"Hypernatraemia" OR "Hypernatremia" AND "Treatment"

BACKGROUND: Rapid correction of dysnatraemias is frequently associated with increased morbidity and mortality. Therefore, it is important to estimate the proper volume and type of infusate required to change the serum sodium concentration predictably. The aim of this study is to evaluate the utility or/and the accuracy of the Adrogue-Madias formula in managing patients with hyponatraemia and hypernatraemia. METHODS: Among the 317 patients who either on admission to our internal medicine clinic or during their hospitalization were found to have hyponatraemia or hypernatraemia, we studied 189 patients (59...

Excessive ingestion of salt is a well-recognized cause of hypernatraemia in children, is uncommonly recognized in debilitated elderly persons, but is rarely diagnosed in healthy, independent adults. We report a case of fatal salt poisoning in a 20-year-old lady who suffered of post-natal depression and ingested large quantities of salt as part of exorcism ritual. She presented with the highest ever documented serum sodium level of 255 mmol L(-1), associated with severe neurological impairment that was unresponsive to aggressive hypotonic fluid replacement...

Hypo- and hypernatraemic (dysnatraemic) disorders are among the most common electrolyte disorders encountered by primary care providers and nephrologists. They represent a diagnostic and therapeutic challenge, and inappropriate management can result in serious sequelae. Several formulas addressing the fluid prescription for dysnatraemic patients have been introduced. Many authors stress the importance of considering output as well as input in formulating a treatment plan for the dysnatraemic patient. However, currently available formulas fail to account for ongoing renal and extrarenal fluid and electrolyte losses...

As part of a population based regional review of all neonatal readmissions, the incidence of dehydration with hypernatraemia in exclusively breast fed infants was estimated. All readmissions to hospital in the first month of life during 1998 from a population of 32 015 live births were reviewed. Eight of 907 readmissions met the case definition, giving an incidence of at least 2.5 per 10 000 live births. Serum sodium at readmission varied from 150 to 175 mmol/l. One infant had convulsions. The sole explanation for hypernatraemia was unsuccessful breast feeding in all cases...

UNLABELLED: Onset and correction of hypernatraemia constitute major hypertonic stresses for mammalian cells. Cells respond by activating specific osmoregulatory mechanisms allowing to preserve their volume and to adapt to their new environmental conditions. These processes have major implications in the management of hypernatraemia. In particular, cells chronically exposed to hypertonic conditions progressively accumulate organic osmolytes to maintain optimal intracellular electrolyte concentrations...

Hypernatraemia is defined as an increase in extracellular sodium concentration, associated with plasma hyperosmolality and cellular dehydration. It can result from excessive water loss, from an increase in the total sodium content or from both mechanisms. As far as neurosurgical pathology is concerned, hypernatraemia due to excessive water loss may be observed in patients who do not sense thirst or are unable to ingest water. Urinary water loss is seen in diabetes insipidus and osmotic diuresis. Extrarenal water losses from pulmonary origin may be observed in intubated or tracheotomized patients...

It is not uncommon for patients to present to the emergency room with severe weakness and a markedly low plasma potassium concentration. We attempted to identify useful clues to the diagnosis of hypokalaemic periodic paralysis (HPP), because its acute treatment aims are unique. We retrospectively reviewed charts over a 10-year period: HPP was the initial diagnosis in 97 patients. Mean patient age was 29+/-1.1 and the male:female ratio was 77:20. When the final diagnosis was HPP (n=73), the acid-base state was normal, the urine K(+) concentration was low, and the transtubular K(+) concentration gradient (TTKG) was <3...

In children, the treatment of acute diarrhoea with the World Health Organization (WHO) standard oral rehydration solution (ORS) provides effective rehydration but does not reduce the severity of diarrhoea. In community practice, carob bean has been used to treat diarrhoeal diseases in Anatolia since ancient times. In order to test clinical antidiarrhoeal effects of carob bean juice (CBJ), 80 children, aged 4-48 months, who were admitted to SSK Tepecik Teaching Hospital with acute diarrhoea and mild or moderate dehydration, were randomly assigned to receive treatment with either standard WHO ORS alone or a combination of standard WHO ORS and CBJ...

INTRODUCTION AND CLINICAL CASE: We present a case of extra-pontine myelinolysis caused by acute hypernatraemia in which a complex picture of late onset extrapyramdial features, choreodystonia and parkinsonism developed. Repeated physical examinations, neurophysiological and neuroimaging studies using magnetic resonance all indicated an extra-pontine site of the lesions, which symmetrically affected the striate and to a lesser extent both thalami. We review the relevant literature available and analyze the cases described as having abnormal movements associated with a myelinolytic syndrome...

AIMS: To illustrate that hypernatraemia is still seen as a problem in paediatric practice and to discuss its management. METHODS: A collection of four patients with hypernatraemia from different causes are reported. Recommended treatment include initial plasma expanders, where necessary, followed by gradual rehydration to prevent cerebral oedema using fluid containing 75-80 mmol/L of sodium until adequate urine output is observed, followed by a maintenance rate of solution containing 35-40 mmol/L of sodium over 48 h...

Between 1972 and 1979 34 patients with severe hypernatraemia (serum sodium larger than or equal to 160 mmol/l) were admitted to the intensive care unit. Among these there were 45% of neuropsychiatric patients with reduced consciousness. Maximal serum sodium concentration was 168 (160--204) mmol/l, maximum serum osmolality 391 (340--520) mosm/kg H2O. Treatment consisted of infusion of hypotonic solutions and potassium substitution. Fluid balance was positive (5,9 during 43 hours) until normal serum sodium concentrations had been reached...

Investigations in a 14 year old girl with arrested growth for 2 years, delayed pubertal development, hypernatraemia without thirst, diabetes mellitus and hyperlipaemia are reported. The hypernatraemia was accompanied by a low vasopressin concentration with an abnormal response to thirst, high plasma renin but normal plasma aldosterone concentrations. Treatment with vasopressin and increased fluid intake decreased serum sodium levels. Serum gonadotrophins were low; GH response during an insulin tolerance test was subnormal and basal serum Prl concentration was elevated...

No abstract text is available yet for this article.

The role of arginine-vasopressin (AVP) in the pathogenesis of deoxycorticosterone acetate (DOCA) salt hypertension in rats was studied with AVP receptor antagonists for its tubular (V2) and/or vascular (V1) actions. When chronic (six weeks) infusion of the antagonists was started concomitantly with DOCA-salt treatment the development of hypertension was attenuated by the V1-antagonist and prevented by the V1V2-antagonist. However, the V1V2-antagonist induced severe and persistent hypernatraemia in all rats...

No abstract text is available yet for this article.

Hypokalaemia and metabolic alkalosis were seen in three patients and additionally hypernatraemia in two patients treated with 100 mega units of sodium penicillin G for subacute bacterial endocarditis. The hypernatraemia was probably due to the administration of insufficient fluid, while urinary potassium loss was an important factor in producing hypokalaemia and metabolic alkalosis after. Penicillin may promote urinary potassium excretion by acting as a non-reabsorbable anion.Potassium depletion during treatment with massive doses of sodium penicillin G may be prevented by concurrently administering potassium-sparing diuretics or by using the potassium salt of penicillin...

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

We describe a patient with chronic hypernatraemia (plasma sodium 148-155 mmol/l) and partial nephrogenic diabetes insipidus who had received prolonged lithium treatment. Despite stopping the drug for one year the abnormalities remained. Infusion of hypertonic saline (NaCl 855 mmol/l) allowed the characterization of osmoregulation of thirst and vasopressin secretion. Linear regression analysis of plasma vasopressin and osmolality defined the function, pAVP = 0.27 (pOsm - 301), and analysis of thirst measured by a visual analogue scale and plasma osmolality, the function, thirst = 0...

No abstract text is available yet for this article.

Severe hypernatraemia in a hospital population should be an avoidable problem. We have looked at its causes and incidence over one year and have shown that serious hypernatraemia (serum sodium greater than 160 mmol/l) as a manifestation of severe dehydration is associated with a high morbidity and mortality. Failure to maintain adequate fluid intake, intentional or unintentional, was the most frequent cause. Nursing and medical staff must be made more aware of this problem and encouraged to initiate early treatment of dehydration...