DOCSLIB.ORG

Disorders of Serum Sodium Concentration in the Elderly Patient

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Disorders of Serum Sodium Concentration in the Elderly Patient Chapter 16: Disorders of Serum Sodium Concentration in the Elderly Patient Michael F. Michelis Division of Nephrology, Lenox Hill Hospital, New York, New York HYPONATREMIA tory that can produce information implicating drugs that facilitate sodium excretion or stimulate Disorders of serum sodium concentration are the AVP secretion. In addition, a thorough physical ex- most common electrolyte abnormalities seen in the amination, including orthostatic BP changes, is es- sential for the accurate determination of the pa- geriatric population.1 Furthermore, the develop- ment of serum sodium abnormalities is associated tient’s body fluid status. This determination may be with increased morbidity and mortality in affected especially difficult in elderly patients who may have chronic changes in skin turgor that are more asso- patients.2 Often, however, the severity of the pri- mary process contributing to the development of ciated with aging than they are with the state of the abnormal serum sodium is responsible for the hydration. unsatisfactory outcome. The most common disor- der of serum sodium concentration in the geriatric Laboratory Diagnosis and Therapy When the history and physical are completed, as- population is hyponatremia. Factors contributing sessment of laboratory data are essential (Figure 1). to the development of hyponatremia in the elderly First, a plasma osmolality must be obtained to include age-associated decreases in GFR and free ensure that one is dealing with hypo-osmolar hypo- water clearance, as well as sodium losses from de- natremia. Normo-osmolar hyponatremia as can creased activity of the renin-angiotensin-aldoste- occur with certain compounds such as mannitol, rone system and increased activity of natriuretic which can also cause hyperosmolality in normon- hormones. The latter, however, may reflect the atremic patients, and hyperosmolar hyponatremia early development of fluid retention as may occur caused by hyperglycemia must be ruled out. Fur- with excessive sodium intake from processed foods thermore, other serum studies are important to de- or subclinical cardiac disease. In addition, studies cide whether levels of substances such as blood urea have suggested increased vasopressin activity in nitrogen and uric acid are elevated and thereby con- some elderly patients. sistent with volume depletion or whether these lev- Patients in outpatient settings exhibit hypona- els seem to be diluted as would be seen with water tremia in about 5% of those tested, with occurrence excess occurring in the syndrome of inappropriate rates increasing to as high as 20% in hospitalized antidiuretic hormone secretion (SIADH). Finally, geriatric patients and 30% in patients seen in inten- urine sodium concentration and urine osmolality sive care units.3 The most common cause of hypo- natremia in this population involves abnormalities must be measured to ascertain the endocrine and of secretion of the pituitary hormone arginine va- renal responses to the hypo-osmolar state. sopressin (AVP), also called antidiuretic hormone In dehydrated patients, levels of urine sodium (ADH). can be considered low (i.e., sodium conservation) when the spot urine sodium concentration is Ͻ20 mEq/L; in older patients, where sodium conserva- Clinical Diagnosis 4 Successful evaluation of serum sodium abnormali- tion may be limited, levels up to 30 mEq/L may also ties in the elderly depends on obtaining a careful history especially noting reports of weight loss that Correspondence: Michael F. Michelis, Director, Division of Ne- can be associated with neoplastic disease, changes phrology, Lenox Hill Hospital, 100 East 77th Street, New York, NY in the level of daily activities that can be associated 10075. E-mail: [email protected] with endocrine abnormalities, and medication his- Copyright ᮊ 2009 by the American Society of Nephrology American Society of Nephrology Geriatric Nephrology Curriculum 1 HYPONATREMIA (DIFFERENTIAL DIAGNOSIS) Confirm Hypoosmolality Volume Assessment (Physical Examination) and Urine Sodium Measurement Hypovolemia Euvolemia Edema Urine Na Urine Na >30 mEq/L <20 mEq/L Urine Na Urine Na Congestive Heart Failure SIADH <20-30 mEq/L >20-30 mEq/L Cirrhosis Diuretic Use - Water Replacement Nephrotic Syndrome Vomiting Addison’s Disease Endocrine Deficiency Diarrhea Polycystic Kidneys Hypoalbuminemia Pancreatitis Bicarbonaturia Diuretic Use Figure 1. Hyponatremia (differential diagnosis). be considered indicative of some degree of conservation of generally treated by addressing the primary underlying abnor- sodium. These urine sodium levels will often be associated with mality and using diuretic regimens. urine osmolality values at least 1.5 times that of the plasma, In elderly hyponatremic patients who appear euvolemic suggesting attempts at water conservation in response to fluid and have elevated urine sodium concentrations (Ͼ20 or 30 deficits. Such patients generally respond to the replacement of mEq/L) and elevated urine osmolalities suggesting inappropri- intravascular volume with normal saline. Patients who appear ate water retention, a diagnosis of SIADH is often made.6 Here dehydrated but who have elevated urine sodium levels (Ͼ30 it is important to rule out endocrine abnormalities such as mEq/L) often have urine osmolalities closer to that of the hypoadrenalism and hypothyroidism. In addition, a careful plasma levels and should be considered to have renal salt wast- search for drugs that stimulate AVP or facilitate the effects of ing in the face of intravascular volume contraction. They AVP in the kidney should be undertaken. If these consider- should also be treated with normal saline while attempts to ations are eliminated from diagnostic possibilities, the patient diagnose the underlying abnormality are made. Various for- should be evaluated for other causes of SIADH. Table 1 lists mulas such as the Adrogue´-Madias formula (Figure 2) have some of the commonly associated central nervous system dis- been used in an attempt to predict the increase in serum so- orders, tumors, and drugs associated with inappropriate AVP dium that can occur when various concentrations of sodium secretion. Certain drug therapies such as SSRIs may pose a replacement therapy are employed.5 If more or less than1Lof special risk for the development of hyponatremia in the el- replacement fluid is used, the change in serum sodium will derly, especially those who are older and smaller in body size.7 vary directly in proportion to the amount of fluid adminis- tered. Table 1. Common causes of SIADH When patients appear to be fluid overloaded or edematous, Central nervous system disease they may have one of several edema-forming states, including Trauma congestive heart failure, nephrotic syndrome, and cirrhosis. Stroke The poor renal perfusion associated with any of these states is Infection generally associated with urine sodium concentrations in the Tumor Intracranial bleeding lower ranges (Ͻ20 to 30 mEq/L) and a tendency to urine os- Neoplasms molalities closer to that seen in the plasma. These disorders are Lung Pancreas ADROGUÉ-MADIAS FORMULA Prostate Throat Lymphoma Infusate sodium concentration – Drugs Patient serum concentration Change in serum sodium concentration with 1L of infusate = SSRIs Total body water + 1L Carbamazepine Figure 2. The Adrogue´ -Madias Formula for the prediction of the Opiates change in serum sodium that can occur following intravenous Cyclophosphamide sodium replacement therapy. Mirtazapine 2 Geriatric Nephrology Curriculum American Society of Nephrology If primary causes of the syndrome SIADH cannot be imme- conservative manner. Current recommendations are that se- diately eliminated, patients should be treated with therapies rum sodium should not increase Ͼ12 mEq/L over a 24-h pe- that can reverse the hyponatremia.8 In patients with a history riod and no more than 18 mEq/L over a 48-h period. with confounding factors such as the possible prior use of di- uretic agents, a trial of normal saline administration may be Complex Clinical Syndromes used. In patients with severe hyponatremia, i.e., serum sodium Finally, complicated situations have been described in which concentrations Ͻ110 mEq/L, it may be appropriate to use patients are hyponatremic and seem to have excess AVP activ- multiple 100-ml intravenous aliquots of hypertonic (3%) sa- ity as well as sodium depletion syndromes.10 On attempts at line to improve the serum sodium levels to avoid more serious correction with saline, including hypertonic saline, patients complications of hyponatremia such as seizures or profound may exhibit a response in which volume correction shuts off coma. In patients with serum sodium concentrations in the AVP secretion and causes a profound water diuresis with rapid 111- to 120-mEq/L range, therapies may include lesser increases in the serum sodium concentration and a tendency amounts of hypertonic saline, and greater reliance on fluid toward too rapid correction. When this occurs, reversal ther- restriction and agents that interfere with AVP effect, such as apy may be required with the administration of free water demeclocycline and the new AVP receptor antagonists. With and/or AVP (usually as the AVP agonist desmopressin). In lesser degrees of hyponatremia, i.e., serum sodium 121 to 129 addition, patients on drugs that stimulate AVP secretion may mEq/L, fluid restriction, demeclocycline, and AVP receptor have the effects of these drugs wear off during the period that antagonists can be used. therapies are undertaken, also
Load more

Recommended publications
  • Hyponatremia and Hypernatremia MICHAEL M
    This is a corrected version of the article that appeared in print. Diagnosis and Management of Sodium Disorders: Hyponatremia and Hypernatremia MICHAEL M. BRAUN, DO, Madigan Army Medical Center, Tacoma, Washington CRAIG H. BARSTOW, MD, Womack Army Medical Center, Fort Bragg, North Carolina NATASHA J. PYZOCHA, DO, Madigan Army Medical Center, Tacoma, Washington Hyponatremia and hypernatremia are common findings in the inpatient and outpatient settings. Sodium disorders are associated with an increased risk of morbidity and mortality. Plasma osmolality plays a critical role in the patho- physiology and treatment of sodium disorders. Hyponatremia and hypernatremia are classified based on volume status (hypovolemia, euvolemia, and hypervolemia). Sodium disorders are diagnosed by findings from the history, physical examination, laboratory studies, and evaluation of volume status. Treatment is based on symptoms and underlying causes. In general, hyponatremia is treated with fluid restriction (in the setting of euvolemia), isotonic saline (in hypovolemia), and diuresis (in hypervolemia). A combination of these therapies may be needed based on the presentation. Hypertonic saline is used to treat severe symptomatic hyponatremia. Medications such as vaptans may have a role in the treatment of euvolemic and hypervolemic hyponatremia. The treatment of hypernatremia involves correcting the underlying cause and correcting the free water deficit. Am( Fam Physician. 2015;91(5):299-307. Copy- right © 2015 American Academy of Family Physicians.) More online yponatremia is a common elec- a worse prognosis in patients with liver cir- at http://www. trolyte disorder defined as a rhosis, pulmonary hypertension, myocardial aafp.org/afp. serum sodium level of less than infarction, chronic kidney disease, hip frac- CME This clinical content 135 mEq per L.1-3 A Dutch sys- tures, and pulmonary embolism.1,8-10 conforms to AAFP criteria Htematic review of 53 studies showed that the for continuing medical Etiology and Pathophysiology education (CME).
    [Show full text]
  • Hyperosmolar Hyperglycemic State (HHS) Erica Kretchman DO October 19 2018 Speaker for Valeritas, Medtronic, Astrazenica, Boehringer Ingelheim
    Hyperosmolar Hyperglycemic State (HHS) Erica Kretchman DO October 19 2018 Speaker for Valeritas, Medtronic, AstraZenica, Boehringer Ingelheim. These do not influence this presentation Objective • Review and understand diagnosis of Hyperosmolar Hyperglycemic State (HHS) and differentiating from Diabetic Ketoacidosis • Treatment of HHS • Complications of HHS Question 1 • Which of the following is NOT a typical finding in HHS? 1. Blood PH <7.30 2. Dehydration 3. Mental Status Changes 4. Osmotic diuresis Question 2 • Hypertonic fluids, such as 3% saline, are the first line of treatment to correct dehydration in HHS 1. True 2. False Question 3 • Which of the following statements is INCORRECT about Hyperosmolar Hyperglycemic State? 1. HHS occurs mainly in type 2 diabetics. 2. This condition presents without ketones in the urine. 3. Metabolic alkalosis presents in severe HHS. 4. Intravenous Regular insulin is used to treat hyperglycemia. Hyperosmolar Hyperglycemic State (HHS) • HHS and DKA are of two of the most serious complications form Diabetes • Hospital admissions for HHS are lower than the rate for DKA and accounts for less than 1 percent of all primary diabetic admissions • Mortality rate for patients with HHS is between 10 and 20 percent, which is approximately 10 times higher than that for DKA • Declined between 1980 and 2009 • Typically from precipitating illness - rare from HHS itself PRECIPITATING FACTORS • The most common events are infection (often pneumonia or urinary tract infection) and discontinuation of or inadequate insulin
    [Show full text]
  • Effect on Ca++. the Clinical Significance of This Observation Re- Suggest That Physiologic Jaundice Results from a Markedly In- Quires Further Evaluation
    ABSTRACTS 413 effect on Ca++. The clinical significance of this observation re- suggest that physiologic jaundice results from a markedly in- quires further evaluation. creased load of bilirubin presented to the liver either from increased bilirubin synthesis or enhanced intestinal reabsorb- Controlled clinical trial of phenobarbital (PB) and light for tion and marked limitation in the capacity to conjugate. management of neonatal hyperbilirubinemia in a predomi- Studies performed at 4 hours of age in a monky born 2 weeks nant Negro population. O. S. VALDES, H. M. MAURER, C. N. post-maturely revealed that hepatic transport and conjugation SHUMWAY, D. DRAPER, and A. HOSSAINI. Med. Coll. of Virginia, of bilirubin was fully mature, indicating that maturation of Richmond, Va. (Intr. by W. E. Laupus). each of these functions may occur in utero. Low birth weight infants, less than 24 hrs of age, were randomly assigned to receive either oral PB, 5 mg/kg/day for 5 A controlled study of intravenous fibrin hydrolysate supple- days, blue light (200-300 footcandles) continuously for 4 days, a ment in prematures <1.3 kg. M. HEATHER BRYAN, PATRICK combination of PB and light, or no treatment. 90% or more of WEI, RICHARD HAMILTON, SANFORD H. JACKSON, INGEBORC C. the infants in each group were Negroes. Infants with a positive RADDE, GRAHAM W. CHANCE, and PAUL R. SWYER. Univ. of Coomb's test were excluded. Toronto and The Research Inst., The Hosp. for Sick Children, Toronto, Ont. Canada. We have compared the effect of early supplemental intra- Total serum bilirubin concentration, mg% (mean ± S.E.) venous 3.5% fibrin hydrolysate plus 10% dextrose to 10% No.
    [Show full text]
  • Severe Hyponatremia with Hypouricemia in a Patient with Medullary Hemorrhage: a Case Report
    SUTIRTHA CHAKRABORTY, TAPAS K BANERJEE SEVERE HYPONATREMIA WITH HYPOURICEMIA IN A PATIENT WITH MEDULLARY HEMORRHAGE: A CASE REPORT The Journal of the International Federation of Clinical Chemistry and Laboratory Medicine SEVERE HYPONATREMIA WITH HYPOURICEMIA IN A PATIENT WITH MEDULLARY HEMORRHAGE: A CASE REPORT Sutirtha Chakraborty1, Tapas K Banerjee2 1Consultant & Chief, Dept. of Biochemistry, Peerless Hospital & B K Roy Research Centre, Kolkata 700094, India 2Sr. Consultant & Head, Dept. of Neurology, National Neurosciences Centre, Peerless Hospital, Kolkata,India Corresponding Author: Dr Sutirtha Chakraborty, MD Consultant & Chief, Dept. of Biochemistry Peerless Hospital & B K Roy Research Centre, Kolkata 700094 , India e‐mail: [email protected] Mobile +91 9874787638 ABSTRACT Hyponatremia is the commonest electrolyte abnormality in hospitalized patients and occurs due to various causes. Here we present a case of SIADH who was diagnosed using commonly available biochemical tests. This case report also discusses the interaction of the laboratory physician with the treating clinician and the approach needed to arrive at a correct diagnosis. It highlights the importance of serum uric acid and fractional excretion of urinary uric acid in the diagnosis of SIADH. It also discusses the approach needed to distinguish SIADH from Cerebral Salt wasting syndrome, where the presenting feature is also hyponatremia. KEY WORDS Hyponatremia, SIADH, Uric Acid. CASE REPORT A 68 year old gentleman was admitted to the Dept. of Neurology with a history of sudden onset uneasiness followed by slurring of speech and giddiness. Examination by the Consultant Neurologist showed that he was conscious and obeying commands with a Glasgow Coma Scale of 14/15.Power was grade 4/5 in all four limbs and DTRs preserved.
    [Show full text]
  • Diagnostic Accuracy of Calculated Serum Osmolarity to Predict Dehydration in Older People: Adding Value to Pathology Laboratory Reports
    Open Access Research BMJ Open: first published as 10.1136/bmjopen-2015-008846 on 21 October 2015. Downloaded from Diagnostic accuracy of calculated serum osmolarity to predict dehydration in older people: adding value to pathology laboratory reports Lee Hooper,1 Asmaa Abdelhamid,1 Adam Ali,1 Diane K Bunn,1 Amy Jennings,1 W Garry John,2 Susan Kerry,2 Gregor Lindner,3 Carmen A Pfortmueller,4 Fredrik Sjöstrand,5 Neil P Walsh,6 Susan J Fairweather-Tait,1 John F Potter,1,2 Paul R Hunter,1,2 Lee Shepstone1 To cite: Hooper L, ABSTRACT et al Strengths and limitations of this study Abdelhamid A, Ali A, . Objectives: To assess which osmolarity equation best Diagnostic accuracy of predicts directly measured serum/plasma osmolality ▪ – calculated serum osmolarity Dehydration has become a generic term we and whether its use could add value to routine blood to predict dehydration in have clearly described dehydration type (water- older people: adding value to test results through screening for dehydration in older loss dehydration) and used serum osmolality, pathology laboratory reports. people. the correct reference standard. BMJ Open 2015;5:e008846. Design: Diagnostic accuracy study. ▪ Assessment of equations in five different groups doi:10.1136/bmjopen-2015- Participants: Older people (≥65 years) in 5 cohorts: of older people including healthy free-living older 008846 Dietary Strategies for Healthy Ageing in Europe people, frailer people living in residential care, (NU-AGE, living in the community), Dehydration and older people visiting emergency care or ▸ Prepublication history and Recognition In our Elders (DRIE, living in residential staying in hospital, living in several European additional material is care), Fortes (admitted to acute medical care), countries, and including men and women, available.
    [Show full text]
  • Using Osmolality to Diagnose and Treat Hyponatremia in Covid-19 Patients
    SCIENTIFIC RESOURCE USING OSMOLALITY TO DIAGNOSE AND TREAT HYPONATREMIA IN COVID-19 PATIENTS ARTICLE SUMMARY Recent publications have shown that COVID-19 (coronavirus disease 2019), an infectious disease caused by a novel coronavirus known as severe acute respiratory syndrome coronavirus (SARS-CoV-2), is associated with electrolyte disorders including hyponatremia.1,2,3 Early diagnosis and etiologic determination are critical in any hyponatremic patient to ensure proper treatment and to avoid potential harm to the patient.4,5 Osmolality testing is quick, inexpensive and effective to help with early detection and diagnosis of hyponatremia.6 Osmolality testing can help ensure that appropriate treatment strategies are implemented early for hyponatremic patients which may be even more significant in patients hospitalized with COVID-19.5,7,8 As clinicians and researchers continue to expand their understanding of COVID-19, additional laboratory testing is important to consider to help better understand and diagnose a COVID-19 patient’s underlying conditions. OSMOLALITY TESTING CAN HELP WITH EARLY DIAGNOSIS AND ETIOLOGICAL DETERMINATION OF HYPONATREMIA, WHICH IS CRITICAL FOR THIS PATIENT POPULATION As association between COVID-19 of hyponatremia. The use of urine and respiratory failure. and hyponatremia has been shown in osmolality to establish a correct Understanding the the literature.1,2,3 Hyponatremia is an underlying diagnosis of hyponatremia is underlying causes electrolyte disorder that occurs when critical to avoid inappropriate treatment
    [Show full text]
  • Hyperchloremia – Why and How
    Document downloaded from http://www.elsevier.es, day 23/05/2017. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. n e f r o l o g i a 2 0 1 6;3 6(4):347–353 Revista de la Sociedad Española de Nefrología www.revistanefrologia.com Brief review Hyperchloremia – Why and how Glenn T. Nagami Nephrology Section, Department of Medicine, VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA, United States a r t i c l e i n f o a b s t r a c t Article history: Hyperchloremia is a common electrolyte disorder that is associated with a diverse group of Received 5 April 2016 clinical conditions. The kidney plays an important role in the regulation of chloride concen- Accepted 11 April 2016 tration through a variety of transporters that are present along the nephron. Nevertheless, Available online 3 June 2016 hyperchloremia can occur when water losses exceed sodium and chloride losses, when the capacity to handle excessive chloride is overwhelmed, or when the serum bicarbonate is low Keywords: with a concomitant rise in chloride as occurs with a normal anion gap metabolic acidosis Hyperchloremia or respiratory alkalosis. The varied nature of the underlying causes of the hyperchloremia Electrolyte disorder will, to a large extent, determine how to treat this electrolyte disturbance. Serum bicarbonate Published by Elsevier Espana,˜ S.L.U. on behalf of Sociedad Espanola˜ de Nefrologıa.´ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).
    [Show full text]
  • An Infant with Chronic Hypernatremia
    European Journal of Endocrinology (2006) 155 S141–S144 ISSN 0804-4643 An infant with chronic hypernatremia M L Marcovecchio Department of Paediatrics, University of Chieti, Via dei Vestini 5, 66100 Chieti, Italy (Correspondence should be addressed to M L Marcovecchio; Email: [email protected]) Abstract A 4-month-old boy was presented with failure to thrive, refusal to feed, delayed motor development, truncal hypotonia, and head lag. His plasma osmolality and sodium were significantly high, while his urine osmolality was inappropriately low and did not increase after desmopressin administration. Despite his hyperosmolality, he presented with a lack of thirst and became clearly polyuric and polydipsic only at the age of 2 years. Initial treatment with indomethacin was ineffective, while the combination of hydrochlorothiazide and amiloride was effective and well tolerated. European Journal of Endocrinology 155 S141–S144 Introduction (61 ml/kg) respectively. Other investigations including thyroid and adrenal function were normal. He was Chronic hypernatremia in young patients is generally refusing oral fluids despite being hypernatremic. the result of alterations in the mechanisms controlling A cranial magnetic resonance imaging scan excluded fluid balance (1). Excessive water loss, as in diabetes structural abnormalities in the hypophysis, hypo- insipidus, or an inadequate fluid intake, as in adipsic thalamus and surrounding area. There was no response hypernatremia, may be the underlying cause. The to 0.3 mg 1-desamino-8-D-arginine-vasopressin (DDAVP) differential diagnosis between these conditions is given intravenously (osmolality pre- 374 mosmol/kg; important in order to choose the appropriate treatment. post- 371 mosmol/kg). This suggested a tubular defect However, pitfalls in the diagnosis are often related to an causing nephrogenic diabetes insipidus (NDI).
    [Show full text]
  • Electrolyte and Acid-Base Disorders Triggered by Aminoglycoside Or Colistin Therapy: a Systematic Review
    antibiotics Review Electrolyte and Acid-Base Disorders Triggered by Aminoglycoside or Colistin Therapy: A Systematic Review Martin Scoglio 1,* , Gabriel Bronz 1, Pietro O. Rinoldi 1,2, Pietro B. Faré 3,Céline Betti 1,2, Mario G. Bianchetti 1, Giacomo D. Simonetti 1,2, Viola Gennaro 1, Samuele Renzi 4, Sebastiano A. G. Lava 5 and Gregorio P. Milani 2,6,7 1 Faculty of Biomedicine, Università della Svizzera Italiana, 6900 Lugano, Switzerland; [email protected] (G.B.); [email protected] (P.O.R.); [email protected] (C.B.); [email protected] (M.G.B.); [email protected] (G.D.S.); [email protected] (V.G.) 2 Department of Pediatrics, Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland; [email protected] 3 Department of Internal Medicine, Ospedale La Carità, Ente Ospedaliero Cantonale, 6600 Locarno, Switzerland; [email protected] 4 Division of Hematology and Oncology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; [email protected] 5 Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois, and University of Lausanne, 1011 Lausanne, Switzerland; [email protected] 6 Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy 7 Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy * Correspondence: [email protected] Citation: Scoglio, M.; Bronz, G.; Abstract: Aminoglycoside or colistin therapy may alter the renal tubular function without decreasing Rinoldi, P.O.; Faré, P.B.; Betti, C.; the glomerular filtration rate. This association has never been extensively investigated.
    [Show full text]
  • Is There a Relationship Between COVID-19 and Hyponatremia?
    medicina Review Is There a Relationship between COVID-19 and Hyponatremia? Gina Gheorghe 1,2,†, Madalina Ilie 1,2, Simona Bungau 3,† , Anca Mihaela Pantea Stoian 4 , Nicolae Bacalbasa 5 and Camelia Cristina Diaconu 6,7,* 1 Department of Gastroenterology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; [email protected] (G.G.); [email protected] (M.I.) 2 Department of Gastroenterology, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania 3 Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania; [email protected] 4 Department of Diabetes, Nutrition and Metabolic Diseases, “Carol Davila” University of Medicine and Pharmacy, 020475 Bucharest, Romania; [email protected] 5 Department of Visceral Surgery, Center of Excellence in Translational Medicine, Fundeni Clinical Institute, 022328 Bucharest, Romania; [email protected] 6 Department of Internal Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania 7 Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania * Correspondence: [email protected]; Tel.: +40-0726-377-300 † This author has equal contribution to the paper as the first author. Abstract: Nowadays, humanity faces one of the most serious health crises, the severe acute respi- ratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. The severity of coronavirus disease 2019 (COVID-19) pandemic is related to the high rate of interhuman transmission of the virus, variability of clinical presentation, and the absence of specific therapeutic methods. COVID-19 can manifest with non-specific symptoms and signs, especially among the elderly. In some cases, the clinical manifestations of hyponatremia may be the first to appear.
    [Show full text]
  • A Case of Hypocalciuric Hypercalcemia Accompanying Cystic Fibrosis
    J Clin Res Pediatr Endocrinol 2015;7(Suppl 2):77-92 A Case of Hypocalciuric Hypercalcemia Accompanying Cystic Fibrosis Yaşar Şen, Sevil Arı Yuca, Fuat Buğrul Blood and urine tests were done in order to find the etiology of hypercalcemia (PTH: 65.5 pg/mL, 25-hydroxy vitamin Selçuk University Faculty of Medicine, Department of Pediatric D: 43.5 ng/mL, urine Ca/Cr ratio 0.19, urine Ca clearance Endorcinology, Konya, Turkey 0.004). In the CaSR gene mutation study, A986S and R990G polymorphisms were heterozygous. 1 month after hydration Introduction: Familial hypocalciuric hypercalcemia (FHH) and clinical state being back to normal, Ca levels were is an autosomal dominant disorder which occurs by an in normal range. In stressful situations, he experienced inactivating gene mutation in the calcium (Ca)-sensing hypernatremia and hypercalcemia together. receptor gene (CaSR). Prevalence is estimated at 1: 78000. Discussion: Polymorphisms may change protein function Ca regulates parathormone (PTH) secretion via CaSR on and capacity of one to repair its damaged DNA. Genetic parathyroid cells. Low levels of Ca increases PTH secretion. polymorphisms help us to define personal sensitivities to CaSR mutation that causes loss of function, leads to total some diseases. The most common CaSR polymorphisms or partial insensitivity of parathyroid cells to Ca’s inhibitory are A986S, R990G, Q1011E and A826T. Our patient effect. For this reason, in order to suppress Ca’s PTH had A986S and R990G mutations. Heterozygous CaSR secretory effect, the setpoint is raised. A higher blood Ca gene mutations generally cause mild disorders in clinic. level is needed to suppress the PTH secretion.
    [Show full text]
  • RECEPTOR ANTAGONISTS Vasopressin V2 Receptor Antagonists
    1 RECEPTOR ANTAGONISTS Vasopressin V2 receptor antagonists J G Verbalis 232 Building D, Division of Endocrinology and Metabolism, Georgetown University School of Medicine, 4000 Reservoir Road NW, Washington DC 20007, USA (Requests for offprints should be addressed toJGVerbalis; Email: [email protected]) Abstract Hyponatremia, whether due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH) or disorders of water retention such as congestive heart failure and cirrhosis, is a very common problem encountered in the care of medical patients. To date, available treatment modalities for disorders of excess arginine vasopressin (AVP) secretion or action have been limited and suboptimal. The recent discovery and development of nonpeptide AVP V2 receptor antagonists represents a promising new treatment option to directly antagonize the effects of elevated plasma AVP concentrations at the level of the renal collecting ducts. By decreasing the water permeability of renal collecting tubules, excretion of retained water is promoted, thereby normalizing or improving hypo-osmolar hyponatremia. In this review, SIADH and other water retaining disorders are briefly discussed, after which the published preclinical and clinical studies of several nonpeptide AVP V2 receptor antagonists are summarized. The likely therapeutic indications and potential complications of these compounds are also described. Journal of Molecular Endocrinology (2002) 29, 1–9 Introduction heart failure (CHF) and cirrhosis with ascites. In these disorders, a relatively decreased intravascular Arginine vasopressin (AVP), the ‘antidiuretic volume and/or pressure leads to water retention as a hormone,’ is the major physiological regulator of result of both decreased distal delivery of glomerular renal free water excretion. Increased AVP secretion filtrate and secondarily elevated plasma AVP levels.
    [Show full text]