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PubMed1991

[Clinical features of hypernatremic hyperosmolar delirium following open heart surgery].

Five cases of hypernatremic hyperosmolar delirium after open heart surgery were reviewed. Minimum serum osmolarity at the time of developing delirium in these cases was 336 mOsm/l. Blood glucose level did not reached to the levels of the typical criteria of hyperosmolar hyperglycemic nonketotic diabetic coma in all cases. The authors have shown that it was difficult to recognize this unique disorder in early postoperative stage. Because of its non-specific symptoms and the postoperative courses which required the patients' cares with much more dry side in water balance. In order to treat the patients with hypernatremic hyperosmolar delirium, the correction of serum osmolarity should be done very slowly, because water intoxication should be prevented. In all five cases in this paper were recovered from delirium as the time when serum natrium level and serum osmolarity were restored to the normal state. We concluded that in order to get a good prognosis of this characteristic disorder, we have shown early recognition of serum hypernatremia and hyperosmolarity state and consequently adequate treatment mentioned above are primarily important.

Adult↗
PubMed1990

[Perioperative infusion therapy in children].

An incorrect fluid therapy can lead to serious complications considerably more rapidly in children, especially in newborns and infants, than in adults. The pediatric patient has a limited range of compensation for maintenance of fluid and electrolyte balance. Precise knowledge of the physiological age-dependent fluid balance, i.e. the large extracellular space, the developing renal function, the increased metabolism, the acid-base state, the electrolyte balance with the relatively higher sodium and chloride requirements must be the basis of an adequate fluid therapy. The basic fluid requirement (normal fluid and electrolyte requirement) varies with age and is influenced considerably by environmental conditions, body temperature and metabolism. For substitution of this basic fluid requirement one-third to one-half strength electrolyte solution in 5% dextrose is used, the amount depending on age. The perioperative fluid requirement, however, has to be calculated with due consideration for the characteristic changes in fluid and electrolyte balance during anaesthesia and surgery, the preoperative fasting period, drug effects of anesthetics, hormonal changes and ventilation; it is higher than the basic fluid requirement (infants 6-8 ml.kg-1.h-1, toddlers 4-6 ml.kg.h-1, schoolchildren 2-4 ml.kg-1.h-1). For intraoperative fluid therapy infusions with an increased sodium concentration (70-100 mmol/l) or Ringer's lactate (Na+ = 130 mmol/l) must be used. On no account must electrolyte-free solutions, e.g., 5-10% glucose, be used intraoperatively, as they can lead to water intoxication. The third-space requirements compensate for the additional losses by drainage, third-space deficits by evaporation and gastric and enteral secretions.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia↗
PubMed1990

[Anesthetic management of a patient with progressive spinal muscular atrophy].

Various problems especially weakness of respiratory muscle and abnormal reaction to muscle relaxant exist during the management of anesthesia for the patients with neuromuscular disease with the disturbance of motor neurons. We had a patient for trans-urethral resection of prostate with spinal progressive muscular atrophy. Using nitrous oxide-oxygen with halothane, and without muscle relaxant, we succeeded in avoiding respiratory failure, aspiration and other serious complications. By measuring serum sodium, rapid discovery and treatment of water intoxication could be achieved.

Aged↗
PubMed1990

Desmopressin for diabetes insipidus, hemostatic disorders and enuresis.

Arginine vasopressin preparations have been used in the treatment of diabetes insipidus for many years. Compared with older antidiuretic agents, the synthetic analog desmopressin is more potent, longer acting and easier to use. It is available for intravenous, subcutaneous and intranasal administration. Desmopressin may be useful in the treatment of hemostatic disorders such as von Willebrand's disease and hemophilia A. It has also been used for nocturnal enuresis. The vasopressor effects of arginine vasopressin preparations have been exploited for use as a temporizing measure in controlling acute gastrointestinal bleeding. Side effects such as hyponatremia and water intoxication are uncommon when these drugs are used with proper precautions.

Deamino Arginine Vasopressin↗
PubMed1990

American Association of Gynecologic Laparoscopists 1988 Membership Survey on Operative Hysteroscopy [correction of hysterectomy].

The 1988 American Association of Gynecologic Laparoscopists' (AAGL) Membership Survey on Operative Hysteroscopy had a 19% response rate. A total of 377 respondents reported performing 7,293 operative hysteroscopies. The number of procedures reported per respondent ranged from 1 to 325; 75% of physicians reported performing 20 or fewer procedures. In 1988, a small number of practitioners performed a large number of procedures. Directed biopsy and polypectomy through the hysteroscope were the procedures most commonly reported. Most operative hysteroscopies were performed for a complaint of either abnormal bleeding (57%) or infertility (27%). The most frequently reported complication was uterine perforation not requiring transfusion (13 per 1,000 procedures). More serious complications which occurred in at least 1 per 1,000 procedures included water intoxication or pulmonary edema, hospital readmission, hospitalization greater than 72 hours, and transfusion for hemorrhage.

Female↗
PubMed1990

Inappropriate antidiuretic state in long-term psychiatric inpatients.

To investigate the occurrence of an inappropriate antidiuretic state in a long-term psychiatric inpatient population, 690 patients underwent serum sodium determination. Forty-four patients (6.4%) had levels less than 133 mmol/l. Fifteen of these patients could be investigated further and the biochemical findings in all were consistent with an inappropriate antidiuretic state. Evidence of previous episodes of water intoxication was found in 80% of these patients. Although more than one possible cause was present in most patients, the two factors most strongly incriminated in the pathogenesis of the inappropriate antidiuretic state were the drugs carbamazepine and hydrochlorothiazide.

Adult↗
PubMed1990

[Clinical analysis of 107 cases with chemical burns].

From 1978 to 1987 107 cases of chemical burns were treated. The patients were mainly young and middle age people (83.08%), with mean burned areas 17.8%. The majority of involved parts were low extremities. 57.44% of burned eyes became blind. Mean days in hospital were 43 days. Cure rate was 98.13% and death rate 1.87%. We emphasized that burned wounds must instantly be washed down with water, intoxication resulting from chemical matters must be effectively treated. Diagnosis of depth of burned wound by acids and means of prevention of chemical burns were also discussed.

Adolescent↗
PubMed1990

American Association of Gynecologic Laparoscopists' 1988 membership survey on operative hysteroscopy.

The 1988 American Association of Gynecologic Laparoscopists' membership survey on operative hysteroscopy had a 19% response rate. A total of 377 respondents reported performing 7,293 operative hysteroscopies. The number of procedures reported per respondent ranged from 1 to 325; 75% of physicians reported performing 20 or fewer procedures. In 1988 a small number of practitioners performed a large number of procedures. Directed biopsy and polypectomy through the hysteroscope were the procedures reported most commonly. Most operative hysteroscopies were performed for a complaint of either abnormal bleeding (57%) or infertility (27%). The complication reported most frequently was uterine perforation not requiring a transfusion (13 per 1,000 procedures). More serious complications that occurred in at least 1 per 1,000 procedures included water intoxication or pulmonary edema, hospital readmission, hospitalization greater than 72 hours and transfusion for hemorrhage.

Gynecology↗
PubMedDate not supplied

Acute carbamazepine poisoning and hyponatremia.

A case of acute carbamazepine poisoning is described, which demonstrates all the immediate side effects of poisoning. Emphasis is placed on water intoxication and hyponatremia as the main cause of irreversible cerebral damage.

Carbamazepine↗
PubMed1986

Oxytocin: pharmacology and clinical application.

Oxytocin is a potent uterine stimulant that is used for the induction and augmentation of labor, antenatal fetal assessment, and control of postpartum hemorrhage. If used improperly, oxytocin can lead to such complications as uterine hypercontractility with fetal distress, uterine rupture, maternal hypotension, water intoxication, and iatrogenic prematurity. These complications can almost always be avoided if oxytocin is given in proper dosages and with careful fetal and maternal monitoring. Recent interest in active management of labor policies has resulted in a reexamination of the use of oxytocin in the augmentation of the labors of nulliparous women.

Female↗
PubMed1987

[Acquired polydipsia in infants].

The authors report a case of acquired polydipsia in an infant. The case was unusual in its presentation, its late onset (without anorexia, nor vomiting), and the normal salt-water balance contrarily to what is observed in water intoxication. The course was favourable after progressive conditioning.

Conditioning, Psychological↗
PubMed1987

[Subacute encephalopathy. Idiosyncratic reaction to carbamazepine?].

A 81 year-old female, weighing 56 kgs, had taken carbamazepine (10.2 mg/kg/day) for simple partial motor seizures of recent onset during 15 days. EEG recording showed slow waves on the left hemisphere. CT was normal. The seizures were controlled for a few days and then reappeared beginning as simple partial seizures and progressing to impairment of consciousness. The patient became confused. On admission she was severely confused. Neurological examination was otherwise normal. Plasma sodium level was 134 meq/l and CBZ plasma level was 4.3 micrograms/ml. EEG showed high voltage bilateral delta waves and a left focus. The drug was withdrawn with relief of clinical symptoms and to a lesser extent, of EEG abnormalities. Phenytoin encephalopathy is a well known pathological entity but to our knowledge there has been no report of carbamazepine encephalopathy with neither excessive plasma level of the drug nor water intoxication. An idiosyncratic reaction is considered likely.

Aged↗
PubMed1985

Percutaneous ultrasonic versus surgical removal of kidney stones.

Kidney stones may be removed without using a surgical incision by a combination of techniques and skills recently developed in the fields of urology and radiology. Percutaneous access to the kidney is established under fluoroscopic control. A guide wire placed into the renal pelvis allows a nephroscope to be inserted and the collecting system visualized. A long hollow metal probe is advanced through the nephroscope and placed in contact with the stone. This probe conducts the ultrasonic energy. The stone absorbs the energy and breaks into fine granules which are evacuated by suction. Percutaneous lithotomy was performed upon 300 of 302 consecutive patients bearing stones which required removal. Targeted calculi were successfully removed from 97 per cent of these patients. Eighty-one per cent had complete stone removal at the primary procedure; 57 patients required additional percutaneous manipulations under local or general anesthesia. The previous 100 patients with kidney stones underwent surgical removal of the calculi. Complications associated with percutaneous stone removal included postoperative fever, delayed urinary bleeding, ureteral edema, symptomatic urinary extravasation and water intoxication. Only 16 patients with complications required prolonged hospitalization or readmission. No complications required surgical management; no deaths occurred. Anesthetic times were similar for both groups, averaging 152 +/- 4 (S. E. M.) minutes for PL and 193 +/- 8 minutes for SL. Hospital recovery days averaged 5.7 +/- 0.3 for PL and 8.4 +/- 0.5 for SL (p less than 0.01). Associated costs averaged $7,203 +/- 255 for PL and $8,849 +/- 660 for SL (p less than 0.01). The number of narcotic administrations per patient (days one to five postoperatively) averaged 9.9 +/- 0.7 for the PL group and 16.8 +/- 0.8 for the SL group (p less than 0.01). The average patient in the PL group felt capable of full activity 2.0 +/- 0.2 weeks after stone removal, whereas no patient who experienced previous SL recalls a recovery period of less than three weeks (p less than 0.01). Most upper urinary tract calculi may be removed cost-effectively using a percutaneous approach. Patients may expect a rapid convalescence with diminished pain.

Humans↗
PubMed1979

Inappropriate secretion of antidiuretic hormone in a dog.

Hyponatremia with simultaneous renal sodium loss was associated with the inappropriate secretion of antidiuretic hormone in a dog with heartworm disease. Antidiuresis caused expansion of extracellular fluid volume, which induced renal salt wasting and a negative sodium balance. The combination of water retention, salt wasting, and inactivation of intracellular solute contributes to the decrease in serum sodium concentration. Water intoxication due to hypotonicity of body gluids induced anorexia, depression, weakness, and incoordination.

Animals↗