Medicine › Pulmonary and Respiratory Medicine

Electrolyte and hormonal disorders

Works Count: 58592

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This cluster of papers focuses on the diagnosis, evaluation, and treatment of hyponatremia, with a particular emphasis on its association with heart failure, elderly patients, osteoporosis, and inappropriate antidiuresis. The role of vasopressin and copeptin as biomarkers, as well as the neurological complications associated with hyponatremia, are also explored.

Keywords

Hyponatremia; Vasopressin; Copeptin; Heart Failure; Diagnosis; Treatment; Elderly; Osteoporosis; Inappropriate Antidiuresis; Neurological Complications

Mechanisms by Which Dehydration May Lead to Chronic Kidney Disease

2015-01-01

Carlos A. Roncal-Jiménez , Miguel A. Lanaspa , Thomas Jensen +2 more

Increased consumption of fructose may play an important role in the epidemic of metabolic syndrome and may presage the development of diabetes, cardiovascular disease, and chronic kidney disease. Once in … Increased consumption of fructose may play an important role in the epidemic of metabolic syndrome and may presage the development of diabetes, cardiovascular disease, and chronic kidney disease. Once in the cell, fructose is phosphorylated by ketohexokinase (KHK), leading to consumption of ATP, formation of AMP, and generation of uric acid through xanthine oxidoreductase (XOR). This study aimed to examine the direct effects of fructose in human kidney proximal tubular cells (HK-2) and whether they are mediated by the fructose metabolism via KHK. At a similar concentration to that observed in peripheral blood after a meal, fructose induced production of monocyte chemotactic protein 1 (MCP-1) and reactive oxygen species in HK-2 cells. Knockdown of KHK by stable transfection with small hairpin RNA demonstrated that these processes were KHK dependent. Several antioxidants, including specific inhibitors of NADPH oxidase and XOR, prevented MCP-1 secretion. We detected XOR mRNA in HK-2 cells and confirmed its activity by identifying uric acid by mass spectrometry. Fructose increased intracellular uric acid, and uric acid induced production of MCP-1 as well. In summary, postprandial concentrations of fructose stimulate redox- and urate-dependent inflammatory mediators in proximal tubular cells.

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The effect of insulin on renal handling of sodium, potassium, calcium, and phosphate in man.

1975-04-01

Ralph A. DeFronzo , Colin R. Cooke , R Andres +2 more

The effects of insulin on the renal handling of sodium, potassium, calcium, and phosphate were studied in man while maintaining the blood glucose concentration at the fasting level by negative … The effects of insulin on the renal handling of sodium, potassium, calcium, and phosphate were studied in man while maintaining the blood glucose concentration at the fasting level by negative feedback servocontrol of a variable glucose infusion. In studies on six water-loaded normal subjects in a steady state of water diuresis, insulin was administered i.v. to raise the plasma insulin concentration to between 98 and 193 muU/ml and infused at a constant rate of 2 mU/kg body weight per min over a total period of 120 min. The blood glucose concentration was not significantly altered, and there was no change in the filtered load of glucose; glomerular filtration rate (CIN) and renal plasma flow (CPAH) were unchanged. Urinary sodium excretion (UNaV) decreased from 401 plus or minus 46 (SEM) to 213 plus or minus 18 mueq/min during insulin administration, the change becoming significant (P smaller than 0.02) within the 30-60 min collection period. Free water clearance (CH2O) increased from 10.6 plus or minus 0.6 to 13 plus or minus 0.5 ml/min (P smaller than 0.025); osmolar clearance decreased and urine flow was unchanged. There was no change in plasma aldosterone concentration, which was low throughout the studies, and a slight reduction was observed in plasma glucagon concentration. Urinary potassium (UKV) and phosphate (UPV) excretion were also both decreased during insulin administration; UKV decreased from 66 plus or minus 9 to 21 plus or minus 1 mueq/min (P smaller than 0.005), and tupv decreased from 504 plus or minus 93 to 230 plus or minus 43 mug/min (P smaller than 0.01). The change in UKV was associated with a significant reduction in plasma potassium concentration. There was also a statistically significant but small reduction in plasma phosphate concentration which was not considered sufficient alone to account for the large reduction in UPV. Urinary calcium excretion (UCaV) increased from 126 plus or minus 24 to 200 plus or minus 17 mug/min (P smaller than 0.01). These studies demonstrate a reduction in UNaV associated with insulin administration that occurs in the absence of changes in the filtered load of glucose, glomerular filtration rate, renal blood flow, and plasma aldosterone concentration. The effect of insulin on CH2O suggests that insulin's effect on sodium excretion is due to enhancement of sodium reabsorption in the diluting segment of the distal nephron.

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Hyponatremia Treatment Guidelines 2007: Expert Panel Recommendations

2007-11-01

Joseph G. Verbalis , Stephen R. Goldsmith , Arthur Greenberg +2 more

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Diagnosis, Evaluation, and Treatment of Hyponatremia: Expert Panel Recommendations

2013-09-26

Joseph G. Verbalis , Steven R. Goldsmith , Arthur Greenberg +4 more

Development and Clinical Application of a New Method for the Radioimmunoassay of Arginine Vasopressin in Human Plasma

1973-09-01

Gary L. Robertson , Ermelinda A. Mahr , Shahid Athar +1 more

A radioimmunoassay has been developed that permits reliable measurements of plasma arginine vasopressin (AVP) at concentrations as low as 0.5 pg/ml in sample volumes of 1 ml or less. Nonhormonal … A radioimmunoassay has been developed that permits reliable measurements of plasma arginine vasopressin (AVP) at concentrations as low as 0.5 pg/ml in sample volumes of 1 ml or less. Nonhormonal immunoreactivity associated with the plasma proteins is eliminated by acetone precipitation before assay, leaving unaltered a component that is immunologically and chromatographically indistinguishable from standard AVP. Storage of plasma results in a decline in AVP concentration and, thus, must be carefully regulated. The plasma AVP values obtained by our method approximate the anticipated levels and vary in accordance with physiologic expections. In recumbent normal subjects, plasma AVP ranged from (mean +/-SD) 5.4+/-3.4 pg/ml after fluid deprivation to 1.4+/-0.8 pg/ml after water loading, and correlated significantly with both plasma osmolality (r=0.52; P<0.001) and urine osmolality (r=0.77; P<0.001). After fluid restriction, plasma AVP was uniformly normal relative to plasma osmolality in patients with nephrogenic diabetes insipidus and primary polydipsia but was distinctly subnormal in all patients with pituitary diabetes insipidus. The infusion of physiologic amounts of posterior pituitary extract caused a dose-related rise in plasma vasopressin that afterwards declined at the expected rate (t(1/2)=22.5+/-4 min). We conclude that, when used appropriately, our radioimmunoassay method provides a useful way of assessing AVP function in man.

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Incidence and Prevalence of Hyponatremia

2006-07-01

Ashish Upadhyay , Bertrand L. Jaber , Nicolaos E. Madias

The Neurohumoral Axis in Congestive Heart Failure

1984-09-01

Gary S. Francis , Steven R. Goldsmith , T. Barry Levine +2 more

The incidence of congestive heart failure is increasing in the United States. This common syndrome is characterized not only by impaired ventricular function but also by an increase in some … The incidence of congestive heart failure is increasing in the United States. This common syndrome is characterized not only by impaired ventricular function but also by an increase in some endogenous vasoconstrictor substances, including norepinephrine, angiotensin II, and arginine vasopressin. Although activation of the systems that release these substances is presumed to be compensatory (to maintain perfusion pressure during inadequate flow), the sympathetic nervous system, renin-angiotensin-aldosterone system, and arginine vasopressin may contribute to the pathogenesis of the syndrome. The excessive vasoconstriction present in heart failure likely produces a further burden on the failing myocardium. New strategies in therapy are being developed to counteract the activation of vasoconstrictor forces in congestive heart failure. Data indicate that selective blockade of the reninangiotensin system is useful. Preliminary data suggest that inhibition of the sympathetic nervous system may be helpful, and inhibition of vasopressin in animals with heart failure is being studied. New and more selective therapy for heart failure may come from these studies.

Acute Vasoconstrictor Response to Intravenous Furosemide in Patients with Chronic Congestive Heart Failure

1985-07-01

Gary S. Francis , Robert M. Siegel , Steven R. Goldsmith +3 more

Hemodynamic and neurohumoral responses to acute diuretic therapy were measured in 15 patients with severe chronic heart failure given intravenous furosemide, 1.3 +/- 0.6 (SD) mg/kg body weight. Left ventricular … Hemodynamic and neurohumoral responses to acute diuretic therapy were measured in 15 patients with severe chronic heart failure given intravenous furosemide, 1.3 +/- 0.6 (SD) mg/kg body weight. Left ventricular pump function deteriorated by 20 minutes, as indicated by a fall in stroke volume index (27 +/- 8 to 24 +/- 7 mL/min X m2 body surface area, p less than 0.01) and an increase in left ventricular filling pressure (28 +/- 7 to 33 +/- 9 mm Hg, p less than 0.01). Increases occurred in heart rate (87 +/- 13 to 91 +/- 16 beats/min, p less than 0.01), mean arterial pressure (90 +/- 15 to 96 +/- 15 mm Hg, p less than 0.01), systemic vascular resistance (1454 +/- 394 to 1676 +/- 415 dynes X s X cm-5, p less than 0.01), plasma renin activity (9.9 +/- 8.5 to 17.8 +/- 16 ng/mL X h, p less than 0.05), plasma norepinephrine level (667 +/- 390 to 839 +/- 368 pg/mL, p less than 0.01), and plasma arginine vasopressin level (6.2 +/- 1.3 to 8.3 +/- 2.0 pg/mL, p less than 0.01). During the next 3.5 hours the patients had diuresis (2085 +/- 1035 mL) and the expected fall in filling pressure (28 +/- 7 to 22 +/- 10 mm Hg, p less than 0.01). Neurohumoral indicators also returned toward the control levels. Intravenous furosemide, in patients with severe chronic heart failure, is associated with acute pump dysfunction temporally related to activation of the neurohumoral axis.

Hyperplasia of the Juxtaglomerular Complex with Hyperaldosteronism and Hypokalemic Alkalosis.

1963-04-01

J R Gill

s1 April 1963Hyperplasia of the Juxtaglomerular Complex with Hyperaldosteronism and Hypokalemic Alkalosis.J. R. Gill Jr., M.D. (Associate), F. C. Bartter, M.D., P. Pronove, M.D., R. C. MacCardle, Ph.D.J. R. Gill … s1 April 1963Hyperplasia of the Juxtaglomerular Complex with Hyperaldosteronism and Hypokalemic Alkalosis.J. R. Gill Jr., M.D. (Associate), F. C. Bartter, M.D., P. Pronove, M.D., R. C. MacCardle, Ph.D.J. R. Gill Jr., M.D. (Associate)Search for more papers by this author, F. C. Bartter, M.D.Search for more papers by this author, P. Pronove, M.D.Search for more papers by this author, R. C. MacCardle, Ph.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-58-4-740_1 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptHyperplasia and hypertrophy of the juxtaglomerular apparatus, and increased aldosterone production which hypokalemic alkalosis, have been found to be associated with normal blood pressure in 2 Negro boys, C. T. and M. W., ages 10 and 25 years, respectively. Growth and development were retarded in both patients, most markedly in C. J., who showed proportional dwarfism. Hypokalemia was known to be present at 5 years in C. J. and at 16 years in M. W. Serum potassium (K) and carbon dioxide (CO2) ranged from 1.3 to 2.2 mEq/liter and 29 to 37 mEq/liter, respectively; serum Na was also depressed. Urinary... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Bethesda, Md. (CI) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByBartter-Syndrom, 1962 1 April 1963Volume 58, Issue 4Page: 740-740KeywordsAldosteroneBlood pressureCarbon dioxidePotassium Issue Published: 1 April 1963 PDF DownloadLoading ...

Production of Polydipsia in Normal Rats by an Intermittent Food Schedule

1961-01-20

John L. Falk

Marked polydipsia was produced in all animals trained to press a bar for food pellets on a 1-minute variable-interval schedule. It is suggested that since this feeding arrangement produces a … Marked polydipsia was produced in all animals trained to press a bar for food pellets on a 1-minute variable-interval schedule. It is suggested that since this feeding arrangement produces a sustained, high fluid intake in the normal, unrestrained animal, it might serve as a useful tool in the study of renal function.

Mortality after Hospitalization with Mild, Moderate, and Severe Hyponatremia

2009-08-27

Sushrut S. Waikar , David B. Mount , Gary C. Curhan

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Deamino-8-D-Arginine Vasopressin Shortens the Bleeding Time in Uremia

1983-01-06

Pier Mannuccio Mannucci , Giuseppe Remuzzi , F Pusineri +4 more

In a randomized double-blind cross-over trial we gave either 1-deamino-8-D-arginine vasopressin or placebo to 12 patients with uremia, hemorrhagic tendencies, and prolonged bleeding times. After vasopressin infusion, all patients had … In a randomized double-blind cross-over trial we gave either 1-deamino-8-D-arginine vasopressin or placebo to 12 patients with uremia, hemorrhagic tendencies, and prolonged bleeding times. After vasopressin infusion, all patients had shortened bleeding times, with the effect lasting for at least four hours in most cases. Platelet count, platelet cyclic AMP levels, platelet retention on glass beads, plasma fibronectin, serum thromboxane B2 and residual prothrombin, hematocrit, and plasma osmolarity were unchanged after vasopressin. A consistent post-infusion increase in factor VIII coagulant activity and, to a lesser extent, in factor VIII-related antigen and ristocetin cofactor accompanied the shortening of bleeding time. In addition, vasopressin induced the appearance in plasma of larger von Willebrand-factor multimers than those present in the resting state. The compound was given to nine additional patients with acute or chronic renal failure and prolonged bleeding times, before major surgery or renal biopsy. In these patients, shortening of the bleeding time was associated with normal hemostasis. Our findings indicate that 1-deamino-8-D-arginine vasopressin can be used for temporary correction of bleeding time and may prevent surgical bleeding in patients with uremia.

Blood Pressure Control—Special Role of the Kidneys and Body Fluids

1991-06-28

Arthur C. Guyton

The arterial pressure of the adult human rarely deviates from normal by more than 10 to 15 percent during each day. To achieve such constancy, the body has a network … The arterial pressure of the adult human rarely deviates from normal by more than 10 to 15 percent during each day. To achieve such constancy, the body has a network of pressure control systems. Several are based on neural receptors that respond within seconds to help correct any abnormal pressure. The activities of these systems are followed within minutes by activation of hormonal controllers. Within hours or days, a kidney pressure control system is induced that increases body fluid volume when the pressure falls (or decreases the volume when the pressure rises). This kidney-fluid system is the dominant method of establishing long-term pressure control.

Separation of Blood Leucocytes, Granulocytes and Lymphocytes

1974-05-01

Arne Bøyum

The present paper describes a technique for separation of leucocytes, mononuclear cells (lymphocytes and monocytes) and granulocytes from small as well as large blood volumes. The present paper describes a technique for separation of leucocytes, mononuclear cells (lymphocytes and monocytes) and granulocytes from small as well as large blood volumes.

Osmotic Demyelination Syndrome Following Correction of Hyponatremia

1986-06-12

Richard H. Sterns , Jack E. Riggs , Sydney S. Schochet

The treatment of hyponatremia is controversial: some authorities have cautioned that rapid correction causes central pontine myelinolysis, and others warn that severe hyponatremia has a high mortality rate unless it … The treatment of hyponatremia is controversial: some authorities have cautioned that rapid correction causes central pontine myelinolysis, and others warn that severe hyponatremia has a high mortality rate unless it is corrected rapidly. Eight patients treated over a five-year period at our two institutions had a neurologic syndrome with clinical or pathological findings typical of central pontine myelinolysis, which developed after the patients presented with severe hyponatremia. Each patient's condition worsened after relatively rapid correction of hyponatremia (greater than 12 mmol of sodium per liter per day)--a phenomenon that we have called the osmotic demyelination syndrome. Five of the patients were treated at one hospital, and accounted for all the neurologic complications recorded among 60 patients with serum sodium concentrations below 116 mmol per liter; no patient in whom the sodium level was raised by less than 12 mmol per liter per day had any neurologic sequelae. Reviewing published reports on patients with very severe hyponatremia (serum sodium less than 106 mmol per liter) revealed that neurologic sequelae were associated with correction of hyponatremia by more than 12 mmol per liter per day; when correction proceeded more slowly, patients had uneventful recoveries. We suggest that the osmotic demyelination syndrome is a preventable complication of overly rapid correction of chronic hyponatremia.

Activity‐dependent Energy Metabolism in Rat Posterior Pituitary Primarily Reflects Sodium Pump Activity

1980-01-01

Marina Mata , David J. Fink , Harold Gainer +5 more

A rapid and potent natriuretic response to intravenous injection of atrial myocardial extract in rats

1981-01-01

Joseph F. DeBold , Heidi Borenstein , A. T. Veress +1 more

NEUROLOGICAL MANIFESTATIONS AND MORBIDITY OF HYPONATREMIA: CORRELATION WITH BRAIN WATER AND ELECTROLYTES

1976-03-01

Allen I. Arieff , Francisco Llach , Shaul G. Massry

1. An attempt was made to evaluate the pathophysiology of symptoms of hyponatremia as related to changes in brain water and electrolytes. Studies were carried out in 66 hyponatremic patients … 1. An attempt was made to evaluate the pathophysiology of symptoms of hyponatremia as related to changes in brain water and electrolytes. Studies were carried out in 66 hyponatremic patients and 5 groups of experimental animals. 2. In hyponatremic patients, symptoms (depression of sensorium, seizures) correlated well with plasma Na+ (r = 0.64, p less than .001), but there was substantial overlap. In patients with acute hyponatremia, all were symptomatic and 50% died. Among patients with hyponatremia of at least 3 days duration, sympatomatic patients had plasma Na+ (115 +/- 1 mEq/L) which was significantly less (p less than .001) than that of asymptomatic patients (plasma Na+ = 122 +/- 1 mEq/L). Among symptomatic patients, mortality was 12% and 8% had seizures, while none of the asymptomatic patients died or had seizures. 3. Among 14 patients with acute (less than 12 hrs) hyponatremia, the mean plasma Na+ was 112 +/- 2 mEq/L. All such patients had some depression of sensorium and four had grand male seizures. Seven of these patients were treated with hypertonic (862 mM) NaCl, while four were treated only with fluid restriction. Of the seven patients treated with hypertonic NaCl, five survived, while three of four patients treated with fluid restriction died. There was no evidence of circulatory congestion or cerebral damage in the patients treated with hypertonic NaCl. 4. Among rabbits with acute (2-3 hours) hyponatremia (plasma Na+ = 119 +/- 1 mEq/L), all had grand mal seizures and 86% died. All such animals had cerebral edema (brain H2O content 17% above control value) but brain content of Na+, K+ and Cl- was normal. 5. Rabbits with 3 1/2 days of hyponatremia (plasma Na+ = 122 +/- 2 mEq/L) appeared to be asymptomatic, even though brain water content was 7% above normal (p less than .01). 6. Rabbits with 16 days of more severe hyponatremia (plasma Na+ = 99 +/- 3 mEq/L) were weak, anorexic, lethargic and unable to walk. Brain water content was 7% above normal, although brain osmolality (218 +/- 12 mOsm/kg H2O) was similar to plasma (215 +/- 8 mOsm/kg). Brain content of Na+, K+, Cl- and osmoles was 17 to 37% less than normal values, so that the brain established osmotic equilibrium with plasma primarily by means of a loss of electrolytes. 7. These studies suggest that in patients with hyponatremia, symptoms and morbidity are only grossly correlated with either magnitude or duration of hyponatremia. Symptoms appear to correlate best with the interplay between a net increase in brain water versus a loss oof brain electrolytes. However, even asymptomatic animals have subclinical brain edema when plasma Na+ is below 125 mEq/L, and such edema may cause permanent brain damage. Thus, many patients with similar levels of plasma Na+, particularly when they are symptomatic, should probably be treated with hypertonic NaCl infusions.

Secretion of brain natriuretic peptide in patients with aneurysmal subarachnoid haemorrhage

1997-01-01

Elmar Berendes , Michael Walter , Paul Cullen +6 more

EFFECT OF GENDER AND SEX HORMONES ON IMMUNE RESPONSES FOLLOWING SHOCK

2000-08-01

Martin K. Angele , Martin G. Schwacha , Alfred Ayala +1 more

Several clinical and experimental studies show a gender dimorphism of the immune and organ responsiveness in the susceptibility to and morbidity from shock, trauma, and sepsis. In this respect, cell-mediated … Several clinical and experimental studies show a gender dimorphism of the immune and organ responsiveness in the susceptibility to and morbidity from shock, trauma, and sepsis. In this respect, cell-mediated immune responses are depressed in males after trauma-hemorrhage, whereas they are unchanged or enhanced in females. Sex hormones contribute to this gender-specific immune response after adverse circulatory conditions. Specifically, studies indicate that androgens are responsible for the immunodepression after trauma-hemorrhage in males. In contrast, female sex steroids seem to exhibit immunoprotective properties after trauma and severe blood loss, because administration of estrogen prevents the androgen-induced immunodepression in castrated male mice. Nonetheless, the precise underlying mechanisms for these immunomodulatory effects of sex steroids after shock remain unknown. Although testosterone depletion, testosterone receptor antagonism, or estrogen treatment has been shown to prevent the depression of immune functions after trauma-hemorrhage, it remains to be established whether differences in the testosterone-estradiol ratio are responsible for the immune dysfunction. Furthermore, sex hormone receptors have been identified on various immune cells, suggesting direct effects. Thus, the immunomodulatory properties of sex hormones after trauma-hemorrhage might represent novel therapeutic strategies for the treatment of immunodepression in trauma patients.

Molecular cloning of the receptor for human antidiuretic hormone

1992-05-01

Mariel Birnbaumer , Anita Seibold , S Gilbert +5 more

Hyponatremia: A Prospective Analysis of Its Epidemiology and the Pathogenetic Role of Vasopressin

1985-02-01

Robert J. Anderson

We prospectively evaluated the frequency, cause, and outcome of hyponatremia (plasma sodium concentration, < 130 meq/L), as well as the hormonal response to this condition, in hospitalized patients. Daily incidence … We prospectively evaluated the frequency, cause, and outcome of hyponatremia (plasma sodium concentration, < 130 meq/L), as well as the hormonal response to this condition, in hospitalized patients. Daily incidence and prevalence of hyponatremia averaged 0.97% and 2.48%, respectively. Two thirds of all hyponatremia was hospital acquired. Normovolemic states (so-called syndrome of inappropriate secretion of antidiuretic hormone) were the most commonly seen clinical setting of hyponatremia. The fatality rate for hyponatremic patients was 60-fold that for patients without documented hyponatremia. Nonosmotic secretion of vasopressin was present in 97% of hyponatremic patients in whom it was sought. In edematous and hypovolemic patients, plasma hormonal responses (increases in plasma renin activity and aldosterone and norepinephrine levels) were compatible with baroreceptor-mediated release of vasopressin. Hyponatremia is a common hospital-acquired electrolyte disturbance that is an indicator of poor prognosis. Nonosmotic secretion of arginine vasopressin is a major pathogenetic factor in this electrolyte disturbance.

The osmoregulation of vasopressin

1976-07-01

Gary L. Robertson , Ronald L. Shelton , Shahid Athar

Effect of urinary extracts from salt-loaded man on urinary sodium excretion by the rat

1972-07-01

Peter Brown , K. G. Koutsaimanis , H. E. de Wardener

Neuromyelitis Optica Brain Lesions Localized at Sites of High Aquaporin 4 Expression

2006-07-01

Sean J. Pittock , Brian G. Weinshenker , Claudia F. Lucchinetti +3 more

<h3>Background</h3> Neuromyelitis optica (NMO)–IgG is a specific autoantibody marker for NMO. It binds selectively to aquaporin 4 (AQP4), which is highly concentrated in astrocytic foot processes at the blood-brain barrier … <h3>Background</h3> Neuromyelitis optica (NMO)–IgG is a specific autoantibody marker for NMO. It binds selectively to aquaporin 4 (AQP4), which is highly concentrated in astrocytic foot processes at the blood-brain barrier and is not restricted to optic nerve and spinal cord. Although it is conventionally believed that the brain is spared, brain imaging abnormalities are not uncommon in patients with NMO. <h3>Objective</h3> To investigate the location of brain lesions that are distinctive for NMO with respect to the localization of AQP4 in mammalian brain. <h3>Design</h3> Observational, retrospective case series. <h3>Setting</h3> Clinical serologic cohort of patients tested for NMO-IgG for whom brain MRI images were available. <h3>Patients</h3> We identified 120 patients seropositive for NMO-IgG for whom brain magnetic resonance images were available. <h3>Main Outcome Measure</h3> Magnetic resonance imaging abnormalities. <h3>Results</h3> In 8 patients we observed recurring and distinctive magnetic resonance imaging abnormalities in the hypothalamic and periventricular areas that corresponded to brain regions of high AQP4 expression. <h3>Conclusion</h3> The distribution of NMO-characteristic brain lesions corresponds to sites of high AQP4 expression.

Mild Chronic Hyponatremia Is Associated With Falls, Unsteadiness, and Attention Deficits

2006-01-01

B. Renneboog , Wim Musch , X. Vandemergel +2 more

The Syndrome of Inappropriate Antidiuresis

2007-05-16

David H. Ellison , Tomás Berl

A 62-year-old woman who reported dysgeusia was found to have a serum sodium level of 122 mmol per liter. The serum osmolality was 250 mOsm per kilogram of water, and … A 62-year-old woman who reported dysgeusia was found to have a serum sodium level of 122 mmol per liter. The serum osmolality was 250 mOsm per kilogram of water, and the urinary osmolality 635 mOsm per kilogram of water. Chest CT showed a mass in the lower lobe of the left lung, which proved to be a small-cell carcinoma. How should her hyponatremia be treated?

Clinical practice guideline on diagnosis and treatment of hyponatraemia

2014-02-21

Goce Spasovski , Raymond Vanholder , Bruno Allolio +7 more

Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: an analysis from the OPTIMIZE-HF registry

2007-02-19

M Gheorghiade , William T. Abraham , Nancy M. Albert +7 more

AimsHyponatraemia has been shown to be an independent predictor of mortality in selected patients with heart failure enrolled in clinical trials. The predictive value of hyponatraemia has not been evaluated … AimsHyponatraemia has been shown to be an independent predictor of mortality in selected patients with heart failure enrolled in clinical trials. The predictive value of hyponatraemia has not been evaluated in unselected patients hospitalized with heart failure.

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Tolvaptan, a Selective Oral Vasopressin V<sub>2</sub>-Receptor Antagonist, for Hyponatremia

2006-11-15

Robert W. Schrier , Peter Groß , Mihai Gheorghiade +4 more

Hyponatremia (serum sodium concentration, <135 mmol per liter) is a predictor of death among patients with chronic heart failure and cirrhosis. At present, therapy for acute and chronic hyponatremia is … Hyponatremia (serum sodium concentration, <135 mmol per liter) is a predictor of death among patients with chronic heart failure and cirrhosis. At present, therapy for acute and chronic hyponatremia is often ineffective and poorly tolerated. We investigated whether tolvaptan, an orally active vasopressin V(2)-receptor antagonist that promotes aquaresis--excretion of electrolyte-free water--might be of benefit in hyponatremia.In two multicenter, randomized, double-blind, placebo-controlled trials, the efficacy of tolvaptan was evaluated in patients with euvolemic or hypervolemic hyponatremia. Patients were randomly assigned to oral placebo (223 patients) or oral tolvaptan (225) at a dose of 15 mg daily. The dose of tolvaptan was increased to 30 mg daily and then to 60 mg daily, if necessary, on the basis of serum sodium concentrations. The two primary end points for all patients were the change in the average daily area under the curve for the serum sodium concentration from baseline to day 4 and the change from baseline to day 30.Serum sodium concentrations increased more in the tolvaptan group than in the placebo group during the first 4 days (P<0.001) and after the full 30 days of therapy (P<0.001). The condition of patients with mild or marked hyponatremia improved (P<0.001 for all comparisons). During the week after discontinuation of tolvaptan on day 30, hyponatremia recurred. Side effects associated with tolvaptan included increased thirst, dry mouth, and increased urination. A planned analysis that combined the two trials showed significant improvement from baseline to day 30 in the tolvaptan group according to scores on the Mental Component of the Medical Outcomes Study 12-item Short-Form General Health Survey.In patients with euvolemic or hypervolemic hyponatremia, tolvaptan, an oral vasopressin V2-receptor antagonist, was effective in increasing serum sodium concentrations at day 4 and day 30. (ClinicalTrials.gov numbers, NCT00072683 [ClinicalTrials.gov] [SALT-1] and NCT00201994 [ClinicalTrials.gov] [SALT-2].).

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Disorders of Plasma Sodium — Causes, Consequences, and Correction

2014-12-31

Richard H. Sterns

This review considers the causes and consequences of an abnormal plasma sodium concentration and offers a framework for correcting it. This review considers the causes and consequences of an abnormal plasma sodium concentration and offers a framework for correcting it.

A syndrome of renal sodium loss and hyponatremia probably resulting from inappropriate secretion of antidiuretic hormone

1957-10-01

William B. Schwartz , Warren A. Bennett , Sidney Curelop +1 more

Effects of Tolvaptan, a Vasopressin Antagonist, in Patients Hospitalized With Worsening Heart Failure<SUBTITLE>A Randomized Controlled Trial</SUBTITLE>

2004-04-27

Mihai Gheorghiade , Wendy A. Gattis , Christopher M. O'Connor +7 more

ContextNearly 1 million hospitalizations for chronic heart failure occur yearly in the United States, with most related to worsening systemic congestion. Diuretic use, the mainstay therapy for congestion, is associated … ContextNearly 1 million hospitalizations for chronic heart failure occur yearly in the United States, with most related to worsening systemic congestion. Diuretic use, the mainstay therapy for congestion, is associated with electrolyte abnormalities and worsening renal function. In contrast to diuretics, the vasopressin antagonist tolvaptan may increase net volume loss in heart failure without adversely affecting electrolytes and renal function.ObjectiveTo evaluate the short- and intermediate-term effects of tolvaptan in patients hospitalized with heart failure.Design, Setting, and ParticipantsRandomized, double-blind, placebo-controlled, parallel-group, dose-ranging, phase 2 trial conducted at 45 centers in the United States and Argentina and enrolling 319 patients with left ventricular ejection fraction of less than 40% and hospitalized for heart failure with persistent signs and symptoms of systemic congestion despite standard therapy.InterventionAfter admission, patients were randomized to receive 30, 60, or 90 mg/d of oral tolvaptan or placebo in addition to standard therapy, including diuretics. The study drug was continued for up to 60 days.Main Outcome MeasuresIn-hospital outcome was change in body weight at 24 hours after randomization; outpatient outcome was worsening heart failure (defined as death, hospitalization, or unscheduled visits for heart failure) at 60 days after randomization.ResultsMedian (interquartile range) body weight at 24 hours after randomization decreased by −1.80 (−3.85 to −0.50), −2.10 (−3.10 to −0.85), −2.05 (−2.80 to −0.60), and −0.60 (−1.60 to 0.00) kg in the groups receiving tolvaptan 30, 60, and 90 mg/d, and placebo, respectively (P≤.008 for all tolvaptan groups vs placebo). The decrease in body weight with tolvaptan was not associated with changes in heart rate or blood pressure, nor did it result in hypokalemia or worsening renal function. There were no differences in worsening heart failure at 60 days between the tolvaptan and placebo groups (P = .88 for trend). In post hoc analysis, 60-day mortality was lower in tolvaptan-treated patients with renal dysfunction or severe systemic congestion.ConclusionTolvaptan administered in addition to standard therapy may hold promise for management of systemic congestion in patients hospitalized for heart failure.

Short-term Clinical Effects of Tolvaptan, an Oral Vasopressin Antagonist, in Patients Hospitalized for Heart Failure<SUBTITLE>The EVEREST Clinical Status Trials</SUBTITLE>

2007-03-25

Mihai Gheorghiade

Outcome Study With Tolvaptan (EVEREST) Investigators HEART FAILURE (HF) IS A MAjor international public health problem presenting significant medical and economic challenges.][5][6][7][8] Congestion characterized by dyspnea, edema, rales, jugular venous … Outcome Study With Tolvaptan (EVEREST) Investigators HEART FAILURE (HF) IS A MAjor international public health problem presenting significant medical and economic challenges.][5][6][7][8] Congestion characterized by dyspnea, edema, rales, jugular venous dis-See also pp

Assay for the Measurement of Copeptin, a Stable Peptide Derived from the Precursor of Vasopressin

2005-11-04

Nils G. Morgenthaler , Joachim Struck , Christine Alonso +1 more

Arginine vasopressin (AVP) is a key regulator of water balance, but its instability makes reliable measurement difficult and precludes routine use. We present a method for quantifying AVP release by … Arginine vasopressin (AVP) is a key regulator of water balance, but its instability makes reliable measurement difficult and precludes routine use. We present a method for quantifying AVP release by use of copeptin, a glycopeptide comprising the C-terminal part of the AVP prohormone.We measured copeptin in 50-microL serum and plasma samples from healthy individuals and from critically ill patients with sepsis. Our sandwich immunoluminometric assay used 2 polyclonal antibodies to amino acids 132-164 of pre-provasopressin.The assay yielded results within 3 h. The analytical detection limit was 1.7 pmol/L, and the interlaboratory CV was <20% for values >2.25 pmol/L. The assay was linear on dilution of the analyte. Ex vivo copeptin stability (<20% loss of analyte) for at least 7 days at room temperature and 14 days at 4 degrees C was shown for serum and EDTA-, heparin-, and citrate plasma. Copeptin (median, 4.2 pmol/L; range, 1-13.8 pmol/L) was detectable in 97.5% of 359 healthy individuals and was not associated with age. Median concentrations were considerably higher in men than women, increased significantly after exercise, and were influenced by fasting and water load. Copeptin was significantly (P <0.001) increased in 60 critically ill patients with sepsis (median, 79.5 pmol/L; range, 10.6-228.0 pmol/L). The correlation between copeptin and AVP for 110 samples was r = 0.78 (P <0.0001).Copeptin is stable for days after blood withdrawal and can be quickly and easily measured. The copeptin assay may be a useful alternative to direct measurement of AVP concentration.

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Physiology of Vasopressin Relevant to Management of Septic Shock

2001-09-01

Cheryl L. Holmes , B. M. Patel , James A. Russell +1 more

The syndrome of inappropriate secretion of antidiuretic hormone

1967-05-01

Frederic C. Bartter , William B. Schwartz

Effects of Oral Tolvaptan in Patients Hospitalized for Worsening Heart Failure<SUBTITLE>The EVEREST Outcome Trial</SUBTITLE>

2007-03-25

Marvin A. Konstam , Mihai Gheorghiade , John C. Burnett +7 more

ContextVasopressin mediates fluid retention in heart failure. Tolvaptan, a vasopressin V2 receptor blocker, shows promise for management of heart failure.ObjectiveTo investigate the effects of tolvaptan initiated in patients hospitalized with … ContextVasopressin mediates fluid retention in heart failure. Tolvaptan, a vasopressin V2 receptor blocker, shows promise for management of heart failure.ObjectiveTo investigate the effects of tolvaptan initiated in patients hospitalized with heart failure.Design, Setting, and ParticipantsThe Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan (EVEREST), an event-driven, randomized, double-blind, placebo-controlled study. The outcome trial comprised 4133 patients within 2 short-term clinical status studies, who were hospitalized with heart failure, randomized at 359 North American, South American, and European sites between October 7, 2003, and February 3, 2006, and followed up during long-term treatment.InterventionWithin 48 hours of admission, patients were randomly assigned to receive oral tolvaptan, 30 mg once per day (n = 2072), or placebo (n = 2061) for a minimum of 60 days, in addition to standard therapy.Main Outcome MeasuresDual primary end points were all-cause mortality (superiority and noninferiority) and cardiovascular death or hospitalization for heart failure (superiority only). Secondary end points included changes in dyspnea, body weight, and edema.ResultsDuring a median follow-up of 9.9 months, 537 patients (25.9%) in the tolvaptan group and 543 (26.3%) in the placebo group died (hazard ratio, 0.98; 95% confidence interval [CI], 0.87-1.11; P = .68). The upper confidence limit for the mortality difference was within the prespecified noninferiority margin of 1.25 (P<.001). The composite of cardiovascular death or hospitalization for heart failure occurred in 871 tolvaptan group patients (42.0%) and 829 placebo group patients (40.2%; hazard ratio, 1.04; 95% CI, 0.95-1.14; P = .55). Secondary end points of cardiovascular mortality, cardiovascular death or hospitalization, and worsening heart failure were also not different. Tolvaptan significantly improved secondary end points of day 1 patient-assessed dyspnea, day 1 body weight, and day 7 edema. In patients with hyponatremia, serum sodium levels significantly increased. The Kansas City Cardiomyopathy Questionnaire overall summary score was not improved at outpatient week 1, but body weight and serum sodium effects persisted long after discharge. Tolvaptan caused increased thirst and dry mouth, but frequencies of major adverse events were similar in the 2 groups.ConclusionTolvaptan initiated for acute treatment of patients hospitalized with heart failure had no effect on long-term mortality or heart failure–related morbidity.Trial Registrationclinicaltrials.gov Identifier: NCT00071331Published online March 25, 2007 (doi:10.1001/jama.297.12.1319).

Lithium, Sodium, and Potassium

1982-02-01

Delno Knudsen , G. A. Peterson , P. F. Pratt

Hyponatremia, Convulsions, Respiratory Arrest, and Permanent Brain Damage after Elective Surgery in Healthy Women

1986-06-12

Allen I. Arieff

Severe hyponatremia developed after elective surgery in 15 previously healthy women who subsequently either died or had permanent brain damage. The mean age was 41 years (range, 22 to 66), … Severe hyponatremia developed after elective surgery in 15 previously healthy women who subsequently either died or had permanent brain damage. The mean age was 41 years (range, 22 to 66), and the preoperative serum sodium level was 138 mmol per liter. All the patients recovered from anesthesia, but about 49 hours after surgery, when the average plasma sodium level was 108 mmol per liter, grand mal seizures, followed by respiratory arrest requiring intubation, developed in all 15. At that time, the urinary sodium level and the osmolality averaged 68 mmol per liter and 501 mOsm per kilogram, suggesting inappropriate secretion of antidiuretic hormone. In 10 of 15 patients, an acute cerebral vascular disorder was suspected, leading to a delay in treatment and multiple diagnostic studies, including CT scanning, cerebral angiography, and open-brain biopsies. The net postoperative fluid retention was 7.5 liters, and when correction of the serum sodium level was initiated, the rate of correction was less than 0.7 mmol per liter per hour. Histologic studies of the brain in five patients were not diagnostic, and no patient had any evidence of central pontine myelinolysis on the basis of autopsy, brain biopsy, or CT scanning. Seven patients recovered from coma after the serum sodium level was increased to 131 mmol per liter, but coma recurred two to six days later and ended in either death or a persistent vegetative state. Overall, 27 percent of the patients died, 13 percent had limb paralysis, and 60 percent were left in a persistent vegetative state.

Treatment of Symptomatic Hyponatremia and Its Relation to Brain Damage

1987-11-05

Juan Carlos Ayus , R. K. Krothapalli , Allen I. Arieff

We studied the effects of replacement therapy in two groups of patients with symptomatic hyponatremia. Thirty-three patients, who were studied prospectively, had no evidence of cerebral demyelinating lesions. Their hyponatremia … We studied the effects of replacement therapy in two groups of patients with symptomatic hyponatremia. Thirty-three patients, who were studied prospectively, had no evidence of cerebral demyelinating lesions. Their hyponatremia (mean serum sodium concentration [+/- SE], 108 +/- 1 mmol per liter) was increased to 126 +/- 1 mmol per liter with hypertonic saline (856 mM) delivered at a rate of 1.3 +/- 0.2 mmol per liter per hour. The serum sodium concentration did not rise to normal or hypernatremic levels in the first 48 hours of therapy, and none of these patients had a respiratory arrest or other hypoxic episode. Twelve patients, evaluated retrospectively, had evidence of cerebral demyelinating lesions at autopsy or on computerized axial tomography. The rate of correction of hyponatremia (1 +/- 0.2 mmol per liter per hour) was similar to the rate in the patients in Group I. However, at least one of four characteristics was present: an increase in serum sodium to normal or hypernatremic levels in the first 48 hours, a change in the serum sodium concentration of more than 25 mmol per liter in the first 48 hours, a hypoxic-anoxic episode, and an elevation of serum sodium to hypernatremic levels in patients with hepatic encephalopathy. Although these four features were associated with demyelination, our observations suggest that this complication does not depend on the rate of correction of hyponatremia.

Hormones and Hemodynamics in Heart Failure

1999-08-19

Robert W. Schrier , William T. Abraham

Heart failure is a major cause of cardiovascular mortality and morbidity, resulting in more than 1 million hospitalizations per year, and is the most common hospital-discharge diagnosis among patients older … Heart failure is a major cause of cardiovascular mortality and morbidity, resulting in more than 1 million hospitalizations per year, and is the most common hospital-discharge diagnosis among patients older than 65 years.1 In recent years, much has been learned about the pathophysiology of heart failure, particularly in the area of fluid and electrolyte metabolism, and this will be the focus of the present review.Regulation of Body-Fluid VolumeThere is considerable evidence in support of a unifying hypothesis of the regulation of body-fluid volume that is applicable to patients with edematous disorders such as cardiac failure, to patients with . . .

Reduced Thirst after Water Deprivation in Healthy Elderly Men

1984-09-20

Paddy A. Phillips , Barbara J. Rolls , J Ledingham +4 more

To determine whether responses to dehydration are altered with age, we investigated the thirst, fluid and electrolyte responses, and hormonal responses to 24 hours of water deprivation in seven healthy … To determine whether responses to dehydration are altered with age, we investigated the thirst, fluid and electrolyte responses, and hormonal responses to 24 hours of water deprivation in seven healthy active elderly men (67 to 75 years old) and seven healthy young men (20 to 31 years old) who were matched for weight loss during water deprivation. After water deprivation, the older men had greater increases in plasma osmolality, sodium concentration, and vasopressin levels. However, their urinary osmolality was lower and they were less thirsty and drank less after water deprivation, so that their plasma and urine were not diluted to predeprivation levels. Regression analysis indicated increased sensitivity of vasopressin osmoreceptors in the older group, although this difference was not statistically significant. We conclude that after 24 hours of water deprivation, there is a deficit in thirst and water intake in healthy elderly men, as compared with younger men, although vasopressin osmoreceptor responsiveness is maintained or even increased. Our findings also suggest that the well-known deficit in urinary concentrating ability that occurs with age reflects renal causes and not a lack of circulating vasopressin. (N Engl J Med 1984; 311:753–9.)

Diuretic Therapy

1998-08-06

D. Craig Brater

Diuretic drugs are widely used for the treatment of patients with edema. Among these drugs, loop diuretics such as furosemide are perhaps the most frequently prescribed, and their clinical pharmacology … Diuretic drugs are widely used for the treatment of patients with edema. Among these drugs, loop diuretics such as furosemide are perhaps the most frequently prescribed, and their clinical pharmacology is better understood than is that of other diuretics. This review will therefore focus on this class of diuretics, but others will be discussed as well.Clinical Pharmacology of DiureticsPharmacokineticsThe pharmacologic characteristics of all loop diuretics are similar. Therefore, a lack of response to adequate doses of one loop diuretic militates against the administration of another loop diuretic; instead, combinations of diuretics with different mechanisms of action should . . .

Hypokalemia

1998-08-13

F. John Gennari

A low serum potassium concentration is perhaps the most common electrolyte abnormality encountered in clinical practice. When defined as a value of less than 3.6 mmol of potassium per liter, … A low serum potassium concentration is perhaps the most common electrolyte abnormality encountered in clinical practice. When defined as a value of less than 3.6 mmol of potassium per liter, hypokalemia is found in over 20 percent of hospitalized patients.1 The majority of these patients have serum potassium concentrations between 3.0 and 3.5 mmol per liter, but as many as one quarter have values below 3.0 mmol per liter. Comparable data are not available for outpatients, but a low serum potassium concentration has been found in 10 to 40 percent of patients treated with thiazide diuretics.2 Hypokalemia is usually well . . .

Hypernatremia

2000-05-18

Horacio J. Adrogué , Nicolaos E. Madias

The serum sodium concentration and thus serum osmolality are closely controlled by water homeostasis, which is mediated by thirst, arginine vasopressin, and the kidneys.1 A disruption in the water balance … The serum sodium concentration and thus serum osmolality are closely controlled by water homeostasis, which is mediated by thirst, arginine vasopressin, and the kidneys.1 A disruption in the water balance is manifested as an abnormality in the serum sodium concentration — hypernatremia or hyponatremia.2,3 Hypernatremia, defined as a rise in the serum sodium concentration to a value exceeding 145 mmol per liter, is a common electrolyte disorder. Because sodium is a functionally impermeable solute, it contributes to tonicity and induces the movement of water across cell membranes.4 Therefore, hypernatremia invariably denotes hypertonic hyperosmolality and always causes cellular dehydration, at . . .

Hyponatremia

2000-05-25

Horacio J. Adrogué , Nicolaos E. Madias

Hyponatremia is defined as a decrease in the serum sodium concentration to a level below 136 mmol per liter. Whereas hypernatremia always denotes hypertonicity, hyponatremia can be associated with low, … Hyponatremia is defined as a decrease in the serum sodium concentration to a level below 136 mmol per liter. Whereas hypernatremia always denotes hypertonicity, hyponatremia can be associated with low, normal, or high tonicity.1,2 Effective osmolality or tonicity refers to the contribution to osmolality of solutes, such as sodium and glucose, that cannot move freely across cell membranes, thereby inducing transcellular shifts in water.3 Dilutional hyponatremia, by far the most common form of the disorder, is caused by water retention. If water intake exceeds the capacity of the kidneys to excrete water, dilution of body solutes results, causing hypo-osmolality . . .

Clinical practice guideline on diagnosis and treatment of hyponatraemia

2014-02-26

Goce Spasovski , Raymond Vanholder , Bruno Allolio +7 more

Hyponatraemia, defined as a serum sodium concentration <135 mmol/l, is the most common disorder of body fluid and electrolyte balance encountered in clinical practice. It can lead to a wide … Hyponatraemia, defined as a serum sodium concentration <135 mmol/l, is the most common disorder of body fluid and electrolyte balance encountered in clinical practice. It can lead to a wide spectrum of clinical symptoms, from subtle to severe or even life threatening, and is associated with increased mortality, morbidity and length of hospital stay in patients presenting with a range of conditions. Despite this, the management of patients remains problematic. The prevalence of hyponatraemia in widely different conditions and the fact that hyponatraemia is managed by clinicians with a broad variety of backgrounds have fostered diverse institution- and speciality-based approaches to diagnosis and treatment. To obtain a common and holistic view, the European Society of Intensive Care Medicine (ESICM), the European Society of Endocrinology (ESE) and the European Renal Association – European Dialysis and Transplant Association (ERA–EDTA), represented by European Renal Best Practice (ERBP), have developed the Clinical Practice Guideline on the diagnostic approach and treatment of hyponatraemia as a joint venture of three societies representing specialists with a natural interest in hyponatraemia. In addition to a rigorous approach to methodology and evaluation, we were keen to ensure that the document focused on patient-important outcomes and included utility for clinicians involved in everyday practice.

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Diagnosis and classification of the polycythemias.

1975-10-01

Nathaniel I. Berlin

Pharmacological therapy for hyperkalemia in feline urethral obstruction has no additional benefit over intravenous fluid and calcium gluconate therapy and prompt unobstruction

2025-06-25

Stephanie Maciorowski , Elizabeth A. Rozanski , Ian M. DeStefano +1 more | Journal of the American Veterinary Medical Association

Abstract Objective Urethral obstruction (UO) in male cats is a potentially fatal condition due to hyperkalemia. The objective of this study was to compare the effect of IV fluids and … Abstract Objective Urethral obstruction (UO) in male cats is a potentially fatal condition due to hyperkalemia. The objective of this study was to compare the effect of IV fluids and calcium gluconate (IVF-Cg) alone or with insulin/dextrose, terbutaline, or sodium bicarbonate on hyperkalemia in male cats presenting with UO. Methods Male cats presenting to a university hospital with UO and a blood potassium > 7.5 mEq/L were prospectively enrolled in this experimental study from July 2019 to September 2024. All cats received a fluid bolus and calcium gluconate dose IV. Cats were randomized to receive IVF-Cg alone or with terbutaline, insulin-dextrose, or sodium bicarbonate. The relative reduction in blood potassium after 4 hours was compared between groups. Results The study enrolled 34 cats, with 8 cats in the bicarbonate and insulin/dextrose groups and 9 cats in the IVF-Cg and terbutaline groups. The median baseline and 4-hour potassium for all cats was 9.1 mEq/L (range, 7.5 to 11.8 mEq/L) and 5.4 mEq/L (range, 4 to 8 mEq/L) respectively. The median relative reduction in blood potassium was 29% (6% to 50%) for IVF-Cg, 37% (12% to 55%) for insulin-dextrose, 36% (8% to 45%) for sodium bicarbonate, and 52% (10% to 56%) for terbutaline. There was no significant difference in percentage change in potassium between groups. Conclusions There is no significant difference between the various treatments for hyperkalemia in male cats with UO. Clinical Relevance There is no adjunctive therapy that is clearly beneficial for promoting resolution of hyperkalemia. Prompt relief of obstruction, calcium gluconate, and administration of IV fluids result in rapid reduction of hyperkalemia and a good prognosis.

Sex Differences in Electrolyte Disturbances Among Diuretic Users According to Renal Function and Age

2025-06-25

Narumi Maida , Shingo Kondo , Naoko Hayashi +3 more | Drug Safety

Diuretics are widely used in Japan for the treatment of hypertension and heart failure. Electrolyte disturbance is a common adverse reaction to diuretics and may be life-threatening. Previous studies have … Diuretics are widely used in Japan for the treatment of hypertension and heart failure. Electrolyte disturbance is a common adverse reaction to diuretics and may be life-threatening. Previous studies have shown that diuretic-induced electrolyte disturbance is more common in women. Electrolyte balance is regulated by the kidneys, and renal function tends to decline with advancing age. The aim of this study was to identify patients at high risk of adverse reactions to diuretics, considering the effects of sex, renal function, and age on susceptibility to diuretic-induced electrolyte disturbance. Claims data for 67,135 patients on diuretics in Japan were sourced from DeSC Healthcare, Inc. The data covered the period from April 2020 to March 2021. Analysis of patient numbers using the chi-squared test showed that hyperkalemia was more common in men than in women (326 vs. 271; p = 0.003) and that hypokalemia was more common in women than in men (413 vs. 285; p < 0.001). Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for women considering age and renal function (estimated glomerular filtration rate [eGFR]). In elderly patients aged ≥ 75 years, the odds of developing hypokalemia in women compared to men were 1.47 (95% CI 1.13-1.91) for eGFR 60-30 mL/min/1.73 m2 and 2.05 (95% CI 1.08-4.10) for eGFR < 30 mL/min/1.73 m2. Among women aged ≥ 75 years, those in lower eGFR groups (60-30 and < 30) had higher odds of hypokalemia compared to men. These data highlight the importance of monitoring for adverse reactions to diuretics, particularly hypokalemia, in elderly women with low eGFR.

Missed Diagnosis of Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) as a Paraneoplastic Syndrome in Small Cell Lung Cancer: A Case Report

2025-06-24

Mohamed Naas , Benjamin K Linkous , Filip Ptak +2 more | Cureus

A Case of Thiazide-Induced Hyponatremia in an Elderly Patient

2025-06-24

Azeem Khalid , Muhammad Ahsan Asif , Mahnoor Imran +2 more | Cureus

Abnormal Eye Movements and Hypernatremia in a 4-month-old Girl

2025-06-23

| American Academy of Pediatrics eBooks

Effects of peritoneal dialysis fluids on arginine vasopressin dynamics in humans and transgenic rats

2025-06-23

Hiromichi Ueno , Yoichi Ueta , Yuki Nonaka +7 more | Peritoneal Dialysis International

Background Fluid retention is a major complication of peritoneal dialysis (PD). Arginine vasopressin (AVP), an antidiuretic hormone, is known to be one of the important factors related to fluid management. … Background Fluid retention is a major complication of peritoneal dialysis (PD). Arginine vasopressin (AVP), an antidiuretic hormone, is known to be one of the important factors related to fluid management. However, the effect of the PD fluid (PDF) on AVP dynamics remains unclear. Methods Plasma AVP levels and osmolality (direct measurement/calculation) were tested upon arrival. Next, we studied the effects of icodextrin-based PDF (I-PDF) and glucose-based PDF (G-PDF) on hypothalamic AVP synthesis in transgenic rats expressing AVP-enhanced green fluorescent protein (eGFP) under the AVP promoter. Results The average plasma AVP levels in PD patients were higher than the normal range and patients with end-stage kidney disease (ESKD), however, the difference was not significant between PD and ESKD patients. In patients with PD, there is a significant correlation between plasma AVP levels and plasma osmolality (measured directly). In the G-PDF and I-PDF groups, eGFP fluorescence intensity increased in the paraventricular nucleus (PVN) and supraoptic nucleus (SON) of the hypothalamus, which are the main AVP synthesis sites. Immunohistochemical analysis revealed the expression of Fos protein, a useful indicator of neuronal activity, in eGFP-positive neurons in the PVN and SON after G-PDF administration. Conclusion To the best of our knowledge, this is the first report demonstrating increased plasma AVP levels in patients with PD and upregulation of hypothalamic AVP after PDF administration in transgenic rats. This study revealed that osmotic changes during PD treatment strongly influence AVP dynamics. These findings provide new insights into fluid management in patients with PD.

Acute Kidney Injury in Endocrine Emergencies

2025-06-22

Naděžda Petejová , J Zadražil , David Karásek +4 more | Kidney & Blood Pressure Research

Background: Acute kidney injury (AKI) is a serious condition in clinical medicine that significantly increases morbidity and mortality, particularly in critically ill patients. Rapid and accurate identification of the underlying … Background: Acute kidney injury (AKI) is a serious condition in clinical medicine that significantly increases morbidity and mortality, particularly in critically ill patients. Rapid and accurate identification of the underlying causes of AKI is crucial for determining appropriate therapeutic management and potentially saving the patient's life. Although endocrine emergencies are a less common cause of AKI in critically ill patients, recognizing when they occur is vital to comprehensive care. Summary: AKI can impair the endocrine system and result in critical conditions for patients, particularly in cases of sepsis. In addition, several factors can contribute to severe conditions associated with AKI, including thyrotoxicosis, adrenal crisis, severe hypothyroidism, complications related to diabetes mellitus, panhypopituitarism, diabetes insipidus with acute hypernatremia, severe hypercalcemia, neuroendocrine tumors, and ovarian hyperstimulation syndrome. Key Message: The early recognition of endocrine emergencies and the impact of AKI on the endocrine system in critically ill patients is essential to intensive and comprehensive care.

The Utility of Copeptin Measurement in Hospitalized Pediatric Patients with SIADH

2025-06-21

Joseph Gibbons , Daina Dreimane | Hormone Research in Paediatrics

Introduction: Hyponatremia is common in hospitalized pediatric patients and in many cases the diagnosis of the Syndrome of Inappropriate Antidiuretic Secretion (SIADH) remains challenging, with no gold standard for diagnosis. … Introduction: Hyponatremia is common in hospitalized pediatric patients and in many cases the diagnosis of the Syndrome of Inappropriate Antidiuretic Secretion (SIADH) remains challenging, with no gold standard for diagnosis. We assessed factors associated with hyponatremia in pediatric patients clinically diagnosed with SIADH, and examined the validity of copeptin level as a useful tool to distinguish SIADH from non-SIADH causes of hyponatremia. Methods: This observational study retrospectively analyzed 19 patients admitted to Children’s Hospital of Orange County in 2021-2024 for hyponatremia. ROC analyses assessed the ability of copeptin level to distinguish diagnostic groups, determining the optimal threshold for classification. Results: Pediatric patients with a diagnosis of SIADH had a significantly higher average urine sodium level (135.4 vs. 68.3 p=.036), and higher average copeptin level (median=14.3 vs. 5.7, p=.036). ROC analyses determined copeptin had good ability to differentiate a clinical diagnosis of SIADH from non-SIADH causes of hyponatremia with Sensitivity 83%, Specificity 71%, PVP 83%, NPV 71%). A significantly higher percentage of patients with copeptin level greater than 8.0 pmol/L were diagnosed with SIADH (83.3% vs. 28.6%), p=.017). Conclusion: Copeptin levels correlated with a clinical diagnosis of SIADH in hospitalized pediatric patients, particularly if elevated above 8.0 pmol/L at the time of hyponatremia, and the patient met the Schwartz and Bartter clinical criteria for SIADH. In some cases of SIADH, copeptin levels may be in normal range, however, could be considered inappropriately high for the degree of hyponatremia.

Risk factors for linezolid-associated hyponatremia focused on differences between intravenous and oral administration: a single-center, retrospective study

2025-06-20

Ryoji Takata , Masatoshi Taga , Hirofumi Nagai +6 more | Journal of Pharmaceutical Health Care and Sciences

Abstract Background Linezolid (LZD)-associated hyponatremia is a rare side effect, and no reports have compared intravenous and oral administration in relation to the development of hyponatremia. This study aimed to … Abstract Background Linezolid (LZD)-associated hyponatremia is a rare side effect, and no reports have compared intravenous and oral administration in relation to the development of hyponatremia. This study aimed to identify risk factors for LZD-associated hyponatremia and to evaluate whether there are differences in the development of hyponatremia between intravenous and oral administration. Methods We conducted a retrospective study that included patients aged ≥ 20 years who received LZD of 1200 mg/day intravenously or orally at Kanazawa Medical University Hospital from January 2011 to December 2023. Patient information was retrospectively examined, and multiple logistic regression analysis was used to assess the risk of intravenous administration for hyponatremia. Additionally, propensity scores were calculated for the intravenous and oral administration groups, and these scores were subsequently used in a propensity score matching analysis. Results This retrospective study revealed hyponatremia in 32 of 240 (13.3%) patients. Intravenous administration (OR = 17.137, 95% CI = 2.029–144.712, P = 0.009), serum sodium level before administration (OR = 0.626, 95% CI = 0.528–0.744, P < 0.001), and creatinine clearance (OR = 0.987, 95% CI = 0.975–0.999, P = 0.040) were identified as independent variables associated with hyponatremia. After propensity score matching, the incidence of LZD-associated hyponatremia was higher with intravenous administration than with oral administration (OR = 9.697, 95% CI = 1.153–81.545, P = 0.029). Conclusions This study identified intravenous administration as an independent risk factor for LZD-associated hyponatremia, and that the risk of hyponatremia was significantly higher with the intravenous administration compared with the oral administration. Patients with the identified risk factors should be administered intravenous LZD more cautiously and carefully monitored for serum sodium levels.

Osmotic Demyelination Syndrome Following Rapid Correction of Hyponatremia in a Young Woman: A Case Report and Review of Literature

2025-06-20

Arifa Akram , Usman Shahbaz Muhammad , Aljowharah Salman Ali +1 more | Cureus

Psychogenic polydipsia: A case of water intoxication

2025-06-19

T. Rama Rao , G. Sravya , Teshi Kaushik +1 more | Indian Journal of Case Reports

Psychogenic polydipsia (PPD), a clinical disorder characterized by polyuria and polydipsia, is a common occurrence in inpatients with psychiatric disorders. Primary polydipsia (PP) is a disorder that is clinically characterized … Psychogenic polydipsia (PPD), a clinical disorder characterized by polyuria and polydipsia, is a common occurrence in inpatients with psychiatric disorders. Primary polydipsia (PP) is a disorder that is clinically characterized by excessive thirst accompanied by increased fluid intake and subsequent excessive excretion of urine without an obvious cause. PP in adults is due to psychogenic causes, is a rare condition and may be more prevalent than thought. There is some evidence for pharmacological management of this condition, but nonpharmacological management, starting from psycho-education to behavioural modification therapy involving family members, can be a very effective strategy. This case report describes a 35-year-old male with schizophrenia who presented with confusion, seizures, and severe hyponatremia due to compulsive water consumption. Prompt diagnosis and management, including fluid restriction, careful sodium correction, and psychiatric intervention, led to symptom resolution. This case highlights the importance of early recognition and a multidisciplinary approach in preventing life-threatening complications associated with PPD. Further research is needed to establish standardized treatment guidelines.

Resmetirom-eligible population among US adults: An estimation analysis based on NHANES 2017–March 2020

2025-06-19

Phuc Le , Eda Kaya , Anh Phan +2 more | Hepatology Communications

Background: Resmetirom received FDA approval for treating adults with noncirrhotic metabolic dysfunction–associated steatohepatitis (MASH) and moderate-to-advanced liver fibrosis (stages F2–F3). Here, we sought to estimate the eligible U.S. adult population … Background: Resmetirom received FDA approval for treating adults with noncirrhotic metabolic dysfunction–associated steatohepatitis (MASH) and moderate-to-advanced liver fibrosis (stages F2–F3). Here, we sought to estimate the eligible U.S. adult population for resmetirom therapy, with secondary analysis focusing on individuals with type 2 diabetes mellitus (T2DM). Methods: A cross-sectional analysis was conducted using data from the National Health and Nutrition Examination Survey (NHANES) 2017–March 2020 cycle. Two eligibility scenarios were examined: a liberal scenario requiring ALT >17 U/L for women or >20 U/L for men, controlled attenuation parameter (CAP) >280 dB/m, and liver stiffness measurement (LSM) >8 kPa; and a restrictive scenario requiring ALT >30 U/L for both sexes, CAP >280 dB/m, and LSM >10 kPa. The analysis incorporated sampling weights to generate nationally representative estimates. Results: The study cohort included 7244 adults (mean age 49.08 y, 49.9% male) with a mean BMI of 29.61 kg/m², mean CAP 263.35 dB/m, and mean LSM 5.8 kPa. An estimated 8.3 million (95% CI: 6.6–9.9 million) adults met the liberal eligibility criteria, while 2.3 million (95% CI: 1.4–3.2 million) met the restrictive criteria. Patients meeting restrictive criteria were predominantly male (76.2% vs. 59.9%) and younger (mean age 46.7 vs. 48.3 y), with similar BMI (38.6 vs. 38.1 kg/m²). Among adults with T2DM, 3.5 million (95% CI: 2.4–4.5 million; 12.2%) met liberal, whereas 0.85 million (95% CI: 0.5–1.2 million; 3.0%) restrictive criteria. Conclusions: A substantial proportion of U.S. adults meet eligibility criteria for resmetirom treatment, with estimates varying significantly based on the stringency of selection criteria.

Osmotic demyelination syndrome: A pediatric case report and a systematic literature review

2025-06-19

Y. Mouhcine , Zineb Ezzoulali , H. Ouazzani +7 more | Radiology Case Reports

Osmotic Demyelination Syndrome Without Dyselectrolytemia- An Awareness in Type 1 Diabetes Mellitus

2025-06-18

Abhishek Kumar , Nivedita Nivedita , Abhishek Sinha +1 more | Neurology India

Water and electrolyte homeostasis during decongestion in heart failure

2025-06-18

Jef Van den Eynde , Frederik H. Verbrugge | European Journal of Heart Failure

Hyponatraemia in ageing

2025-06-17

Sophie Monnerat , Mirjam Christ‐Crain , Julie Refardt | Nature Reviews Endocrinology

Neurological aspects of electrolyte disorders

2025-06-15

Robin Howard , Aravindhan Baheerathan , Rachel Brown +2 more | Practical Neurology

Electrolyte disorders are common in clinical practice and can occur as a consequence of primary neurological disease or as a complication of general medical disorders or critical illness. They may … Electrolyte disorders are common in clinical practice and can occur as a consequence of primary neurological disease or as a complication of general medical disorders or critical illness. They may affect fluid shifts, cause disordered transmembrane potential or disrupt neurotransmission. Disorders of sodium, potassium, calcium, phosphate and magnesium metabolism are associated with a range of neurological complications that cause neuromuscular and central neurological disturbance. It is important to distinguish between acute and chronic hyponatraemia because prevention of long-term complications depends on appropriate management. Acute hyponatraemia can rarely cause cerebral oedema, seizures or encephalopathy. Potassium metabolism disorders are associated with cardiac and neuromuscular abnormalities. Calcium derangement can give neurological manifestations that range from mild and non-specific symptoms to encephalopathy. Phosphate and magnesium disturbances are particularly associated with neuromuscular weakness and are important causes of respiratory impairment and failure to wean from ventilatory support in critically ill patients.

Tumor necrosis factor-alpha in mediation of acute salt loading induced natriuresis in mice; evidence for its physiological role in regulating kidney function.

2025-06-14

Dewan S. A. Majid , Alexander Castillo | AJP Regulatory Integrative and Comparative Physiology

Tumor necrosis factor-alpha (TNF-α) exerts natriuresis via activation of its receptor type 1 in the kidney. Although chronic high salt (HS) intake produces this cytokine by immune activation of the … Tumor necrosis factor-alpha (TNF-α) exerts natriuresis via activation of its receptor type 1 in the kidney. Although chronic high salt (HS) intake produces this cytokine by immune activation of the mononuclear phagocyte cells, it has not yet been examined whether acute salt loading produces this cytokine and can induce consequent natriuresis. Here, we measured the changes in plasma level and urinary excretion rate of TNF-α (U TNFα V) during intravenous infusion of isotonic saline (0.9% NaCl), first at euvolemic conditions (3 µL/min for 60 min; Baseline period) and then at an enhanced infusion rate (12 µL/min for 90 min; Salt-loading period) in control mice (n=7) and TNF-α inactivator, etanercept (ETN; 0.5 mg/kg intraperitoneally once daily for 3 days prior to the experiment day; n=7) treated mice. TNF-α concentration in samples were determined using ELISA kit (Bioscience, Woburn, MA). During Baseline period, TNF-α level in plasma was undetected but it increased during salt-loading period in both control (3.7±1.3 pg/mL) and ETN treated (3.3±1.2 pg/mL) mice. In control mice, the baseline U TNFα V was minimal (0.01±0.002 pg/min/g) but increased to 0.1±0.03 pg/min/g (P<0.05) with associated increase in urinary sodium excretion (U Na V; 0.5±0.2 to 4.8 ±1.2 µmol/min/g; P<0.05) during salt-loading period. In ETN treated mice, both the U TNFα V (0.01±0.004 to 0.02±0.01 pg/min/g) and U Na V (0.4±0.6 to 1.1±0.3 µmol/min/g) responses to salt-loading were markedly attenuated. These findings demonstrate that TNF-α contributes to saline induced natriuresis, suggesting a physiological role for this cytokine in regulating renal excretory function during acute salt loading.

1730-P: The Antiobesity Medications and Renal Outcomes, One Answer But with Multiple Implications—A Meta-analysis of Randomized Controlled Trials

2025-06-13

CHU LIN , Xiaoling Cai , Linong Ji | Diabetes

Introduction and Objective: The association between anti-obesity medications (AOMs) and renal outcomes need to be comprehensively investigated. Methods: PubMed, Embase, the Cochrane Center Register of Controlled Trials for Studies and … Introduction and Objective: The association between anti-obesity medications (AOMs) and renal outcomes need to be comprehensively investigated. Methods: PubMed, Embase, the Cochrane Center Register of Controlled Trials for Studies and Clinicaltrial.gov website were systematically searched for randomized controlled trials (RCTs) of AOMs from the inception to December 2024. The primary endpoint was the association between AOM treatments and the risk of renal outcomes, which were presented by the relative risk (RR) with the 95% confidence interval (CI) in random-effect model. Results: A total of 57 RCTs with 140384 participants involving 11 kinds of AOMs were included. Compared with placebo, every 5kg weight reduction mediated by AOMs was associated with the decreased risk of all-cause mortality in patients with overweight or obesity (RR = 0.73, 95%CI, 0.59 to 0.90), which was mainly driven by the use of GLP-1RA (RR = 0.62, 95%CI, 0.41 to 0.94). However, compared with placebo, the weight reduction mediated by AOMs was not associated with the risk of chronic kidney disease (RR = 0.86, 95%CI, 0.58 to 1.27), renal failure (RR = 0.91, 95%CI, 0.55 to 1.49), diabetic kidney disease (RR = 1.55, 95%CI, 0.43 to 5.53), proteinuria (RR = 0.72, 95%CI, 0.003 to 198.96), or acute kidney injury (RR = 0.98, 95%CI, 0.78 to 1.21). Conclusion: The AOM treatments were associated with a reduced risk of all-cause mortality in patients with overweight or obesity. However, the weight reductions mediated by AOMs were not associated with potential renal benefits in AOM users. Disclosure C. Lin: None. X. Cai: None. L. Ji: None.

Abstract P4-10-07: Evaluation of pharmacokinetics and safety of imlunestrant in participants with hepatic impairment

2025-06-13

Stephanie White , Elaine Shanks , Eunice Yuen +3 more | Clinical Cancer Research

Abstract Background: Imlunestrant is a next-generation, oral selective estrogen receptor (ER) degrader designed to deliver continuous ER-target inhibition. Imlunestrant is under study for the treatment of ER+ advanced breast and … Abstract Background: Imlunestrant is a next-generation, oral selective estrogen receptor (ER) degrader designed to deliver continuous ER-target inhibition. Imlunestrant is under study for the treatment of ER+ advanced breast and endometrial cancers. Hepatic impairment (HI) is a common condition, particularly in cancer patients, and it can alter the pharmacokinetics (PK) of anticancer drugs, impacting their safety. Given that the intended patient population for imlunestrant may include cancer patients with HI, it is crucial to determine whether HI can impact the imlunestrant PK and safety profile. Here we present PK and safety data of imlunestrant in postmenopausal females of nonchildbearing potential (FONCBP) with and without HI following a single oral dose in a fasted state. Methods: This phase 1, open-label, 3-site study was conducted between July 2022 and February 2024 in FONCBP with normal hepatic function or HI. Participants (pts) were assigned to 4 different treatment arms, according to the Child-Pugh (CP) score: Group (G) 1 - normal hepatic function; G2: mild HI; G3: moderate HI, and G4 - severe HI. Pts were screened 28 days prior to enrollment, admitted to a clinical research unit (CRU) on Day -1, where they remained resident for PK and safety assessment following drug administration. In G 1, 2 and 3, pts received a single dose of 400 mg of imlunestrant, whereas pts in G4 received a single dose of 200 mg, while fasted. Plasma samples were collected for PK analyses. Key endpoints included PK parameters (AUC(0-tlast), AUC(0-∞), and Cmax) and safety. Results: Twenty-seven females (G1: n=9; G2: n=6; G3: n=6; G4: n=6) were included in the study (age: 45-71 years). Compared to pts with normal hepatic function, the AUC(0-tlast) geometric least square mean (GLSM) ratios for pts with mild or moderate HI by the CP scores were 1.2 (90% confidence interval (CI); 0.82, 1.8) and 2.2 (1.5, 3.3), respectively. Compared to pts with normal hepatic function, the dose-normalized (DN)-AUC(0-tlast) in pts with severe HI by the CP scores was 2.9 (90% CI;1.8, 4.7). The AUC (0-∞) GLSM ratios were 1.2 (90% CI; 0.8, 1.8) and 2.2 (90% CI; 1.5, 3.3) for the mild and moderate HI groups, respectively. The AUC(0-∞) normalized ratio of the severe HI group was 3.1 (90% CI; 1.9, 4.9). The imlunestrant Cmax GLSM ratio was similar between pts with normal hepatic function and those with mild (1.3 (90% CI; 0.8, 2.0)), moderate (1.5 (90% CI; 1, 2.4)) and severe (1.6 (90% CI; 1, 2.7)) HI. The median elimination half-life was 33.1 hours in pts with normal hepatic function, 42.8, 46.3 and 67.0 hours in pts with mild, moderate and severe HI, respectively. Additional exploratory analysis of PK parameters based on the National Cancer Institute (NCI) classification of HI, showed there were significant differences in imlunestrant PK when administered to pts with mild and moderate HI compared to pts with normal hepatic function. Only 1 pt was categorized with severe HI by NCI classification as such, this group was excluded from NCI based analyses. The average fraction unbound in plasma was similar across groups. Most TEAEs were mild or moderate in severity. TEAEs were reported by 2 pts with moderate HI and severe HI, respectively. Nausea and headache were the only TEAEs reported by more than 1 pt. Conclusions: Imlunestrant administered as a single oral dose in the fasted state was well tolerated in healthy FONCBP, as well as pts with mild, moderate and severe HI determined by the CP classification. There were no significant differences in the exposure profiles of imlunestrant in pts with mild HI in comparison to pts with normal hepatic function. However, in pts with moderate and severe HI, statistically significant increases in imlunestrant AUC (but not Cmax) were observed when compared with normal hepatic function. This data will inform the recommendations for dosing patients with HI under treatment with imlunestrant. Citation Format: Stephanie White, Elaine Shanks, Eunice Yuen, Stephen David Hall, Vivian Rodriguez Cruz, Xuejing Wang. Evaluation of pharmacokinetics and safety of imlunestrant in participants with hepatic impairment [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P4-10-07.

Diagnostic et traitement d’un diabète insipide

2025-06-13

J. Charbit , H. Staquet , S. Tran Ba +2 more | EMC - Endocrinologie - Nutrition

The Incidence, Characteristics, Management and Outcomes of Peripartum Hyponatraemia in the United Kingdom: A Prospective Study Using the <scp>UK</scp> Obstetric Surveillance System (<scp>UKOSS</scp>)

2025-06-13

Arani Pillai , Laila J. Tata , Nuala Lucas +2 more | BJOG An International Journal of Obstetrics & Gynaecology

ABSTRACT Objective To determine the national incidence, characteristics, management and outcomes of peripartum hyponatraemia. Design Prospective, observational study using United Kingdom (UK) Obstetric Surveillance System (UKOSS) methodology. Setting 192 of … ABSTRACT Objective To determine the national incidence, characteristics, management and outcomes of peripartum hyponatraemia. Design Prospective, observational study using United Kingdom (UK) Obstetric Surveillance System (UKOSS) methodology. Setting 192 of the 194 consultant‐led obstetric units in UK National Health Service (NHS) hospitals. Population Peripartum UK obstetric admissions. Methods Units submitted cases monthly to UKOSS (April 2019–September 2020). The case definition was symptomatic hyponatraemia (sodium < 125 mmol/L) in labour or ≤ 48 h postpartum, excluding other causes of symptoms. Pre‐eclampsia was excluded as a separate aetiology of hyponatraemia and potential cause of symptoms. As symptom documentation varied, characteristics, management and outcomes were compared between cases with and without reported symptoms. Main Outcome Measures Demographics, symptoms, labour details, management and outcomes. Results Eighty cases were submitted. We excluded 23 cases (10 with sodium ≥ 125 mmol/L and 13 with pre‐eclampsia). A further 25 had sodium < 125 mmol/L with no symptoms documented. Thirty‐two met the UKOSS definition, resulting in an estimate of 3.0 cases of peripartum hyponatraemia with documented symptoms per 100 000 maternities (95% confidence interval 2.0–4.1), using a national estimate of 1 050 915 maternities across the study period. Characteristics and outcomes of cases with and without documented symptoms had some variation; 53% versus 24% had critical care admissions, 41% versus 40% had neonatal unit admissions, and 38% versus 20% had spontaneous vaginal birth. Conclusions Peripartum hyponatraemia was associated with maternal morbidity. Neonatal morbidity and operative birth were high, even without documented maternal symptoms. Poor recognition and documentation of symptoms have likely underestimated the incidence.

378-P: Enhanced Renal Protective Effects of Tirzepatide in T2D People

2025-06-13

Shizuka Kaneko , Tomonao Hirobata | Diabetes

Introduction and Objective: In Japan, 1/400 diabetes people undergo hemodialysis. Chronic Kidney Disease (CKD) can lead to cardiovascular events (CV). Early detection and protection against renal failure is paramount. A … Introduction and Objective: In Japan, 1/400 diabetes people undergo hemodialysis. Chronic Kidney Disease (CKD) can lead to cardiovascular events (CV). Early detection and protection against renal failure is paramount. A report has revealed GLP-1RAg provides renal protection and decreases CV in Type 2 Diabetes (T2D) people. However, effects of GIP, another incretin hormone, on renal function are unknown. This study analyzed whether Tirzepatide (Tir), GLP-1RAg/GIPR agonist, has enhanced renal protection compared to GLP-1RAg therapy alone in real-world long duration applications. Methods: Retrospective univariate and multivariate analyses regarding HbA1c, eGFR, body weight and age were performed on three groups, A) eGFR &gt;60, B) eGFR 59~30, and C) eGFR &lt;30, of T2D cases receiving Tir or GLP1RAg for 12 months or more from 04/2023. Adverse events were monitored. Results: Of 367 T2D cases new to Tir (male 209, age 66.8±14.4, starting HbA1c 8.0±1.5%), 267 were analyzed (male 150, age 62±15, BMI 25.9±7.2, starting HbA1c 8.2±3.4%) and achieved HbA1c 6.7±2.4 % (P&lt;0.01) over more than 1 years. In group B (70 cases/male 50, HbA1c 7.9 ± 1.5%, eGFR 42.2 ± 7.4), 43 improved significantly (eGFR 50 ± 8.7 was 50.1 ± 11.4 (P &lt; 0.01)), 3 were unchanged and 24 worsened (eGFR 50 ± 8.7 was 5.1 ± 11.4 (P &lt; 0.01)). Tir eGFR provided significant favorable changes compared to semagletide injections, GLP-1RAg alone (P&lt;0.01). No significant difference in weight loss occured. Group A (187 cases/male 92, HbA1c 8.1±1.6%, eGFR 85.5±18.1) and C (16 cases/male 11, HbA1c 8.7±1.3%, eGFR 20.9±6.6) had no significant changes. Reasons for discontinuation were excessive weight loss, appetite loss or nausea/vomiting. Conclusion: This study suggests addition of GIP to GLP-1 signaling enhances reno-protective effects and prevents renal impairment more than GLP1RAg alone without serious side effects and may lead to comparable reductions in CVs. This could result in greater general well-being and immense medical cost savings. Observations in larger numbers are needed. Disclosure S. Kaneko: Speaker's Bureau; Mitsubishi Tanabe Pharma Corporation, Novo Nordisk. Research Support; Novo Nordisk. Consultant; Novo Nordisk. Speaker's Bureau; AstraZeneca, Kowa Company, Ltd, Eli Lilly and Company. Research Support; Eli Lilly and Company. Speaker's Bureau; Novartis Pharmaceuticals Corporation, Sumitomo Dainippon Pharma Co., Ltd, Otsuka Pharmaceutical. T. Hirobata: Consultant; OtsukaPharmaceutical Co.,Ltd, Kowa Company, Ltd, Sanofi, Sumitomo Dainippon Pharma Co., Ltd, Taisho Pharmaceutical Holdings Co., Ltd, Novartis Pharmaceuticals Corporation, Novo Nordisk, Bayer Pharmaceuticals, Inc, Boehringer-Ingelheim, Mochida pharmaceutical Co., Ltd. Research Support; Novo Nordisk.

2080-LB: Analysis of Hyperemesis Gravidarum and Diabetes-Associated Gene TCF7L2 in Pregnancy

2025-06-13

Marlena S. Fejzo , HANNAH THOMPSON , ZAINAB NEEMUCHWALA +3 more | Diabetes

Introduction and Objective: Hyperemesis Gravidarum (HG) lies at the severe end of the clinical spectrum of nausea and vomiting of pregnancy and can be life-threatening. Recently, we found TCF7L2, the … Introduction and Objective: Hyperemesis Gravidarum (HG) lies at the severe end of the clinical spectrum of nausea and vomiting of pregnancy and can be life-threatening. Recently, we found TCF7L2, the greatest genetic risk factor for type 2 diabetes (and a risk factor for gestational diabetes), is also associated with HG and is highly expressed in extra-villous trophoblasts peaking during decidual invasion. Herein, we analyze circulating TCF7L2 levels, clinical data, and genotype in HG pregnancies to explore its role in HG risk. Methods: Blood and clinical data were obtained from 82 HG patients visiting a treatment clinic. Circulating TCF7L2 levels were measured by immunoassay. A standard t-test for normally distributed and a Whitney-Mann test for non-normal data were used to determine whether altered levels were associated with gestational age (GA), maternal race/ethnicity, nausea and vomiting severity (validated PUQE score), and weight. The rare TCF7L2 genetic variant associated with HG (rs76856932) was sequenced in 60 HG patients. Results: The median level of circulating TCF7L2 was 1.1 (0.2-73) ng/ml during 4-36 weeks’ GA. Patients with TCF7L2 levels in the lowest quartile had significantly more severe symptoms and weighed significantly less at their first clinic visit (median 9.5 weeks). We found no evidence for an association between TCF7L2 levels and GA or maternal race/ethnicity. rs76856932 was identified in one Latina patient. Conclusion: Higher levels for those with less severe symptoms suggests TCF7L2 may have a protective effect against HG. TCF7L2 is a transcription factor that may control GLP-1 expression and is associated with liraglutide effects resulting in greater weight loss in obesity. More research is needed to elucidate the mechanism by which TCF7L2 may alter weight and HG risk and whether it represents a novel treatment target for HG as well as other conditions associated with abnormal appetite. Disclosure M. Fejzo: Consultant; NGM BIO. Stock/Shareholder; NGM BIO. Consultant; Harmonia Healthcare. Stock/Shareholder; Harmonia Healthcare. H. Thompson: None. Z. Neemuchwala: None. K. Fejzo: None. K. MacGibbon: None. A. Housholder: None. Funding Eppley Foundation

Authors reply: “What every intensivist should know about type D hyperlactatemia”

2025-06-12

Raquel Simões Ballarin , Taline Lazzarin , Marcos Ferreira Minicucci | Journal of Critical Care

Hyponatremia Presents With Seizure in a Patient With Arnold-Chiari Malformation: A Case Report

2025-06-11

Mohamed Z. Peediyakkal , Nabil Sherif Mahmood , Ashib Thurakkal +6 more | Cureus

Perspective Chapter: Potassium Regulation in Pregnancy and Pre-Eclampsia – The Identity and Role of Non-Genomic Steroids

2025-06-05

Fred I. Chasalow | IntechOpen eBooks

Preeclampsia affects 5–8% of pregnant women. It is characterized by hypertension and proteinuria after 20 weeks of gestation and is attributed to abnormal placental formation and development. This perspective chapter … Preeclampsia affects 5–8% of pregnant women. It is characterized by hypertension and proteinuria after 20 weeks of gestation and is attributed to abnormal placental formation and development. This perspective chapter presents a new hypothesis concerning the biochemical mechanism of preeclampsia, reversing the postulated link between abnormal placental formation and its biochemical cause. We discovered two new types of steroids that function with non-genomic mechanisms. The steroids are phosphodiesters of steroids with 23 or 24 carbon atoms. One type has a lactone E-ring similar to spironolactone; the second type has a carboxyl group instead of the lactone. We also propose a biosynthetic pathway for these steroids. The compounds with 23 carbon atoms match up with the maternal isoforms of the sodium-potassium pump NaK-ATPase and epithelial sodium channel ENaC. These two proteins are the primary maternal regulators of potassium during pregnancy. The 24-carbon compounds match the corresponding fetal isoforms of the two proteins. These studies suggest that the symptoms of preeclampsia result from inadequate synthesis of the 24-carbon compounds and over production of the 23-carbon compounds. Accordingly, pre-eclampsia may no longer be a syndrome but a series of biosynthetic defects in a previously unknown steroid biosynthetic pathway. We thus propose that the specific defect in the pathway may result in a loss-of-function mutation of 16α-hydroxylase, which could also cause estriol deficiency, which may underlie the inadequate placentation observed in preeclampsia.

Influence of awakening from general anesthesia on the distribution of glucose 2.5% with balanced electrolytes in adults

2025-06-04

Robert G. Hahn , Fredrik Sjöstrand | Frontiers in Medicine

Background The glucose-free crystalloid fluid used for intravenous infusion during surgery might be combined with or replaced by 2.5% glucose in debilitated patients. The aim of the present study was … Background The glucose-free crystalloid fluid used for intravenous infusion during surgery might be combined with or replaced by 2.5% glucose in debilitated patients. The aim of the present study was to use kinetic modeling to quantify the distribution of 2.5% glucose with balanced electrolytes administered during and after general anesthesia. The hypothesis was that awakening from anesthesia changes glucose and/or fluid volume kinetics in distinct ways. Methods A secondary analysis was performed based on data derived during and after intravenous administration of an isotonic mixture of 20 mL/kg of glucose 2.5% with electrolytes over 60 min in 12 non-diabetic adult patients undergoing laparoscopic cholecystectomy. Population glucose and volume kinetic analyses were performed based on blood and urine data collected for 4 h, which included 2 postoperative hours. Periods before and after awakening from anesthesia were contrasted using covariate analysis and further compared to 35 infusions in 17 awake volunteers who had received the same fluid at different rates and volumes. Results The return flow of distributed fluid to the plasma was strongly retarded during and after anesthesia and promoted peripheral edema. Awakening decreased the rate of distribution, which counteracted the additional build-up of this edema but expanded the plasma volume. Urine output was strongly dependent on the mean arterial pressure; the urine flow rate at 75 mmHg was only 22% of the flow rate obtained at 90 mmHg. Simulations showed that the rate of administration of glucose 2.5% should be &lt; 500 mL over 30 min to maintain plasma glucose &lt; 10 mmol/L during surgery and postoperatively. Conclusion Awakening from general anesthesia inhibits the distribution of 2.5% glucose solution and accelerates the return of distributed fluid, with both responses increasing the plasma volume. These two effects counteract postoperative development of hypovolemia.