1/43. Hypertonic saline test for the investigation of posterior pituitary function.The hypertonic saline test is a useful technique for distinguishing partial diabetes insipidus from psychogenic polydipsia, and for the diagnosis of complex disorders of osmoreceptor and posterior pituitary function. However, there is little information concerning its use in childhood. The experience of using this test in five children (11 months to 18 years) who presented diagnostic problems is reported. In two patients, in whom water deprivation tests were equivocal or impractical, an inappropriately low antidiuretic hormone (ADH) concentration (< 1 pmol/l) was demonstrated in the presence of an adequate osmotic stimulus (plasma osmolality > 295 mosmol/kg). In two children--one presenting with adipsic hypernatraemia and the other with hyponatraemia complicating desmopressin treatment of partial diabetes insipidus--defects of osmoreceptor function were identified. Confirming a diagnosis of idiopathic syndrome of inappropriate ADH secretion (SIADH) was possible in a patient with no other evidence of pituitary dysfunction. The hypertonic saline test was well tolerated, easy to perform, and diagnostic in all cases.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
2/43. Bioelectrical impedance analysis in the clinical management of a pregnant woman undergoing dialysis.We report a case of successful pregnancy in a woman who was initially diagnosed with renal failure in mid-pregnancy. She was started on hemodialysis, and her fluid balance was serially monitored with bioelectrical impedance analysis. Her body weight decreased and bioelectrical impedance values increased, along with resolution of pulmonary edema in the process of the removal of excessive fluid retention with hemodialysis. The bioelectrical impedance values decreased immediately after the usual dose of oral ritodrine was administered, partly because producing sodium and water retention by ritodrine were enhanced in the setting of fluid imbalances. This decrease preceded the onset of pulmonary edema, while no changes were noted in maternal body weight before hemodialysis. These results suggest that the serial measurement of bioelectrical impedance values enables more reliable and earlier detection of abnormal water retention in pregnant women undergoing dialysis than the effect of body weight changes.- - - - - - - - - - ranking = 2keywords = water (Clic here for more details about this article) |
3/43. hyponatremia with increased plasma antidiuretic hormone in a case of hypothyroidism.We report a 70-year-old woman with hypothyroidism and severe hyponatremia. Her plasma antidiuretic hormone (ADH) level was inappropriately high for her low plasma osmolality. Her low serum sodium level was gradually corrected by water restriction and sodium supplementation prior to the initiation of thyroid hormone replacement. After a diagnosis of Hashimoto's thyroiditis had been made, the patient was treated with levothyroxine. Following this treatment, the patient's serum sodium level increased drastically. It is suggested that the elevated plasma ADH level played an important role in the development of hyponatremia in this case.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
4/43. Surgical treatment of pancreatic vasoactive intestinal polypeptide-secreting tumor: a case report.A 68-year-old woman presented with secretory watery diarrhea causing hypokalimia, hypoalbuminemia and dehydration for 5 years. Subsequent investigations including abdominal ultrasonography and computed tomography scanning revealed a mass measuring 7 x 6 cm in the pancreatic tail. The diagnosis of pancreatic VIPomas was suspected on the basis of clinical symptoms. The patient underwent distal pancreatectomy and splenectomy after resuscitation of electrolyte imbalance, dehydration and malnutrition. The pathological examination with histoimmunochemical stain confirmed the diagnosis. Postoperative course is uneventful and the patient does not have symptoms any longer during the follow-up period.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
5/43. sodium and water disturbances in patients with Sheehan's syndrome.Sheehan's syndrome has been attributed to ischemic damage of the pituitary gland or hypothalamic-pituitary stalk during the peripartum period. Well-described clinical features of Sheehan's syndrome include hypothyroidism, adrenal insufficiency, hypogonadism, growth hormone deficiency, hypoprolactinemia, and different sodium and water disturbances. The occurrence of sodium and water disturbances associated with Sheehan's syndrome depends on the degree of pituitary damage, time of onset since the initial pituitary insult, and concurrent medical conditions that also may play a role in sodium and water balance. We present a patient with Sheehan's syndrome with severe chronic hyponatremia; discuss a potential problem in the patient's management; and review the literature for various sodium and water disturbances, including acute and chronic hyponatremia as well as overt and subclinical central diabetes insipidus. Although Sheehan's syndrome is more prevalent in developing countries, the increasingly large immigrant population within the united states warrants better awareness of this syndrome and its potential complicating sodium and water disturbances. Prompt diagnosis and an understanding of the pathogenic mechanisms of sodium and water disturbances associated with Sheehan's syndrome may avoid potential treatment-related complications.- - - - - - - - - - ranking = 10keywords = water (Clic here for more details about this article) |
6/43. Acute renal failure and metabolic disturbances in the short bowel syndrome.BACKGROUND: short bowel syndrome (SBS) describes a malabsorptive state caused by extensive loss of small intestinal length. AIM: To improve understanding of the metabolic complications of SBS. DESIGN: observational study of five patients with SBS who presented with acute renal failure. RESULTS: Acute renal failure in our patients was predominantly due to salt and fluid depletion, and sepsis. Electrolyte imbalance was a major cause of morbidity. Metabolic acidosis was seen in three patients, and may arise from excessive gastrointestinal bicarbonate loss, compounded by impaired renal homeostasis. Our patients also manifested disturbances of calcium and magnesium homeostasis. DISCUSSION: patients with SBS are at high risk of renal failure. Prevention of this complication requires close monitoring and the maintenance of sodium homeostasis through increased intake and measures to reduce loss (e.g. anti-motility agents and large bowel re-anastomosis), and calcium, magnesium and vitamin d supplementation.- - - - - - - - - - ranking = 0.031978215685809keywords = intake (Clic here for more details about this article) |
7/43. Villous adenoma of the colon with electrolyte depletion.The case is presented of a villous adenoma of the colon associated with profuse, watery diarrhoea of such severity as to cause dehydration and electrolyte depletion.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
8/43. Regulation of water, sodium and potassium: implications for practice.Regulation of fluid balance is a complex subject. Sharon Edwards discusses the physiological principles involved.- - - - - - - - - - ranking = 4keywords = water (Clic here for more details about this article) |
9/43. Nonketotic hyperglycemic hyperosmolar coma. Report of neurosurgical cases with a review of mechanisms and treatment.Seventy-eight critically ill patients who died while on the neurosurgical service were studied retrospectively to establish the prevalence of nonketotic hyperglycemic hyperosmolar coma (NHHC). All the patients had been comatose before death, and all underwent necropsy. Criteria for the diagnosis of NHHC included moderate-to-severe hyperglycemia with glucosuria, absence of significant acetonuria, hyperosmolarity with dehydration, and neurological dysfunction. This study revealed seven cases of unequivocal NHHC (9%), and six of hyperosmolarity but with incomplete records. Five of the seven confirmed cases of NHHC demonstrated no evidence of cerebral edema transtentorial herniation, or brain-stem damage, and showed central nervous system (CNS) lesions compatible with survival. Fatal complications of this syndrome, such as acute renal failure, terminal arrhythmias, and vascular accidents, both cerebral and systemic, were common in this series. The mechanism of coma in NHHC is believed related to shifts of free water from the cerebral extravascular space to the hypertonic intravascular space, with subsequent intracellular dehydration, accumulation of metabolic products of glucose, and brain shrinkage. It is uncertain whether injury to specific areas in the CNS is a predisposing factor to the development of NHHC. Factors documented to be significant in its development include nonspecific stress to primary illnesses, hyperosmolar tube feedings, dehydration, diabetes and mannitol, Dilantin, or steroid administration.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
10/43. Growth hormone and nutritional support: adverse metabolic effects.The use of growth hormone in clinical nutritional support has received considerable attention over the past decade. The most encouraging results have been improved nitrogen retention and protein synthesis in the presence of hypocaloric nutritional support. Adverse effects, however, can limit the clinical usefulness of this technology. In the following case study, an obese 71-year-old man with a history of chronic obstructive pulmonary disease remained ventilator dependent 2 months following anterior cervical fusion and had severe depletion of visceral proteins despite nitrogen equilibrium. He was treated with 10 mg of recombinant human growth hormone (Genentech) subcutaneously every other day while also receiving nutritional support. We hypothesized that growth hormone administration could promote both protein synthesis and the development of muscle mass, particularly in the respiratory muscles, without increasing nutrient intake and, therefore, without increasing CO2 production. The patient, however, developed two potentially life-threatening adverse effects: hyperglycemia and fluid retention. The severity of these adverse effects led to discontinuation of this mode of therapy.- - - - - - - - - - ranking = 0.031978215685809keywords = intake (Clic here for more details about this article) |
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