PubMed · 14157174
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H H MARSH. 1964. DEHYDRATION.. https://pubmed.ncbi.nlm.nih.gov/14157174/
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Central diabetes insipidus (DI) is a rare but recognized complication of myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) that is caused by leukemic infiltration to the hypothalamo-neurohypophyseal system. In rare patients in whom a wide region of the hypothalamus is involved, central DI results in hypodipsic hypernatremia and dehydration. Typical DI symptoms such as polydipsia, polyuria, and marked thirst are concealed in these cases, because the hypothalamic "thirst center" cannot send thirst stimuli to the cerebral cortex. Herein we describe a patient with MDS developing into AML, who presented with hypodipsic hypernatremia and dehydration. A diagnosis of central DI was made on the ground of a low level of serum anti-diuretic hormone (ADH) despite high serum osmolality. A magnetic resonance imaging study revealed attenuation of a physiological "bright spot" of the neurohypophysis. An induction course chemotherapy including regular-dose cytarabine and daunorubicin produced a rapid improvement of hypernatremia. The bone marrow aspirate after two courses of chemotherapy showed complete remission. At that point, ADH release and the "bright spot" were recovered. In order to correctly diagnose central DI in association with hematological malignancies, we should not overlook this atypical type of DI.
OBJECTIVES: We conducted a retrospective evaluation of enteral infusion with a marketed hypoosmolar oral rehydration solution (HORS), as an alternative to intravenous infusion. POPULATION AND METHODS: Premature infants, with difficult venous condition, 30 weeks or more during HORS infusion. Enteral ORS started after well-tolerated milk gastric gavage. Gradual increase of enteral feeding. RESULTS: January 1999 to April 2001, 105 neonates 28 weeks to 36 weeks, birth weight 1050 to 2700g, including 71.5% eutrophic newborns 30 to 34 weeks; 13.3% hypotrophic<10th P. More than 90% had a physiological weight curve: weight loss vs birth<15%, back to birth weight at day 15. No significant pathology during ORS. Failure of ORS for 7/105 children. Relative risk increased 8 fold if term was less than 30 weeks, 7 folds in the event of enteropathy before ORS. In 26.7% of the infants, gastric enteral residuals exceeded 1/3 of intake, vomiting and/or abdominal ballooning lasted less than 48 hours. There were 4 deaths during follow-up (periventricular leucomalacia, myocardial infarctus) and 1 necrotizing enterocolitis. At theoretical birth date, 25% of the neonates were hypotrophic<10th P. At one and 2 years of age, less than 5% were still hypotrophic: relative risk increased 18 fold when birth weight was<5th P. CONCLUSION: HORS is an efficient, well-tolerated, low-cost and less invasive alternative to intravenous infusion. It must be reserved for eutrophic neonates born>30 weeks gestation due to risk of failure and insufficient growth. Validation with a multicentric clinical trial is in progress.
Leaf-level morphological and structural adaptations to reduce water loss were examined in five olive (Olea europaea L.) tree cultivars (Arbequina, Blanqueta, Cobrançosa, Manzanilla and Negrinha) growing under field conditions with low water availability. Leaf measurements included leaf tissue thickness, stomatal density, leaf area, leaf mass per unit area, density of leaf tissue, relative water content, succulence, water saturation deficit, water content at saturation and cuticular transpiration rate. We found considerable genotypic differences among the cultivars. Negrinha, Manzanilla and Cobrançosa had more morphological and structural leaf adaptations to protect against water loss than the other cultivars. Manzanilla and Negrinha enhanced their sclerophylly by building parenchyma tissues and increasing protective structures like the upper cuticle and both the upper and lower epidermis. Cobrançosa exhibited good protection against water loss through high density of foliar tissue and by thick cuticle and trichome layers. Compared with the Negrinha, Manzanilla and Cobrançosa cultivars, Arbequina leaves had a thinner trichome layer, implying that the leaves were less protected against water loss; however, the development of smaller leaves may reduce water loss at the whole-plant level. Among cultivars, Blanqueta had the largest leaves and some anatomical traits that may lead to high water loss, especially from the adaxial surface. The mechanisms employed by the cultivars to cope with summer stress are discussed at the morpho-structural level.