Cerebral bleeding, infarcts, and persumed extrapontine myelinolysis in hypernatraemic dehydration

Abstract The neuroimaging findings in an infant with hypernatremic dehydration are presented. Brain parenchymal haemorrhage and extensive multiple infarcts were present in the acute stage. Follow-up CT showed bilateral, symmetrical changes presumed to indicate extrapontine myelinolysis in the thalamus and globus pallidus. MRI confirmed sparing of the pons. Only three previous cases of neuroimaging abnormalities due to hypernatraemia have been described in the radiological literature. Received: 30 December 1997 Accepted: 6 May 1998     

颅咽管瘤全切除术后钠代谢紊乱及处理

目的分析颅咽管瘤全切除术后钠代谢紊乱的病理生理、诊断及处理。方法对我科86例巨大颅咽管瘤(直径>3.5cm)全切除患者进行回顾性分析,根据血钠、尿钠、渗透压以及中心静脉压等确定钠代谢紊乱类型,并进行相应处理。结果发生低钠血症29例(33.7％,29/86)、高钠血症13例(15.1％,13/86)、高钠及低钠血症交替9例(10.5％,9/86)。高钠及低钠血症平均开始时间分别为术后(2.3±0.7)d和(4.8±1.6)d。2例死于严重下丘脑反应,其余钠代谢紊乱均纠正良好,平均住院时间26 d。结论钠代谢紊乱是颅咽管瘤全切除术后常见表现之一。高钠血症与尿崩症关系密切,而低钠血症主要有两个原因:脑性盐耗综合征和抗利尿激素不适当分泌综合征,二者要仔细区分,前者着重补液、补盐,而后者应在补盐的基础上要适当限水和利尿。     

Fatal hypernatraemia after hypertonic Saline irrigation of hepatic hydatid cysts

A 7-year-old boy with hepatic hydatid cysts developed fatal hypernatraemia after surgery for cyst removal where 20% hypertonic saline (HS) was used as a scolicidal agent. Symptoms of generalised seizures, tachycardia, and hypotension developed within 6 h of surgery. Serum electrolytes confirmed hypernatraemia (170 mmol/l) and hyperchloraemia (141 mmol/l). Despite attempts at resuscitation, he died 20 h later. The literature is reviewed, emphasising the potential dangers of the use of HS and the clinical presentation and appropriate management of hypernatraemia. Accepted: 15 February 2001     

Effect of hypernatraemia and the neurohypophysial peptide, arginine vasotocin (AVT) on behavioural thermoregulation in the agamid lizard, Ctenophorus ornatus

Hypernatraemia induced by chronic injections of sodium chloride provokes thermal depression in the agamid lizard, Ctenophorus (formerly Amphibolurus) ornatus, with a fall of two degrees Celsius in the mean body temperature selected behaviourally in a photo-thermal gradient. The placement of an electrolytic lesion in the base of the hypothalamus, designed to eliminate secretion of the neuropeptide arginine vasotocin (AVT), did not affect the lizards' thermoregulatory behaviour and their Preferred Body Temperature (PBT) was not significantly different from that of unoperated controls. Saline loading, however, did not induce thermal depression in these tract-operated individuals and their PBT was significantly higher than that of salt-loaded intact individuals. When AVT was injected into operated, salt-loaded, animals, however, thermal depression was observed, supporting the hypothesis that thermal depression brought about by hypernatraemia is mediated through the action of AVT. AVT similarly significantly depressed the PBT of injected intact individuals by 3.2 degrees C when compared with hydrated controls. Immunostaining for AVT confirmed that the lesions placed in the region of the median eminence virtually eliminated AVT located in the neurohypophysial tract, and the pars nervosa. This is the first report of an effect of this peptide on behavioural thermoregulation in a lizard.     

Fatores de risco para mortalidade após hemorragia subaracnoidea: estudo observacional retrospectivo

Background and objectivesSubarachnoid haemorrhage is an important cause of morbidity and mortality. The aim of the study was to determine predictors of mortality among patients with subarachnoid hemorrhage hospitalized in an Intensive Care Unit.MethodsThis is a retrospective study of patients with subarachnoid hemorrhage admitted to the Intensive Care Unit of our institution during a 7 year period (2009–2015). Data were collected from the Intensive Care Unit computerized database and the patients’ chart reviews.ResultsWe included in the study 107 patients with subarachnoid haemorrhage. A ruptured aneurysm was the cause of subarachnoid haemorrhage in 76 (71%) patients. The overall mortality was 40% (43 patients), and was significantly associated with septic shock, midline shift on CT scan, inter‐hospital transfer, aspiration pneumonia and hypernatraemia during the first 72 hours of Intensive Care Unit stay. Multivariate analysis of patients with subarachnoid hemorrhage following an aneurysm rupture revealed that mortality was significantly associated with septic shock and hypernatremia during the first 72 hours of Intensive Care Unit stay, while early treatment of aneurysm (clipping or endovascular coiling) within the first 72 hours was identified as a predictor of a good prognosis.ConclusionsTransferred patients with subarachnoid haemorrhage had lower survival rates. Septic shock and hypernatraemia were important complications among critically ill patients with subarachnoid haemorrhage and were associated increased mortality.     

Non-invasive estimation of arterial blood pH using exhaled CO/CO2 analyser,microwave radar and infrared thermography for patients after massive haemorrhage

In order to conduct non-contact estimation of arterial blood pH after massive haemorrhage, we calculated the arterial pH based on linear-regression analysis of exhaled gas concentrations (CO and CO₂) and vital signs (heart rate, respiratory rate, and surface temperature) measured using non-contact methods in hypovolemic animals.     

Indomethacin treatment in a patient with lithium-induced polyuria

Lithium intoxication causes polyuria, central nervous system manifestations, and ultimately stupor progressing to coma. Moreover, polyuria leading to hypernatraemia itself can progress to convulsions and coma. We present a patient with lithium intoxication who remained polyuric, hypernatraemic and somnolent despite normal serum lithium concentrations. After institution of indomethacin orally, polyuria and hypernatraemia disappeared and patient regained consciousness.     

Behavioral evidence for the existence of two pools of cellular inositol

Lithium reduces brain inositol levels by inhibiting inositol monophosphatase. In a previous study it was found that administration of pilocarpine to Li-treated rats causes limbic seizure behavior which can be reversed by i.c.v. myo-inositol but not chiro-inositol, suggesting that this behavior is related to inositol depletion in the PI cycle. Hyponatremia can lower brain inositol and hypernatremia can raise brain inositol. We now report that induction of low brain inositol by hyponatremia followed by pilocarpine did not cause limbic seizures. Induction of high brain inositol using hypernatremia followed by Li-pilocarpine administration did not reverse limbic seizures. These data support the concept that inositol available for Pl synthesis and inositol for osmotic function are sequestered in different cellular pools.