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Biomedical subjects

P Vestergaard

Publications and source records attributed to P Vestergaard.

At least 109 records · Page 6Linked to original sources
PubMed1988

Distinction between proximal and distal regulations of sodium and potassium excretion in humans.

The clearances of creatinine (CCr), lithium (CLi), sodium (CNa), and potassium (CK) were determined during three consecutive 2-hour periods in a large number of physically healthy persons who were in lithium treatment for manic-depressive illness. CLi was used as a measure of the proximal tubular fluid output (Vprox). CLi showed considerable spontaneous variations from one 2-hour period to another, and neither bladder emptying errors nor changes of CCr could account for these. The variations of CLi, which reflected variations of Vprox, resulted in joint variations of CNa and CK. Also the ratios CNa/CLi and CK/CLi, which reflected the distal handling of sodium and potassium, showed considerable spontaneous variations. These were correlated neither with each other nor with variations of CLi. Our study indicates that through the use of CLi as a measure of Vprox it is possible to distinguish between a single joint proximal regulation and two separate distal regulations of sodium and potassium excretion. Further studies concerning the interplay between proximal and distal regulations under normal and pathological conditions may provide deeper insight into the way in which the kidney functions.

Bipolar Disorder↗
PubMed1987

Changes in serum thyroxine (T4) and serum thyroid stimulating hormone (TSH) during prolonged lithium treatment.

We determined serum T4 and serum TSH serially in a cohort of patients given lithium treatment for up to 6 years; the total lithium exposure time was 409 years and the average serum lithium concentration 0.69 mmol/l. T4 showed a small and not significant fall at 6 months and returned to the pre-lithium level at 12 months. Hereafter, T4 rose gradually and after 6 years of lithium treatment T4 was 53% higher than the pre-lithium value. TSH was significantly increased at 6 and 12 months and then returned to the pre-lithium level. Eight patients required thyroxine treatment for lithium-induced hypothyroidism, i.e. 2 per 100 years of lithium exposure time. Single deviant values of T4 and TSH could be seen, followed by normal values. We suggest that TSH is determined at intervals during lithium treatment. It may be prudent to subject lithium-treated patients with abnormal thyroid values to re-examination and to abstain from starting thyroxine treatment on the basis of a single deviant value.

Follow-Up Studies↗
PubMed1987

Does long-term lithium treatment induce diabetes mellitus?

Fasting blood sugar was determined in manic-depressive patients before the start of lithium treatment and at intervals during treatment for up to 6 years. The total exposure time to lithium was 495.5 years. Even though the patients gained significantly in age and body weight during the treatment, their mean blood sugar values remained the same as before treatment was started, and only 1 patient developed manifest diabetes. There is no reason to believe that long-term lithium treatment leads to increased risk of developing diabetes mellitus.

Adolescent↗
PubMed1986

Renal function of patients in long-term treatment with lithium citrate alone or in combination with neuroleptics and antidepressant drugs.

Renal function was studied in patients given lithium citrate alone or in combination with neuroleptics or tricyclic antidepressants or both. No other drugs were given. None of the groups given lithium citrate with other drugs had lithium ion clearances that differed significantly from the groups given lithium citrate alone, nor was there any difference in the clearances of sodium, potassium, or creatinine between these groups. The 24-hour urine volume of patients receiving antidepressant drugs was similar to that of the patients receiving lithium citrate monotherapy but was significantly higher in patients given neuroleptics. The increase in urine volume could not be ascribed to alterations in glomerular filtration rate or proximal tubular resorption but could be accounted for entirely by lowered resorption of water in the distal tubules. We concluded that no change of lithium citrate dose is required when patients so treated are given additional neuroleptic or tricyclic antidepressant drugs.

Adult↗
PubMed1986

Lithium treatment and blood pressure.

The average systolic and diastolic blood pressures of 377 manic-depressive patients were not significantly different before and during lithium treatment. Before the treatment blood pressure was slightly but significantly lower in spring and fall than in winter and summer; during lithium treatment the seasonal variations disappeared.

Adult↗
PubMed1986

A comparison of DSM-III and ICD-8 diagnoses for major affective disorders and the use of biological markers for depression.

The aims of the present study were to investigate the value of adding DSM-III diagnosis and Newcastle Scale Rating to the ICD-8 diagnosis currently used and to investigate the association between Dexamethasone Suppression Test (DST) and the Thyrotropine Releasing Hormone- Thyroid Stimulating Hormone (TRH-TSH) test and the three classification systems for depression. Twenty-six depressed in-patients were included, 17 women and 9 men, with a mean age of 51.5 years. Fourteen patients were psychotic depressed. DST and Newcastle Scale Rating were performed on 18 patients and TRH-TSH test was performed on 16 patients. The addition of DSM-III diagnosis on the 4-digit level did not have any value compared to the ICD-8 diagnosis. However, DSM-III diagnosis on the 5-digit level added important clinical information which corresponded better to Newcastle Scale scores and DST and TRH-TSH test results than ICD-8 diagnosis. The main advantage of the DSM-III classification of depression on the 5-digit level compared to ICD-8 concerns depression on the border between psychosis and neurosis. In clinical practice there is a risk of underestimating the severity of a depression if ICD-8/9 is used as the only criterion for severity. This may have tragic consequences for the patient. This study suggests that rating of the depression on the Newcastle Scale or provision of a DSM-III diagnosis on the 5-digit level are valuable assessment procedures of severity.

Adult↗
PubMed1986

The renal lithium clearance and its correlations with other biological variables: observations in a large group of physically healthy persons.

The lithium clearance (CLi) is a measure of the delivery of fluid from the proximal tubules to the loop of Henle. We determined the correlations between CLi and a number of variables on 350 occasions in 164 physically healthy persons in lithium treatment for manic-depressive illness. CLi was significantly correlated (p less than 0.001) with sex, age, body surface, urine flow, sodium clearance, potassium clearance, serum lithium concentration, and lithium dosage. Correlations with sex, age and body surface lost statistical significance when the renal variables and the surface were divided by creatinine clearance; these correlations are indirect and caused by common correlations with the filtration rate. The findings show that the fractional delivery of fluid from the proximal tubules is independent of sex, age and body surface. Correlations with urine flow, serum lithium, and lithium dosage could be explained by circumstances connected with the lithium treatment. These variables do not seem to affect CLi. It is concluded that factors which should be taken into account if the assessment of lithium clearance values include the creatinine clearance, the sodium clearance, and the potassium clearance.

Adult↗
PubMed1984

Heart rate variation in patients treated with antidepressants. An index of anticholinergic effects?

The aim of the present study was to investigate whether heart rate variation as obtained simply from an electrocardiographic registration is influenced in subjects given antidepressive medication. The mean difference between consecutive R-R intervals (MCD) was reduced in patients (n = 23) treated with various doses of tri- or tetracyclic antidepressants [7.7 (1.8-32.3) ms in patients versus 24.8 (7.0-87.7) ms in controls]. Among those receiving 1.67 mg tricyclic antidepressant or more per kilogram body wt (n = 12) MCD was further reduced [5.0 (2.1-12.0) ms] with no overlapping of values as compared to controls (n = 9). In a subgroup of patients treated with clomipramine the MCD was related inversely to the dosage (R = 0.78, P less than 0.02). In an additional group of seven patients, MCD was reduced following a few days of treatment with antidepressants as compared to pretreatment values (P less than 0.02), indicating that the reduction is a result of therapy and not a concomitant of the affective state. We suggest that measurements of heart rate variation could be a useful tool to measure anticholinergic effects of antidepressants.

Adult↗
PubMed1984

The effect of age on lithium dosage requirements.

Analysis of more than 350 observations of patients who had been under lithium treatment for 6 months to 4 years showed a significant negative correlation between dosage requirements and age; old patients required less lithium than young patients to maintain a particular serum lithium concentration. The decline in dosage requirement with increasing age could be fully accounted for by the age-dependent fall in the glomerular filtration rate and lithium clearance. There was no age-dependent change in tablet compliance, and the duration of exposure to lithium did not influence the dosage requirement.

Adult↗
PubMed1983

Patient attitudes towards lithium.

Many patients discontinue prophylactic lithium treatment against medical advice. Knowledge of patient attitudes towards lithium treatment may help explain and prevent non-compliant behaviour. One hundred and forty patients given lithium treatment from 2 to 17 years were asked what they found most advantageous about the treatment and what they found most disadvantageous. Seventy-five per cent of the patients experienced freedom from symptoms and the reestablishment of social functions in the family and in work as the main benefit of the treatment. Twenty-five per cent perceived no other advantages than possibly the satisfaction of demands from the family or the doctor. Seventy per cent of the patients considered various somatic and non-somatic complaints the main disadvantage of lithium treatment and 30% found no disadvantages at all. Psychological and other non-somatic complaints related to work, training, patient status, and the administration of lithium tablets were almost as frequent as somatic complaints. The advantages and disadvantages perceived by the patients did not necessarily correspond with the physician's perception of good or bad treatment response or the presence of unwanted effects.

Adult↗
PubMed1982

Lithium treatment regimen and renal water handling: the significance of dosage pattern and tablet type examined through comparison of results from two clinics with different treatment regimens.

For many year two Danish psychiatric hospitals having used different lithium treatment regimens. In one, slow-release tablets were given in two daily doses and, in the other conventional tablets were given in a single daily dose. In both hospitals many patients developed polyuria. Multiple regression analyses with sex, age, treatment duration, serum lithium concentration, and treatment regimen as predictor variables showed that the two treatment regimens did not affect the glomerular filtration rate or the proximal reabsorption differently, but that distal water reabsorption was significantly less affected and polyuria less pronounced in the patients given conventional tablets once daily than in those give slow-release tablets twice daily. The authors are divided among themselves as regards the implications of these findings.

Adult↗
PubMed1982

Plasma arginine-vasopressin, renal-concentrating ability and lithium excretion in a group of patients on long-term lithium treatment.

Plasma arginine-vasopressin (AVP) was measured before and after 24 h of a 26-hour renal concentration test in 47 patients treated with lithium for 6-180 months (mean 70 months). In 34 of the patients, plasma AVP was also measured before and after a 2- to 4-hour period of water loading, and in 31 of the patients, creatinine, 125iothalamate, 131I-hippuran and lithium clearances were measured. Plasma AVP values were compared to those obtained in 8 healthy controls. Baseline AVP levels were significantly higher in the lithium-treated patients than in healthy controls. During the period of water deprivation AVP values increased significantly and during oral water loading a significant decrease took place, AVP values still being significantly higher in the lithium-treated patients than in the healthy controls. During oral water loading a slight increase in lithium clearance as well as fractional lithium excretion was seen as compared to values obtained during the last 2 h of a renal concentration test. This study demonstrates that antidiuretic hormone production is neither blocked nor inhibited during lithium treatment. The hypothalamic system reacts on water deprivation as well as on water loading. This study supports the notion that the main lithium-induced renal affection is a vasopressin-resistant impairment of renal concentrating ability.

Adult↗
PubMed1981

Renal side effects of lithium: the importance of the serum lithium level.

Patients given long-term treatment with lithium often develop an impairment of renal water reabsorption which may lead to clinically significant adverse reactions. A convenient measure of this impairment may be obtained using the ratio of urine volume (V) divided by lithium clearance (CLi). When data from a large group of patients were recalculated, this ratio showed a statistically significant correlation with the serum lithium level. This finding supports the suggestion that patients might advantageously be maintained at lower serum levels than those commonly employed.

Absorption↗