/L. The objective of this narrative review is to present new findings about the aspects of sex, race location, sports discipline, and length of performance. The prevalence of EAH depends on the duration of an endurance performance (i.e., low in marathon running, high to very high in ultra-marathon running), the sports discipline (i.e., rather rare in cycling, more frequent in running and triathlon, and very frequent in swimming), sex (i.e., increased in women with several reported deaths), the ambient temperature (i.e., very high in hot temperatures) and the country where competition takes place (i.e., very common in the USA, very little in Europe, practically never in Africa, Asia, and Oceania). A possible explanation for the increased prevalence of EAH in women could be the so-called Varon-Ayus syndrome with severe hyponatremia, lung and cerebral edema, which was first observed in marathon runners. Regarding the race location, races in Europe seemed to be held under rather moderate conditions whereas races held in the USA were often performed under thermally stressing conditions (i.e., greater heat or greater cold).


Assuntos
Grupos de Populações Continentais/estatística & dados numéricos , Exercício/fisiologia , Hiponatremia/etiologia , Resistência Física/fisiologia , Fatores Sexuais , Humanos , Hiponatremia/fisiopatologia , Prevalência , Fatores de Risco , Sódio/análise , Sódio/sangue , Esportes/fisiologia , Esportes/estatística & dados numéricos , Temperatura Ambiente , Equilíbrio Hidroeletrolítico/fisiologia
12.
BMC Neurol ; 19(1): 169, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31319788

RESUMO

BACKGROUND: Cerebral salt wasting (CSW) is a rare metabolic disorder with severe hyponatremia and volume depletion usually caused by brain injury like trauma, cerebral lesion, tumor or a cerebral hematoma. The renal function is normal with excretion of very high amounts of sodium in the urine. Diagnosis is made by excluding other reasons for hyponatremia, mainly the syndrome of inappropriate antidiuretic hormone secretion (SIADH). CASE PRESENTATION: A 60-year-old patient was admitted to the emergency room with pain in the upper abdomen and visual disturbance two weeks after knee replacement. The patient was confused with severe hematoma at the site of the knee endoprosthesis. Laboratory values showed massive thrombocytosis, leukocytosis, anemia, severe hyponatremia and no evidence of infection. CT scan of the abdomen was inconspicuous. Head MRI showed no ischemia or bleeding, but a mild microangiopathy. A myeloproliferative neoplasm (MPN) was suspected and confirmed by bone marrow biopsy. Cerebral salt wasting syndrome was identified as the cause of severe hyponatremia most likely provoked by cerebral microcirculatory disturbance. The hematoma at the operation site was interpreted as a result of a secondary von Willebrand syndrome (vWS) due to the myeloproliferative neoplasm with massive thrombocytosis. After starting cytoreductive therapy with hydroxycarbamide, thrombocytosis and blood sodium slowly improved along with normalization of his mental condition. CONCLUSION: To the best of our knowledge this is the first description of a patient with CSW most likely caused by a microcirculatory disturbance due to a massive thrombocytosis in the context of a myeloproliferative neoplasm.


Assuntos
Hiponatremia/etiologia , Síndrome de Secreção Inadequada de HAD/diagnóstico , Transtornos Mieloproliferativos/complicações , Hematoma/complicações , Humanos , Imagem por Ressonância Magnética , Masculino , Microcirculação , Pessoa de Meia-Idade , Transtornos Mieloproliferativos/diagnóstico , Sódio/sangue , Tomografia Computadorizada por Raios X
13.
Eur J Pediatr ; 178(9): 1353-1361, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31300884

RESUMO

Hyponatremia is one of the most common electrolyte disorders in hospitalized children. The underlying mechanisms are poorly understood and potentially multifactorial, making management difficult, particularly in neonates. This retrospective study aimed to determine the incidence and etiologies of hyponatremia in hospitalized children under the age of 100 days, in our pediatric tertiary care hospital over a 1-year period. The etiology of hyponatremia was determined by reviewing the data noted in each patient's medical reports. Neonatal hyponatremia had a prevalence of 4.3% (86/2012 patients) and was mostly hospital-acquired (74/86 patients). Fifty-nine patients (68.9%) were preterm neonates. The etiology was iatrogenic in 26 cases (30.2%). In other cases, hyponatremia was due to transient (23 patients, 26.7%) or genetic abnormalities of the renal mineralocorticoid pathway (3 patients, 3.4%), SIADH (12 patients, 14%), digestive disease (3 patients, 3.5%), acute renal failure (3 patients, 3.5%), or heart failure (1 patient, 1.2%).Conclusion: Our findings confirm that hyponatremia is a frequent electrolyte disorder in neonates. Various mechanisms underlie this condition, most of which could be prevented by optimized management. The prevalence of genetic hypoaldosteronism and pseudohypoaldosteronism was higher than expected. We provide a simple diagram to help physicians identify the mechanisms underlying neonatal hyponatremia. What is Known: • In neonates, hyponatremia may be multifactorial, making it difficult to treat. • Newborns display partial resistance to aldosterone, and preterms have a defect in aldosterone secretion. What is New: • Four percent of hospitalized neonates had hyponatremia, 86% hospital-acquired. Hyponatremia was due to a transient or constitutional defect of the mineralocorticoid pathway in 26/86 patients (30%) which is higher than expected. • We propose a tree diagram for improving the management of hyponatremia in neonates.


Assuntos
Hiponatremia/epidemiologia , Hiponatremia/etiologia , Feminino , Hospitalização , Humanos , Hiponatremia/diagnóstico , Incidência , Lactente , Recém-Nascido , Masculino , Prevalência , Estudos Retrospectivos , Fatores de Risco
14.
Artigo em Inglês | MEDLINE | ID: mdl-31343133

RESUMO

Hyponatremia is the one of the most common electrolyte abnormality in the clinical practice and is associated with increased morbidity and mortality. Decreased serum sodium levels are occasionally observed in patients with diabetes mellitus, especially in those, who pre-sent with the diabetic ketoacidosis. It can develop at the each stage of a treatment, as a complication of hyperglycemia and intensity of the therapy, but also the other underlying causes should be consider. In this report we present a patient with symptomatic hyponatremia in the new diagnosed patient with type 1 diabetes mellitus.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Cetoacidose Diabética/complicações , Hiponatremia/etiologia , Pré-Escolar , Diabetes Mellitus Tipo 1/diagnóstico , Cetoacidose Diabética/diagnóstico , Humanos , Hiponatremia/diagnóstico , Masculino
15.
Rinsho Shinkeigaku ; 59(8): 541-544, 2019 Aug 29.
Artigo em Japonês | MEDLINE | ID: mdl-31341131

RESUMO

We present a case of tuberculous meningitis (TBM), wherein pleural effusion developed as a manifestation of paradoxical reaction during anti-tuberculosis therapy. An 87-year-old diabetic man was referred to our clinic for fever and impaired consciousness. He did not obey vocal commands. No ocular motor deficit, facial palsy, or limb weakness was observed. He had hyponatremia due to inappropriate antidiuresis. Examination of the cerebrospinal fluid revealed lymphocytosis and high adenosine deaminase (ADA) activity, suggestive of TBM. He was treated with isoniazid, rifampicin, and pyrazinamide, after which his symptoms quickly resolved. Lymphocyte count, ADA activity, and protein concentration in the cerebrospinal fluid decreased. However, approximately 30 days after the initiation of therapy, he developed mild hypoxemia. A chest CT scan revealed pleural effusion. The pleural fluid was exudate with elevated ADA activity, which was consistent with tuberculous pleural effusion. Shortly after the use of a herbal medicine, Goreisan extract, hyponatremia and hypoproteinemia improved, and the pleural effusion was reduced. Approximately one-third of patients with TBM are reported to develop a paradoxical reaction, such as tuberculoma, hydrocephalus, and optochiasmatic and spinal arachnoiditis. The present case suggests that extra-central nervous system manifestations, including pleural effusion, should be considered when treating TBM.


Assuntos
Antituberculosos/efeitos adversos , Antituberculosos/uso terapêutico , Derrame Pleural/etiologia , Tuberculose Meníngea/complicações , Tuberculose Meníngea/tratamento farmacológico , Tuberculose Pleural/etiologia , Adenosina Desaminase/líquido cefalorraquidiano , Idoso de 80 Anos ou mais , Biomarcadores/líquido cefalorraquidiano , Medicamentos de Ervas Chinesas/uso terapêutico , Humanos , Hiponatremia/tratamento farmacológico , Hiponatremia/etiologia , Masculino , Medicina Kampo , Fitoterapia , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/tratamento farmacológico , Radiografia Torácica , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tuberculose Meníngea/diagnóstico , Tuberculose Pleural/diagnóstico por imagem , Tuberculose Pleural/tratamento farmacológico
16.
Medicine (Baltimore) ; 98(28): e16407, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305453

RESUMO

RATIONALE: The misdiagnosis of hypopituitarism is common due to its rarity and its nonspecific clinical manifestations. Our case report highlights the importance of critical evaluation regarding hypopituitarism as a cause of recurrent hypoglycemia, hyponatremia, and gastrointestinal symptoms in patients with T1DM, as misdiagnosis might be fatal to the patient. PATIENT CONCERNS: We herein report the case of 35-year-old female patient who presented with 18 years of history of well-controlled type 1 diabetes mellitus and a 6-month history of recurrent nausea and vomiting, generalized weakness, hyponatremia, and severe hypoglycemia, despite a reduction in the dose of insulin. She was considered as having "type 1 diabetes and gastroparesis." Four months later, she was diagnosed with hypothyroidism, and 25 µg/d of levothyroxine was prescribed. However, the levothyroxine had to be discontinued 1 week later because of frequent vomiting by the patient. DIAGNOSIS: Further evaluation in our hospital revealed low-normal adrenocorticotropic hormone, low-normal serum cortisol, and low 24-hours urinary cortisol excretion. Secondary hypothyroidism and hypogonadotropic hypogonadism were also demonstrated. Based on the endocrinological findings, she was diagnosed with hypopituitarism possibly due to lymphocytic hypophysitis. Diabetic nephropathy was another diagnosis made after kidney biopsy. INTERVENTIONS: The patient was treated with 100 mg/d of hydrocortisone intravenously for 2 weeks. After that, she continued on 15 mg/d of prednisone, and then 25 µg/d of levothyroxine was administered. OUTCOMES: The patient's insulin requirement increased to a premorbid level, the severe hypoglycemia resolved, the physical discomforts were alleviated, and blood electrolytes returned to normal. LESSONS: This uncommon case reinforced the significance of a timely diagnosis and appropriate treatment of hypopituitarism. We recommend that physicians focus their awareness on this potentially life-threatening disease, as it is a condition potentially fatal to the patient if not recognized and treated.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Hipoglicemia/etiologia , Hiponatremia/etiologia , Hipopituitarismo/complicações , Adulto , Nefropatias Diabéticas/complicações , Diagnóstico Diferencial , Feminino , Humanos , Hipoglicemia/diagnóstico , Hipoglicemia/tratamento farmacológico , Hiponatremia/diagnóstico , Hiponatremia/tratamento farmacológico , Hipopituitarismo/diagnóstico , Hipopituitarismo/tratamento farmacológico
17.
Med. intensiva (Madr., Ed. impr.) ; 43(5): 302-316, jun.-jul. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-183243

RESUMO

La hiponatremia es el trastorno electrolítico más prevalente en las Unidades de Cuidados Intensivos. Se asocia a un aumento de la morbilidad, mortalidad y estancia hospitalaria. La mayoría de los estudios publicados hasta el momento son observacionales, retrospectivos y no incluyen pacientes críticos, lo que dificulta la extracción de conclusiones sólidas. Además, debido a la escasa evidencia científica de calidad, incluso las recomendaciones realizadas por distintas sociedades científicas recientemente publicadas difieren en aspectos importantes como son el diagnóstico o el tratamiento de la hiponatremia. Los mecanismos etiopatogénicos en los pacientes críticos suelen ser complejos. Sin embargo, hay que profundizar en ellos para llegar al diagnóstico más probable y a la pauta de tratamiento más adecuada. Todo ello, ha motivado la realización de esta revisión práctica sobre aspectos útiles en el abordaje de la hiponatremia en las Unidades de Cuidados intensivos, con el objetivo de homogeneizar el manejo de esta entidad y disponer de un algoritmo diagnóstico a nivel nacional


Hyponatremia is the most prevalent electrolyte disorder in Intensive Care Units. It is associated with an increase in morbidity, mortality and hospital stay. The majority of the published studies are observational, retrospective and do not include critical patients; hence it is difficult to draw definitive conclusions. Moreover, the lack of clinical evidence has led to important dissimilarities in the recommendations coming from different scientific societies. Finally, etiopathogenic mechanisms leading to hyponatremia in the critical care patient are complex and often combined, and an intensive analysis is clearly needed. A study was therefore made to review all clinical aspects about hyponatremia management in the critical care setting. The aim was to develop a Spanish nationwide algorithm to standardize hyponatremia diagnosis and treatment in the critical care patient


Assuntos
Humanos , Consenso , Hiponatremia/diagnóstico , Cuidados Críticos , Unidades de Terapia Intensiva , Hiponatremia/etiologia , Diagnóstico Diferencial , Sociedades Médicas/normas , Hiponatremia/fisiopatologia , Algoritmos
18.
J Med Case Rep ; 13(1): 188, 2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31221202

RESUMO

BACKGROUND: Leser-Trélat syndrome, which manifests as eruptive multiple seborrheic keratoses, is a rare paraneoplastic sign. Hyponatremia in the elderly population is an often overlooked but potentially sinister biochemical abnormality. Cancer-related causes of hyponatremia include syndrome of inappropriate antidiuretic hormone secretion, cerebral or renal salt wasting, and adrenal dysfunction. We report a case of an elderly man who presented with both syndrome of inappropriate antidiuretic hormone secretion and Leser-Trélat syndrome, and was eventually found to have renal malignancy. CASE PRESENTATION: A 74-year-old indigenous Malaysian man with underlying chronic kidney disease presented with recurrent admissions for hyponatremia with parameters indicative of syndrome of inappropriate antidiuretic hormone secretion, constitutional symptoms, and diffuse skin lesions suggestive of multiple seborrheic keratoses. A radiological workup revealed metastatic renal cell carcinoma with evidence of metastasis to the brain, adrenal glands, bone, and lungs. CONCLUSIONS: To the best of our knowledge, renal malignancy presenting as syndrome of inappropriate antidiuretic hormone secretion and Leser-Trélat concurrently is rare. The causes of hyponatremia in the elderly, approach to investigation, and value as a poor prognostic marker in malignancy are highlighted. We also discuss Leser-Trélat syndrome, its pathophysiology, and its possible implications on clinical practice.


Assuntos
Carcinoma de Células Renais/complicações , Síndrome de Secreção Inadequada de HAD/etiologia , Ceratose Seborreica/etiologia , Neoplasias Renais/complicações , Síndromes Paraneoplásicas/etiologia , Idoso , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/secundário , Humanos , Hiponatremia/etiologia , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/patologia , Masculino
20.
BMJ Case Rep ; 12(6)2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31189542

RESUMO

Spinal cord injury (SCI) is associated with a range of secondary health issues. Altered neurological function can complicate diagnosis, which may have serious consequences. Here we present the case of a tetraplegic person presenting with confusion and bradycardia. Initial testing revealed severe hyponatraemia (sodium 96 mmol/L) and ST elevation associated with labile blood pressure. Delayed further investigation identified sigmoid volvulus-endoscopic decompression led to resolution of haemodynamic lability and a diagnosis of autonomic dysreflexia. Low mood and poor documentation in the community were found to contribute to poor compliance with an established bowel management plan. Inpatient care involved electrolyte correction and establishment of regular bowel motions. The patient was discharged at baseline neurology with psychological support. This case highlights poor awareness of the secondary health issues affecting those with SCI and the complex relationship between mental and physical health.


Assuntos
Disreflexia Autonômica/fisiopatologia , Hiponatremia/fisiopatologia , Quadriplegia/fisiopatologia , Traumatismos da Medula Espinal/fisiopatologia , Adulto , Disreflexia Autonômica/etiologia , Humanos , Hiponatremia/etiologia , Quadriplegia/etiologia , Traumatismos da Medula Espinal/complicações
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