Hyponatremic seizures after suprapubic catheter placement in 7-year-old child

We report a case of hyponatremic seizures in a 7-year old boy with spina bifida following cystoscopy and suprapubic catheter placement. Immediate postoperative cystogram and pelvic computed tomogram (CT) after the development of seizures demonstrated a fluid collection from the suprapubic catheter site into the anterior abdominal wall. The subsequent reabsorption of free water from the fluid collection, with the contribution of postoperative hypotonic intravenous fluid administration and possible transient inappropriate antidiuretic hormone (ADH) secretion resulted in acute dilutional hyponatremia and consequent seizures. Strategies to prevent hyponatremia in children during urological procedures, with emphasis on the importance of reserving free water as the irrigation fluid are discussed.     

大面积脑梗死并发低钠血症的诊断治疗

目的总结大面积脑梗死低钠血症的诊断和治疗经验。方法对57例大面积脑梗死后低钠血症患者的临床表现及实验室检查、治疗、临床疗效进行回顾分析。结果对排钠增加和摄钠不足者,充分补钠;对抗利尿激素分泌不当综合征者应限水治疗;对脑性盐耗综合征者应补水和补盐治疗;全部患者的低钠血症均得到纠正。结论对大面积脑梗死并低钠血症进行正确诊断、合理处理对预后具有重要意义。     

护理干预对颈髓损伤后低钠血症的影响

目的探讨护理干预对颈髓损伤后低钠血症的影响。方法 60例颈髓损伤伴低血钠患者分成对照组(n=30)和护理干预组(n=30)。对照组未给予相关低钠血症的护理干预,护理干预组由责任护士给予相关低钠血症的护理干预。对1个月后两组的血清钠值及病程进行分析。结果 1个月后护理干预组血钠值明显高于对照组(P<0.01),并且护理干预组病程较对照组明显缩短(P<0.01),病情反复病例较对照组少(P<0.05)。结论护理干预有利于改善颈髓损伤患者的低钠血症。     

Hepatic encephalopathy and post‐transplant hyponatremia predict early calcineurin inhibitor‐induced neurotoxicity after liver transplantation

Early calcineurin inhibitor‐induced neurotoxicity (ECIIN) is considered when neurological symptoms occur within 4 weeks after liver transplantation (LT). Risk factors and clinical outcome of ECIIN remain largely unknown. We sought to estimate the incidence, risk factors, and outcome of ECIIN after LT. We retrospectively evaluated 158 patients that underwent LT in a 2‐year period and received immunosuppression with calcineurin inhibitors (CNI) and prednisone. ECIIN was considered when moderate/severe neurological events (after excluding other etiologies) occurred within 4 weeks after LT and improved after modification of CNI. Demographic and clinical variables were analyzed as risk factors. Twenty‐eight (18%) patients developed ECIIN and the remaining 130 patients were analyzed as controls. History of pre‐LT hepatic encephalopathy (OR 3.16, 95% CI 1.29–7.75, P = 0.012), post‐LT hyponatremia (OR 3.34, 95% CI 1.38–9.85, P = 0.028), and surgical time >7 h (OR 2.62, 95% CI 1.07–6.41, P = 0.035) were independent factors for ECIIN. Acute graft rejection and infections were more frequent in the ECIIN group. In addition, length of stay was longer in ECIIN patients. In conclusion, pre‐LT hepatic encephalopathy, surgical time >7 h, and post‐LT hyponatremia are risk factors for ECIIN. Clinical complications and a longer hospital stay are associated with ECIIN development.     

Use of desmopressin in elderly patients in Denmark

PURPOSE: Against the background of the approval of the use of desmopressin in the treatment of nocturia in adults, the aim of the present study was to describe patterns of its use in elderly patients in Denmark from 2000 to 2004. METHODS: Data were obtained from the Danish Register of Medicinal Product Statistics on nationwide sales of desmopressin and two commonly used measures of drug utilisation: 1-year prevalence (number of patients treated at least once during 1 year/1000 inhabitants) and therapeutic intensity (Daily Defined Doses (DDD)/1000 inhabitants/day). RESULTS: In 2002, the 1-year prevalence rose ranging from a 5-fold increase among men aged 60-69 years to a 14-fold increased prevalence in men >/=90 years. In women, relative increases of the same magnitude were noted. Similarly, marked increases of the therapeutic intensities were observed in both men and women in 2002, this was followed by steady growth in most age groups. By the end of the study period in 2004, the highest therapeutic intensities were observed in men (1.06 DDD/1000 inhabitants/day) and women (0.92 DDD/1000 inhabitants/day) aged 80-89 years. CONCLUSION: After approval in 2002 of the use of desmopressin in the management of nocturia in adults, a substantial increased utilisation was observed in patients >/=80 years. Given the high prevalence of risk factors for hyponatremia in these elderly patients, the pattern of utilisation is noteworthy and may need to be reviewed.     

垂体后叶素对咯血患者血钠影响的临床分析

目的：分析垂体后叶素对咯血患者血钠影响的临床特点。方法：收集2006年10月至2009年10月首都医科大学附属北京安贞医院急诊重症监护室应用垂体后叶素治疗咯血患者的临床资料,进行回顾性分析。结果：共有14例咯血患者应用垂体后叶素治疗。垂体后叶素的用量为3～5 U,加入0.9%氯化钠注射液20 mL中缓慢静脉推注,之后用垂体后叶素6～12 U＋0.9%氯化钠注射液250 mL缓慢静脉滴注,止血后改为垂体后叶素6～12 U＋0.9%氯化钠注射液250 mL静脉滴注,维持12～24 h后停药。4例患者使用垂体后叶素1d后止血遂停药,血钠无变化。使用垂体后叶素2～12 d止血后停药的10例患者出现低钠血症[由入院时（137.4±1.3）mmol/L降至（124.9±5.6）mmol/L,P〈0.05]。10例患者中男性4例,女性6例,年龄47～79岁,平均62岁。其中9例（用药时间2～9 d,平均4 d）表现为恶心、呕吐、头晕及疲乏,垂体后叶素平均累计总用量为57（24～108）U/人,为轻度低钠血症;1例（用药时间12 d）表现为反应迟钝和昏睡,垂体后叶素累计总用量为124 U,停用垂体后叶素后出现一过性多尿,为重度低钠血症。对低钠血症患者用3%～4%氯化钠注射液静脉滴注补钠治疗,患者血钠由（124.9±5.6）mmol/L升至（138.1±1.2）mmol/L（P〈0.05）。经止血和补钠治疗,所有患者康复出院。结论：使用垂体后叶素治疗咯血应密切监测患者临床表现和血钠变化;已经止血并出现低钠血症者应停用垂体后叶素并给予对症治疗。     

The effects of 6 months of increased water intake on blood sodium, glomerular filtration rate, blood pressure, and quality of life in elderly (aged 55-75) men

OBJECTIVES: To study whether there are any negative or positive effects of 6 months of increased fluid intake in reasonably healthy elderly men. DESIGN: Randomized trial. SETTING: Community-based. PARTICIPANTS: One hundred forty-one healthy participants aged 55 to 75. INTERVENTION: One group was given the advice to increase their daily fluid intake by 1.5 L of water; the other group was given placebo medication (8 mL inactive syrup per day). MEASUREMENTS: At 6 months blood sodium, glomerular filtration rate (GFR), blood pressure, and quality of life (QOL) were measured. The changes in water turnover were measured using deuterium. RESULTS: Most subjects did not manage to increase their fluid intake by 1.5 L. The average increase in the intervention group was approximately 1 L. Twenty-four-hour water turnover in the water group was 359 mL (95% confidence interval=171-548) higher than that of the control group at 6-month follow-up. Blood pressure, sodium level, GFR, and QOL did not change significantly in either group during the intervention period. In addition, the cases reporting a worsening on the effect measures were equally distributed over the two study groups. CONCLUSION: The advice to increase fluid intake by 1.5 L had no negative effects in reasonably healthy men aged 55 to 75.     

Hyponatremia and arginine vasopressin dysregulation: mechanisms, clinical consequences, and management

Hyponatremia, the most common electrolyte disorder, occurs frequently in older people and in hospitalized patients. Physiological changes of aging that interact with diseases and drugs commonly present in older people put this population at greater risk for hyponatremia. It can accompany central nervous system disorders, pulmonary and renal disease, cancer, congestive heart failure, and liver cirrhosis, as well as many commonly used drugs. Delayed recognition can lead to symptomatic hyponatremia with consequent cerebral edema and possibly irreversible neurological damage. Symptoms and signs of hyponatremia may be subtle or not attributed to hyponatremia. Most cases are of the euvolemic type, in which extracellular fluid volume is normal and is often due to the syndrome of inappropriate secretion of antidiuretic hormone. Hyponatremia can also occur in association with hypervolemia or hypovolemia. Common to all of these circumstances is increased secretion of arginine vasopressin (AVP). Understanding of the pathophysiological basis of hyponatremia and of brain compensatory mechanisms is critical to safe treatment. Fluid restriction or infusion of hypertonic saline can improve symptoms and normalize serum sodium levels but does not address excess AVP, which in most cases is the underlying cause of the disorder. A major new approach to treatment of hyponatremia is the development of aquaretics: AVP-receptor antagonists that provide a targeted therapeutic approach to correcting the many kinds of hyponatremia caused by excess AVP levels.     

Use of sodium concentration and anion gap to improve correlation between serum chloride and bicarbonate concentrations

Although most acid-base disorders cause opposite and equal changes in serum chloride and bicarbonate concentrations, this inverse relationship can be distorted by changes in the anion gap and/or water balance. Therefore, we examined the relationship between chloride and bicarbonate before and after adjusting for anion gap and serum sodium concentration. Patients with abnormal electrolytes were grouped by chloride and bicarbonate concentrations (low, normal, and high). Then, chloride and anion gap-adjusted bicarbonate were adjusted for water excess (or deficit), manifesting as hyponatremia (or hypernatremia), after which patients were reclassified. Classification by chloride and bicarbonate changed in 82% of the 135 patients after adjustment for anion gap and sodium. Serum chloride and bicarbonate were each low (concordant) in 23 patients, while 18 had discordant chlorides and bicarbonates (9 low/high, 9 high/low). After adjustments, chloride and bicarbonate were discordant in 40 patients (31 low/high, 9 high/low) and concordant in none. The correlation between serum chloride and bicarbonate improved from -0.459 to -0.998 after adjustments for sodium and anion gap. A very close inverse relationship between serum chloride and bicarbonate concentrations is commonly distorted by concomitant water disturbances and anion gap acidoses in internal medicine patients admitted with electrolyte disorders.     

术前应用非那雄胺对经尿道前列腺电切术手术效果的影响

目的探讨接受经尿道前列腺电切手术(TURP)前应用非那雄胺对降低良性前列腺增生患者经尿道电切综合征(TURS)效果及其作用机制。方法将接受TURP的良性前列腺增生患者180例随机分成两组,治疗组术前服用非那雄胺,对照组不服用药物。对比两组术中失血情况、术中血钠值,术后免疫组化法检测前列腺组织中血管内皮生长因子(VEGF)表达情况。结果治疗组术中失血量、前列腺组织中VEGF计数低于对照组(P<0.05),术中血钠值高于对照组(P<0.05)。结论术前服用非那雄胺能够防止和减少TURS的发生。