Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.386
Filtrar
1.
Medicine (Baltimore) ; 99(33): e20746, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32871970

RESUMO

RATIONALE: Hyponatremia occurs frequently in the hospital setting and may be attributable to a host of etiologies. Drugs are frequently implicated. Trimethoprim-sulfamethoxazole (TMP/SMX) represents a well-recognized pharmacologic precipitant of drug-induced hyponatremia, with several reports extant in the retrievable literature. Nephrologists thus debate the mechanisms giving rise to TMP/SMX-induced hyponatremia and the precise mechanism by which treatment with TMP/SMX generates reductions of serum sodium concentration remain controversial. The agent has a well-known effect of antagonizing the effects of aldosterone upon the distal nephron. Renal salt wasting and the syndrome of inappropriate antidiuretic hormone secretion represent implicated mechanistic intermediaries in TMP/SMX-induced hyponatremia. PATIENT CONCERNS: The patient endorsed no explicit concerns. DIAGNOSES: We describe the case of an 83-year-old female clinically diagnosed with pneumonia found to have an initial serum sodium in the range of 130 to 134 mEq/L consistent with mild hyponatremia upon admission. Sputum cultures grew Achromobacter xylosoxidans susceptible to TMP/SMX. The patient's serum sodium concentration precipitously decline following institution of treatment with TMP/SMX to 112 to 114 mEq/L during the course of 5 days. INTERVENTIONS: Severe hyponatremia proved recalcitrant to initial therapy with supplemental salt tabs and standard doses of the vasopressin receptor antagonist tolvaptan. OUTCOMES: Escalating doses of tolvaptan increased the patient's sodium to 120 to 124 mEq/L. The patient was transferred to another hospital for further management. During her stay, the patient did not exhibit frank or obvious clinical features consistent with hyponatremia nor readily appreciable evidence of volume depletion. LESSONS: TMP/SMX represents a frequent, though underreported cause of hyponatremia in the hospital setting several authors believe natriuresis may represent the most common mechanism underlying TMP/SMX-induced hyponatremia. Evidence implicating natriuresis to be mechanistic in TMP/SMX-induced hyponatremia include clinically appreciable hypovolemia and resolution of hyponatremia with oral or intravenous salt repletion. Salt repletion failed to monotherapeutically enhance our patient's hyponatremiadisfavoring renal salt wasting as originately mechanistic. Contemporaneous refractoriness of serum sodium to fluid restriction nor standard doses of tolvaptan confounded our initial attempts to mechanistically attribute the patient's hyponatremia to a specific cause. Clinical euvolemia and rapid response of hyponatremia to exceptionally high doses of tolvaptan strongly favors syndrome of inappropriate antidiuretic hormone to represent the chief mechanism by which TMP/SMX exacerbates hyponatremia.


Assuntos
Achromobacter denitrificans , Antibacterianos/efeitos adversos , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Hiponatremia/induzido quimicamente , Combinação Trimetoprima e Sulfametoxazol/efeitos adversos , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Diagnóstico Diferencial , Feminino , Infecções por Bactérias Gram-Negativas/sangue , Infecções por Bactérias Gram-Negativas/complicações , Humanos , Hiponatremia/complicações , Hiponatremia/fisiopatologia , Hiponatremia/terapia , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
2.
Am J Case Rep ; 21: e925779, 2020 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-32790652

RESUMO

BACKGROUND Coronavirus disease 2019 (COVID-19) infection commonly presents as fever, cough, and shortness of breath in adults. Children are thought to have milder respiratory symptoms and to recover more quickly. We describe a new presentation of COVID-19 infection in children consisting of multisystem inflammation with decreased left ventricular function and evidence of lung disease. CASE REPORT Three children presented with fever, conjunctivitis, dry and cracked lips, rash, and/or cervical lymphadenopathy for at least 5 days. Two of these children required mechanical ventilation, and 1 of the 2 needed extracorporeal membrane oxygenation (ECMO) to support cardiorespiratory function. All of these children had moderate to severe hyponatremia and lymphopenia, which is usually seen in COVID-19. They were treated with intravenous immunoglobulin and high-dose aspirin. All of the children recovered. CONCLUSIONS Early recognition of children with multisystem inflammation is important because they are at increased risk for deterioration. Treatment with intravenous immunoglobulin and aspirin was used because this regimen has been shown to be beneficial in vasculitis of Kawasaki disease. The development of shock due to cardiac involvement may require ECMO.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/virologia , Antipiréticos/uso terapêutico , Aspirina/uso terapêutico , Criança , Pré-Escolar , Conjuntivite/terapia , Conjuntivite/virologia , Infecções por Coronavirus/terapia , Exantema/terapia , Exantema/virologia , Oxigenação por Membrana Extracorpórea , Feminino , Febre/terapia , Febre/virologia , Insuficiência Cardíaca/terapia , Insuficiência Cardíaca/virologia , Humanos , Hiponatremia/terapia , Hiponatremia/virologia , Imunoglobulinas Intravenosas , Linfadenopatia/terapia , Linfadenopatia/virologia , Linfopenia/terapia , Linfopenia/virologia , Masculino , Pandemias , Pneumonia Viral/terapia , Respiração Artificial , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Síndrome de Resposta Inflamatória Sistêmica/terapia , Vasculite/terapia , Vasculite/virologia
3.
Z Gerontol Geriatr ; 53(5): 463-472, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32691149

RESUMO

The aim of this continuing medical education (CME) article (part II) is to describe the particular challenge of the treatment of hyponatremia, which occurs in older patients. This part II follows on from part I concerning the diagnosis in the previous volume. A staged approach is necessary. The best treatment is always when the underlying cause can be eliminated. Hyponatremia in older patients is mainly induced by the syndrome of inappropriate antidiuretic hormone (SIADH) secretion. The authors use a concept for the first, second and third line strategy: (1) changing or discontinuation of drugs, (2) fluid restriction and (3) tolvaptan medication. The algorithm for treatment should be simple. It also contains recommendations for the correction rate. Caution is also needed in order to avoid the occurrence of an osmotic demyelination syndrome (ODS).


Assuntos
Antagonistas dos Receptores de Hormônios Antidiuréticos/uso terapêutico , Hidratação/métodos , Hiponatremia/terapia , Síndrome de Secreção Inadequada de HAD/complicações , Solução Salina Hipertônica/uso terapêutico , Tolvaptan/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Terapia Combinada , Humanos , Hiponatremia/diagnóstico , Hiponatremia/etiologia , Síndrome de Secreção Inadequada de HAD/diagnóstico , Infusões Intravenosas , Resultado do Tratamento
4.
J Neurovirol ; 26(5): 797-799, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32720233

RESUMO

There is concern that the global burden of coronavirus disease of 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection might yield an increased occurrence of Guillain-Barré syndrome (GBS). It is currently unknown whether concomitant SARS-CoV-2 infection and GBS are pathophysiologically related, what biomarkers are useful for diagnosis, and what is the optimal treatment given the medical comorbidities, complications, and simultaneous infection. We report a patient who developed severe GBS following SARS-CoV-2 infection at the peak of the initial COVID-19 surge (April 2020) in New York City and discuss diagnostic and management issues and complications that may warrant special consideration in similar patients.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/complicações , Síndrome de Guillain-Barré/complicações , Hiponatremia/complicações , Pneumonia Viral/complicações , Doença Aguda , Idoso , Anticoagulantes/uso terapêutico , Infecções por Coronavirus/patologia , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Progressão da Doença , Enoxaparina/uso terapêutico , Feminino , Síndrome de Guillain-Barré/patologia , Síndrome de Guillain-Barré/terapia , Síndrome de Guillain-Barré/virologia , Humanos , Hiponatremia/patologia , Hiponatremia/terapia , Hiponatremia/virologia , Cidade de Nova Iorque , Pandemias , Plasmaferese , Pneumonia Viral/patologia , Pneumonia Viral/terapia , Pneumonia Viral/virologia
5.
Medicine (Baltimore) ; 99(24): e20283, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541452

RESUMO

RATIONALE: There is an increasing and compelling need for early recognition of features of osmotic demyelination syndrome (ODS), and a further attempt at correcting this even where presentation is late. PATIENT CONCERNS: A 49-year-old male admitted into the emergency department with a complaint of lethargy and severe hyponatremia, with subsequent ODS supervening on initial attempts at correction. DIAGNOSIS: Rapid rise in serum sodium concentration (121 mmol/L in 8 hours from a nadir of 101 mmol/L), concomitant deterioration in patient's conscious level support the diagnosis of ODS. INTERVENTION: Concomitant administration of 5% dextrose water with desmopressin with a therapeutic objective of gradual relowering of serum sodium concentration. OUTCOMES: Significant improvement in patients' conscious level and motor function with the commencement of sodium relowering therapy. The patient was eventually discharged home. LESSONS: Regardless of the temporal profile of neurologic sequelae following ODS due to hyponatremia, its worthwhile attempting initial sodium relowering with dextrose 5% and desmopressin and then monitoring of biochemical and neurologic markers.


Assuntos
Doenças Desmielinizantes/induzido quimicamente , Doenças Desmielinizantes/terapia , Hiponatremia/complicações , Antidiuréticos/administração & dosagem , Antidiuréticos/uso terapêutico , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Desamino Arginina Vasopressina/administração & dosagem , Desamino Arginina Vasopressina/uso terapêutico , Doenças Desmielinizantes/sangue , Doenças Desmielinizantes/diagnóstico , Quimioterapia Combinada/métodos , Glucose/administração & dosagem , Glucose/uso terapêutico , Humanos , Hiponatremia/terapia , Doença Iatrogênica , Letargia/etiologia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Concentração Osmolar , Solução Salina Hipertônica/efeitos adversos , Sódio/sangue , Edulcorantes/administração & dosagem , Edulcorantes/uso terapêutico , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
7.
Eur J Endocrinol ; 183(1): G9-G15, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: covidwho-548771

RESUMO

COVID-19 has changed the nature of medical consultations, emphasizing virtual patient counseling, with relevance for patients with diabetes insipidus (DI) or hyponatraemia. The main complication of desmopressin treatment in DI is dilutional hyponatraemia. Since plasma sodium monitoring is not always possible in times of COVID-19, we recommend to delay the desmopressin dose once a week until aquaresis occurs allowing excess retained water to be excreted. Patients should measure their body weight daily. Patients with DI admitted to the hospital with COVID-19 have a high risk for mortality due to volume depletion. Specialists must supervise fluid replacement and dosing of desmopressin. Patients after pituitary surgery should drink to thirst and measure their body weight daily to early recognize the development of the postoperative syndrome of inappropriate antidiuresis (SIAD). They should know hyponatraemia symptoms. The prevalence of hyponatraemia in patients with pneumonia due to COVID-19 is not yet known, but seems to be low. In contrast, hypernatraemia may develop in COVID-19 patients in ICU, from different multifactorial reasons, for example, due to insensible water losses from pyrexia, increased respiration rate and use of diuretics. Hypernatraemic dehydration may contribute to the high risk of acute kidney injury in COVID-19. IV fluid replacement should be administered with caution in severe cases of COVID-19 because of the risk of pulmonary oedema.


Assuntos
Antidiuréticos/administração & dosagem , Infecções por Coronavirus/terapia , Desamino Arginina Vasopressina/administração & dosagem , Diabetes Insípido Neurogênico/terapia , Hidratação/métodos , Hipernatremia/terapia , Hiponatremia/terapia , Síndrome de Secreção Inadequada de HAD/terapia , Pneumonia Viral/terapia , Lesões Encefálicas/complicações , Infecções por Coronavirus/complicações , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Desidratação/terapia , Diabetes Insípido/complicações , Diabetes Insípido/terapia , Diabetes Insípido Neurogênico/complicações , Gerenciamento Clínico , Humanos , Hiponatremia/etiologia , Hiponatremia/prevenção & controle , Soluções Hipotônicas/uso terapêutico , Procedimentos Neurocirúrgicos , Pandemias/prevenção & controle , Pneumonia Viral/complicações , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Complicações Pós-Operatórias/terapia , Guias de Prática Clínica como Assunto , Solução Salina/uso terapêutico , Choque/etiologia , Choque/terapia
8.
Medicine (Baltimore) ; 99(20): e20129, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443324

RESUMO

INTRODUCTION: Drug-induced fever is easy to overlook in respiratory departments. High fever is a rare side effect of trihexyphenidyl, which can be used clinically to treat Parkinson's disease. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a group of clinical syndromes caused by various diseases, resulting in water retention and refractory hyponatremia. However, pneumonia combined with malignant hyperthermia and SIADH has rarely been reported. We describe an unusual case of malignant hyperthermia and refractory hyponatremia due to trihexyphenidyl adverse reaction. PATIENT CONCERNS: Fifty-five-year-old male with pneumonia presented with malignant hyperthermia and refractory hyponatremia has a history of Parkinson's disease. DIAGNOSIS: Early considerations related the described hyperthermia findings to the manifestations of pneumonia. However, the last findings were due to trihexyphenidyl adverse reaction. INTERVENTIONS: Broad-spectrum antibiotics, oral and intravenous supplement of concentrated sodium chloride, drug, and physical cooling. OUTCOMES: The patient survived. During the 3-month follow up, the patient was no recurrence of fever or hyponatremia. CONCLUSION: High fever and SIADH can be a rare adverse reaction to trihexyphenidyl. Therefore, possible drug factors should be considered in the case. Consideration of other possible causes can improve early diagnosis and treatment of patients with fever of unknown origins.


Assuntos
Antiparkinsonianos/efeitos adversos , Hipertermia Maligna/etiologia , Doença de Parkinson/tratamento farmacológico , Pneumonia/complicações , Triexifenidil/efeitos adversos , Antiparkinsonianos/uso terapêutico , Humanos , Hiponatremia/etiologia , Hiponatremia/terapia , Masculino , Hipertermia Maligna/terapia , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Pneumonia/terapia , Triexifenidil/uso terapêutico
9.
Eur J Endocrinol ; 183(1): G9-G15, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32380474

RESUMO

COVID-19 has changed the nature of medical consultations, emphasizing virtual patient counseling, with relevance for patients with diabetes insipidus (DI) or hyponatraemia. The main complication of desmopressin treatment in DI is dilutional hyponatraemia. Since plasma sodium monitoring is not always possible in times of COVID-19, we recommend to delay the desmopressin dose once a week until aquaresis occurs allowing excess retained water to be excreted. Patients should measure their body weight daily. Patients with DI admitted to the hospital with COVID-19 have a high risk for mortality due to volume depletion. Specialists must supervise fluid replacement and dosing of desmopressin. Patients after pituitary surgery should drink to thirst and measure their body weight daily to early recognize the development of the postoperative syndrome of inappropriate antidiuresis (SIAD). They should know hyponatraemia symptoms. The prevalence of hyponatraemia in patients with pneumonia due to COVID-19 is not yet known, but seems to be low. In contrast, hypernatraemia may develop in COVID-19 patients in ICU, from different multifactorial reasons, for example, due to insensible water losses from pyrexia, increased respiration rate and use of diuretics. Hypernatraemic dehydration may contribute to the high risk of acute kidney injury in COVID-19. IV fluid replacement should be administered with caution in severe cases of COVID-19 because of the risk of pulmonary oedema.


Assuntos
Antidiuréticos/administração & dosagem , Infecções por Coronavirus/terapia , Desamino Arginina Vasopressina/administração & dosagem , Diabetes Insípido Neurogênico/terapia , Hidratação/métodos , Hipernatremia/terapia , Hiponatremia/terapia , Síndrome de Secreção Inadequada de HAD/terapia , Pneumonia Viral/terapia , Lesões Encefálicas/complicações , Infecções por Coronavirus/complicações , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Desidratação/terapia , Diabetes Insípido/complicações , Diabetes Insípido/terapia , Diabetes Insípido Neurogênico/complicações , Gerenciamento Clínico , Humanos , Hiponatremia/etiologia , Hiponatremia/prevenção & controle , Soluções Hipotônicas/uso terapêutico , Procedimentos Neurocirúrgicos , Pandemias/prevenção & controle , Pneumonia Viral/complicações , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Complicações Pós-Operatórias/terapia , Guias de Prática Clínica como Assunto , Solução Salina/uso terapêutico , Choque/etiologia , Choque/terapia
10.
J Clin Neurosci ; 78: 409-410, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32354647

RESUMO

Acute water intoxication (AWI) is a disorder of excess water intake that can manifest in neurological injury and death. We describe a case of a 54-year-old man that presents to the emergency department with a generalized toxic-clonic seizure due to AWI. Initial computed tomography of the brain demonstrated diffuse cerebral edema. However, with correction of serum sodium over the one hospital day, the patient's neurological symptoms and imaging completely resolved. Clinicians should recognize of reversibility of this entity with management of hyponatremia.


Assuntos
Edema Encefálico/etiologia , Sódio/sangue , Intoxicação por Água/sangue , Encéfalo/diagnóstico por imagem , Edema Encefálico/diagnóstico por imagem , Edema Encefálico/prevenção & controle , Intervenção Médica Precoce , Humanos , Hiponatremia/diagnóstico , Hiponatremia/terapia , Masculino , Pessoa de Meia-Idade , Convulsões , Tomografia Computadorizada por Raios X/métodos , Intoxicação por Água/diagnóstico
11.
Am J Kidney Dis ; 76(2): 203-212, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32199708

RESUMO

RATIONALE & OBJECTIVE: First-line therapy for syndrome of inappropriate antidiuresis (SIAD) is fluid restriction. Additional treatment for patients who do not respond to fluid restriction are water restriction with furosemide or water restriction with furosemide and salt supplementation. However, the efficacy of these treatments has never been tested in a randomized controlled study. The objective of this study was to investigate whether, combined with fluid restriction, furosemide with or without sodium chloride (NaCl) supplementation was more effective than fluid restriction alone in the treatment of hyponatremia in SIAD. STUDY DESIGN: Open-label randomized controlled study. SETTING & PARTICIPANTS: Patients with serum sodium concentrations ([Na+]) ≤ 130mmol/L due to SIAD. INTERVENTION(S): Random assignment to 1 of 3 groups: fluid restriction alone (FR), fluid restriction and furosemide (FR+FM), or fluid restriction, furosemide, and NaCl (FR+FM+NaCl). Strictness of fluid restriction (<1,000 or<500mL/d) was guided by the urine to serum electrolyte ratio. Furosemide dosage was 20 to 40mg/d. NaCl supplements were 3g/d. All treatments were continued for 28 days. OUTCOMES: The primary outcome was change in [Na+] at days 4, 7, 14, and 28 after randomization. RESULTS: 92 patients were recruited (FR, n=31; FR+FM, n=30; FR+FM+NaCl, n=31). Baseline [Na+] was 125±4mmol/L, and there were no significant differences between groups. Mean [Na+] on day 4 in all treatment groups was significantly increased from baseline by 5mmol/L (P<0.001); however, the change in [Na+] was not significantly different across groups (P=0.7). There was no significant difference in percentage of patients or time to reach [Na+] ≥ 130 or≥135mmol/L across the 3 groups. Acute kidney injury and hypokalemia (potassium≤3.0mmol/L) were more common in patients receiving furosemide. LIMITATIONS: Open-label treatment. CONCLUSIONS: In patients with SIAD, furosemide with NaCl supplement in combination with fluid restriction did not show benefits in correction of [Na+] compared with treatment with fluid restriction alone. Incidences of acute kidney injury and hypokalemia were increased in patients receiving furosemide. FUNDING: None. TRIAL REGISTRATION: Registered at the Thai Clinical Trial Registry with study number TCTR20170629004.


Assuntos
Hidratação/métodos , Furosemida/uso terapêutico , Hiponatremia/terapia , Síndrome de Secreção Inadequada de HAD/terapia , Cloreto de Sódio/uso terapêutico , Inibidores de Simportadores de Cloreto de Sódio e Potássio/uso terapêutico , Adulto , Idoso , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
12.
Wilderness Environ Med ; 31(1): 50-62, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32044213

RESUMO

Exercise-associated hyponatremia (EAH) is defined by a serum or plasma sodium concentration below the normal reference range of 135 mmol·L-1 that occurs during or up to 24 h after prolonged physical activity. It is reported to occur in individual physical activities or during organized endurance events conducted in environments in which medical care is limited and often not available, and patient evacuation to definitive care is often greatly delayed. Rapid recognition and appropriate treatment are essential in the severe form to increase the likelihood of a positive outcome. To mitigate the risk of EAH mismanagement, care providers in the prehospital and in hospital settings must differentiate from other causes that present with similar signs and symptoms. EAH most commonly has overlapping signs and symptoms with heat exhaustion and exertional heat stroke. Failure in this regard is a recognized cause of worsened morbidity and mortality. In an effort to produce best practice guidelines for EAH management, the Wilderness Medical Society convened an expert panel in May 2018. The panel was charged with updating the WMS Practice Guidelines for Treatment of Exercise-Associated Hyponatremia published in 2014 using evidence-based guidelines for the prevention, recognition, and treatment of EAH. Recommendations are made based on presenting with symptomatic EAH, particularly when point-of-care blood sodium testing is unavailable in the field. These recommendations are graded on the basis of the quality of supporting evidence and balanced between the benefits and risks/burdens for each parameter according to the methodology stipulated by the American College of Chest Physicians.


Assuntos
Exercício Físico , Hiponatremia/terapia , Padrões de Prática Médica/normas , Sociedades Médicas , Medicina Selvagem/normas , Humanos , Hiponatremia/etiologia , Sociedades Médicas/estatística & dados numéricos
13.
Leukemia ; 34(9): 2430-2440, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32094461

RESUMO

Selinexor is an oral, small molecule inhibitor of the nuclear export protein exportin 1 with demonstrated activity in hematologic and solid malignancies. Side effects associated with selinexor include nausea, vomiting, fatigue, diarrhea, decreased appetite, weight loss, thrombocytopenia, neutropenia, and hyponatremia. We reviewed 437 patients with multiple myeloma treated with selinexor and assessed the kinetics of adverse events and impact of supportive care measures. Selinexor reduced both platelets and neutrophils over the first cycle of treatment and reached a nadir between 28 and 42 days. Platelet transfusions and thrombopoietin receptor agonists were effective at treating thrombocytopenia, and granulocyte colony stimulating factors were effective at resolving neutropenia. The onset of gastrointestinal side effects (nausea, vomiting, and diarrhea) was most common during the first 1-2 weeks of treatment. Nausea could be mitigated with 5-HT3 antagonists and either neurokinin 1 receptor antagonists, olanzapine, or cannbainoids. Loperamide and bismuth subsalicylate ameliorated diarrhea. The primary constitutional side effects of fatigue and decreased appetite could be managed with methylphenidate, megestrol, cannabinoids or olanzapine, respectively. Hyponatremia was highly responsive to sodium replacement. Selinexor has well-established adverse effects that mainly occur within the first 8 weeks of treatment, are reversible, and respond to supportive care.


Assuntos
Antineoplásicos/efeitos adversos , Ensaios Clínicos como Assunto , Hidrazinas/efeitos adversos , Mieloma Múltiplo/tratamento farmacológico , Triazóis/efeitos adversos , Idoso , Antineoplásicos/uso terapêutico , Apetite/efeitos dos fármacos , Diarreia/induzido quimicamente , Fadiga/induzido quimicamente , Fadiga/tratamento farmacológico , Feminino , Humanos , Hidrazinas/uso terapêutico , Hiponatremia/induzido quimicamente , Hiponatremia/terapia , Masculino , Pessoa de Meia-Idade , Náusea/induzido quimicamente , Náusea/tratamento farmacológico , Trombocitopenia/induzido quimicamente , Triazóis/uso terapêutico
14.
Med Klin Intensivmed Notfmed ; 115(1): 29-36, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31792559

RESUMO

Hyponatremia (sodium <135 mmol/l) is the most common electrolyte disorder. Despite identical serum concentrations, clinical symptomatology can vary greatly from mild to life-threatening. Accordingly, individual patients require immediate active treatment, while the majority of (mostly oligosymptomatic) patients should first undergo differentiated diagnosis. The most important element is the assessment of the clinical situation of the patient and never isolated laboratory chemical constellations: "Treat the patient, not the numbers".


Assuntos
Cuidados Críticos , Hiponatremia , Fluxo de Trabalho , Humanos , Hiponatremia/diagnóstico , Hiponatremia/terapia , Sódio
15.
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
16.
BMJ Case Rep ; 12(12)2019 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-31822529

RESUMO

We describe a 67-year-old man admitted from a mental health unit with an incidental finding of hyponatraemia on routine blood tests. Laboratory investigations were in keeping with syndrome of inappropriate antidiuretic hormone secretion (SIADH). He had been recently commenced on mirtazapine. During his inpatient stay, he became increasingly confused. Review of a previous admission with hyponatraemia raised the possibility of voltage-gated potassium channel antibody-associated limbic encephalitis, although subsequent investigations deemed this unlikely as a cause of hyponatraemia. Although his sodium levels improved with fluid restriction, serial point-of-care testing proved misleading in monitoring the efficacy of treatment as inconsistencies were seen in comparison with laboratory testing. The cause of hyponatraemia may have been medication-induced SIADH and/or polydipsia. This case highlights the importance of collating detailed histories and laboratory blood testing to guide management in cases of hyponatraemia of unknown aetiology.


Assuntos
Hiponatremia/líquido cefalorraquidiano , Síndrome de Secreção Inadequada de HAD/diagnóstico , Mirtazapina/efeitos adversos , Psicotrópicos/efeitos adversos , Idoso , Confusão , Humanos , Hiponatremia/etiologia , Hiponatremia/fisiopatologia , Hiponatremia/terapia , Síndrome de Secreção Inadequada de HAD/fisiopatologia , Síndrome de Secreção Inadequada de HAD/terapia , Masculino , Anamnese , Mirtazapina/uso terapêutico , Sistemas Automatizados de Assistência Junto ao Leito , Polidipsia , Psicotrópicos/uso terapêutico , Punção Espinal , Ideação Suicida , Resultado do Tratamento
17.
JAAPA ; 32(10): 48-50, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31567743

RESUMO

Despite the high incidence of hyponatremia, the correct approach to management, particularly in patients with severe hyponatremia (serum sodium of 120 mEq/L or less), is controversial. This article reviews two major consensus guidelines and recent studies that can help clinicians make evidence-based treatment decisions and reduce patient risk for iatrogenic osmotic demyelination from overly aggressive treatment.


Assuntos
Hiponatremia/terapia , Solução Salina Hipertônica/uso terapêutico , Doenças Desmielinizantes/induzido quimicamente , Doenças Desmielinizantes/prevenção & controle , Gerenciamento Clínico , Humanos , Doença Iatrogênica/prevenção & controle , Guias de Prática Clínica como Assunto , Medição de Risco
18.
Trans Am Clin Climatol Assoc ; 130: 76-87, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31516170

RESUMO

Exercise-associated hyponatremia (EAH) is defined by an acute fall in the serum or plasma sodium concentration to below 135 mmol/L that occurs during or up to 24 hours after prolonged physical activity. EAH has been reported in nearly every form of endurance activity and has a common pathogenic feature of excessive water intake which is usually coupled with elevated vasopressin levels. Symptomatic EAH is uncommon but can be a cause of mortality in otherwise healthy adults and children. Rapid recognition and appropriate treatment with hypertonic saline are essential to maximizing outcomes and preventing death.


Assuntos
Arginina Vasopressina/metabolismo , Comportamento de Ingestão de Líquido , Água Potável , Exercício Físico/fisiologia , Hiponatremia/fisiopatologia , Doenças Assintomáticas , Hidratação , Humanos , Hiponatremia/epidemiologia , Hiponatremia/metabolismo , Hiponatremia/terapia , Solução Salina Hipertônica/uso terapêutico
19.
J Vet Emerg Crit Care (San Antonio) ; 29(5): 461-471, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31448558

RESUMO

OBJECTIVE: To review the pathophysiology, diagnostic approach, and treatment recommendations for hyponatremia in dogs and cats. ETIOLOGY: Hyponatremia almost always results from an increase in total body water (TBW), and not from loss of sodium. Abnormalities in antidiuretic hormone (ADH) are commonly part of the etiology of hyponatremia. DIAGNOSIS: Diagnosis of hyponatremia focuses on the cause of the increase of TBW. Assessment of the patient's volume status and measurement of urine sodium concentration are important factors. Measurement or calculated estimation of plasma osmolality can also guide the assessment of hyponatremia. THERAPY: Too rapid correction of serum sodium can precipitate osmotic demyelination syndrome. As a general rule, serum sodium concentration should be raised ≤10 mmol/L over 24 hours, but rapid increases in serum sodium are indicated if neurologic abnormalities are evident. Serum sodium can be increased using hypertonic saline, with dosing based on the patient's calculated sodium deficit. Treatment of the underlying cause of water ingestion or retention is also required to fully resolve hyponatremia. PROGNOSIS: Mortality rates are significantly higher in dogs and cats with hyponatremia compared to those with normal serum sodium concentrations, even in patients with mild hypontremia (<5 mmol/L below the lower value of the reference interval). Hyponatremia is also associated with increased risk of death if present during specific disease states in dogs.


Assuntos
Doenças do Gato/terapia , Doenças do Cão/terapia , Hiponatremia/veterinária , Solução Salina Hipertônica/uso terapêutico , Animais , Doenças do Gato/sangue , Gatos , Doenças do Cão/sangue , Cães , Esquema de Medicação/veterinária , Hiponatremia/terapia , Infusões Intravenosas/veterinária , Solução Salina Hipertônica/administração & dosagem , Sódio/sangue
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA