Offshore telemedicine emergency service: a 1-year experience

Journal of Public Health - Offshore wind energy is a fast growing market. Accordingly, a correspondingly large number of employees are working at the wind farms. Owing to the harsh operating...     

Hyponatremia in a pediatric stroke patient: syndrome of inappropriate antidiuretic hormone secretion or cerebral salt wasting?

OBJECTIVE: To determine the potential role of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) in the pathogenesis of cerebral salt wasting. DESIGN: Clinical case report. SETTING: Regional pediatric intensive care unit. PATIENT: A 3-yr-old boy with a cerebral infarct secondary to traumatic carotid artery dissection who developed hyponatremia associated with weight loss and excessive renal sodium excretion on the sixth day after hospitalization. MEASUREMENTS AND MAIN RESULTS: Plasma concentrations of ANP, BNP, antidiuretic hormone, and renin were determined serially and compared with concentrations measured in a group of eight healthy children undergoing elective surgical procedures. Compared with controls, ANP and BNP plasma concentrations on the eighth day after hospitalization were increased 1.9-fold and 7.7-fold, respectively. Thereafter, the course of ANP and BNP paralleled that of sodium and H2O excretion and remained elevated until the 14th (BNP) and 16th (ANP) days after hospitalization. Serum antidiuretic hormone and renin concentrations were within normal ranges during the entire observation period. CONCLUSION: Cerebral salt wasting is associated with elevated plasma concentrations of ANP and BNP. Natriuretic peptides may play a role in the pathogenesis of this syndrome.     

Vergiftung mit Alkylphosphat (Dimethoat) in suizidaler Absicht

The widespread use of organophosphates as insecticides has increased the likelihood of poisoning with these compounds. Although poisoning can result from occupational exposure or accidental ingestion, in most cases there is suicidal intent, especially in developing countries where the highest incidence of morbidity and mortality from this cause occurs. Several organophosphates are used as insecticides because they inhibit the acetylcholinesterase of insects. The same mechanism accounts for acute toxicity in humans and it is characterized by signs of cholinergic overstimulation. The presented case describes the management of treatment of a patient with organophosphate poisoning.     

Differential secretion of atrial and brain natriuretic peptide in critically ill patients

Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are cardiac hormones with natriuretic, vasorelaxant, and aldosterone-inhibiting properties. We analyzed the plasma of 178 critically ill patients for ANP, BNP, aldosterone, and serum sodium concentration, as well as serum and urine osmolality and sodium filtration fraction. Mean plasma concentrations of ANP and BNP were increased in critically ill patients compared with healthy controls (ANP, 14.3 +/- 5.8 pmol/L versus 8.8 +/- 3.2 pmol/L, P < 0.05; BNP, 26.2 +/- 10.7 pmol/L versus 4.6 +/- 2.8 pmol/L, P < 0.0001). The relative increases in ANP concentrations were comparable in all diseases. BNP concentrations, by contrast, showed a wider variation. The largest BNP concentrations were observed in patients who underwent cardiac surgical procedures and in patients with subarachnoid hemorrhage. ANP, but not BNP, was correlated with aldosterone levels (r = 0.4, P < 0.001), serum sodium (r = 0.42, P < 0.001), sodium filtration fraction (r = 0.3, P < 0.001), serum osmolality (r = 0.25, P < 0.01), urinary osmolality (r = -0.24, P < 0.01), and central venous pressure (r = 0.22, P < 0.01). ANP and BNP concentrations were increased in critically ill patients; however, this did not correlate with the severity of illness or mortality. Our data support a regulatory role for ANP in the maintenance of water and electrolyte balance. The physiologic role of BNP, by contrast, is less clear. ANP and BNP are not predictors for the severity of illness and mortality in critically ill patients.