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At least 775 records · Page 43Linked to original sources
PubMed1994

Effects of water loading in schizophrenic patients with polydipsia-hyponatremia: an MRI pilot study.

We conducted an MRI pilot study of three schizophrenic patients with the syndrome of polydipsia-hyponatremia. Paired MRI scans were obtained at baseline and in the water-loaded state to study the acute effects of water loading and accompanying changes in serum sodium and osmolality on brain structures. We report the pilot data on the observed individual MRI changes of reduced volume of the lateral ventricles in all three patients, and the third ventricles in two patients, in the water-loaded state. These changes were not statistically significant possibly because of small sample size.

Adult↗
PubMed2004

Transcription factor tonicity-responsive enhancer-binding protein (TonEBP) which transactivates osmoprotective genes is expressed and upregulated following acute systemic hypertonicity in neurons in brain.

Tonicity-responsive enhancer-binding protein (TonEBP) was initially identified as a transcription factor involved in adaptation of renal cells to hypertonicity by activation of osmoprotective genes encoding proteins for accumulation of compatible osmolytes. Since brain osmoadaptation is observed in relationship to neurological disorders resulting from pathological osmotic disbalances of blood plasma we have investigated through immunocytochemistry TonEBP expression in cerebral cortex and hippocampus of normal rat and rats submitted to an acute systemic hypertonicity or to a prolonged systemic hypotonicity. TonEBP-expressing cells were identified using double immunofluorescence and appropriate cell type markers. Their relative proportion was determined by quantitative image analysis. In normal rats TonEBP expressed primarily in neurons where it was strictly located in the cell nucleus but heterogeneously distributed into a nucleoplasmic pool and a granular pool. In animals made acutely hypertonic TonEBP labeling increased dramatically exclusively in the nuclei of neurons and reached a maximum within 1 h. In hypertonic animals TonEBP labeling covered the whole cell nucleus of virtually all neurons, appeared finely punctuated but was no more granular. Optical density of the labeling as determined by image analysis correlated linearly with the increased plasma osmolality. In animals made hypotonic for several days no conspicuous decrease of TonEBP labeling was observed. In normal animals a very minor proportion of non-neuronal cells showed a faint TonEBP nuclear labeling. This proportion increased slightly in hypertonic animals. Nevertheless these non-neuronal TonEBP-positive nuclei which belonged to oligodendrocytes and to a small subpopulation of astrocytes remained always very weakly labeled when compared with neuron nuclei. Brain capillary endothelial cells as well as microglial cells showed no TonEBP-labeling even in hypertonic animals. Our data demonstrate that in brain TonEBP is significantly expressed and tonicity-overexpressed in neurons and accordingly suggest that neurons only among brain cells accumulate compatible osmolytes through TonEBP-mediated activation of osmoprotective genes to adapt to acute systemic hypertonicity.

Animals↗
PubMed1972

Hyponatremia.

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Diuretics↗
PubMed1976

Hypernatremia--problems in management.

Hypernatremia may be produced under several different circumstances but most frequently is the result of excessive water loss with diarrhea and the excessive solute load secondary to inappropriate preparation of formula. The clinical manifestations vary and depend primarily on the degree of dehydration and the rate at which the hyperosmolar state has been reached. The management of the patient will, of course, depend upon the mechanism of hypernatremia and degree of dehydration and/or hypovolemia that is present. It seems clear that the exact nature of the rehydrating solution is not of major importance. The volume is of great concern but most vital seems to be the rate of rehydration. If rehydration is accomplished too rapidly the child becomes edematous, develops increased intracranial pressure, stupor, and convulsions. If fluids are given slowly and at a well regulated rate, these complications can usually be avoided. The patient should be monitored regularly with electrolytes, careful determination of weights, and records of intake and output. The rate of rehydration should be monitored to assure that the planned schedule of 24 to 72 hours (depending on the severity of the problem) is followed. Approximately 10 to 15 per cent of children with serum sodium of 160 mEq per liter or greater will have permanent neurological deficits.

Brain Diseases↗
PubMed1976

Syndrome of inappropriate antidiuretic hormone secretion (SIADH).

SIADH consists of hyponatremia and hyposmolality, continued urinary loss of sodium, excretion of an inappropriately concentrated urine, and absence of dehydration, usually in the presence of normal renal and adrenal function. The retention of excess water caused by the inappropriate secretion of antidiuretic hormone is central to the development of the syndrome. In pediatrics, SIADH is most commonly seen in patients with meningitis or postoperatively. Fluid restriction is vital in such patients to prevent the development of symptomatic SIADH. Fluid restriction alone will also result in the correction of serum electrolyte composition in patients with SIADH. Hypertonic saline should be used only in severely symptomatic patients.

Adult↗
PubMed1997

Asymmetry of the total body water prediction bias using the impedance index.

Our purpose was to prove on a geometric basis that the bias of total body water (TBW) prediction equations based on the impedance index is far greater in fluid overloading than in dehydration. We used formal evaluation of conventional bioimpedance regression equations in both normal and abnormal body fluid status. We plotted the hyperboloid function generated from a standard prediction equation for the TBW over the resistance-reactance (RXc) plane containing the bivariate tolerance intervals (ellipses) of the healthy population. The equation estimated 35 L TBW for the average man (both sexes) of 170 cm height. Leaving the center of the tolerance ellipses, over which the function was relatively flat, the predicted TBW rapidly increased to absurd values for the shorter vectors, indicating fluid overloading (e.g., > 100 L for R < 170 ohm). Migration of the longer impedance vectors beyond the upper pole of 95% tolerance ellipse, which is in the dehydration region, produced less biased estimates of TBW (e.g., < 22 L for the extreme R values > 850 ohm). Different formulas produced TBW prediction bias of the same order. Due to the hyperbolic shape, functions of the impedance index are critically dependent on the region of the RXc plane where they are calculated and they produce misleading results in patients with fluid overload.

Adolescent↗
PubMed1995

Dilutional hyponatremia during hysteroscopic myomectomy with sorbitol-mannitol distention medium.

To determine the frequency of hyponatremic complications during hysteroscopic myoma resections using sorbitol-mannitol distending medium and its relationship to operative time, fluid balance, and myoma size, we reviewed all operative hysteroscopic procedures performed by the Section of Reproductive Endocrinology and Fertility at Yale-New Haven Hospital over a 1-year period during which that medium was used. Twenty-six cases were identified of which seven involved hysteroscopic myoma resections. Hyponatremia occurred in four of the seven patients, and in one it was associated with severe posttransurethral prostatic resection (post-TURP) syndrome. The degree of hyponatremia varied roughly in direct proportion to fibroid volume and fibroid volume as a percentage of uterine volume. No relationship was found between the degree of hyponatremia and operating time, estimated submucosal volume, and uterine volume. We conclude that dilutional hyponatremia and the post-TURP syndrome may occur with the use of sorbitol-mannitol distension medium during hysteroscopy. They occur more frequently during operative hysteroscopy to resect myomata, with myoma size and myoma volume expressed as a percentage of uterine volume possibly influencing the degree of hyponatremia.

Abdominal Pain↗
PubMed1975

Potassium depletion induced by vasopressin and overhydration in the rabbit.

1. In order to study the effect of overhydration on body potassium, experiments were performed on pair-fed rabbits, one of which was maintained continuously on vasopressin and given extra water (60-90 ml day-1 kg-1) for 6-8 days, while the other served as control. 2. Overhydrated rabbits excreted significantly more potassium (53%) in their urine than control rabbits and accumulated a mean potassium deficit of 65-0 mmol, significantly higher than the mean value of 37-1 mmol in the control rabbits. 3. In the overhydrated rabbits, potassium fell significantly in both erythrocytes, from 266 to 173 mmol/kg of dry cells, and also in muscle, from 435 to 341 mmol/kg of fat-free dry solids. Neither changed significantly in the control animals. 4. Overhydration in the presence of vasopressin leads to potassium depletion in the rabbit and a similar phenomenon might be expected in man. Potassium depletion due to overhydration might account for the hypokalaemia and reduction in exchangeable potassium observed in some patients with the syndrome of inappropriate secretion of antidiuretic hormone.

Animals↗
PubMed1996

[Addition of ethanol to the distension medium in surgical hysteroscopy as screening to prevent "fluid overload". A prospective randomized comparative study of ablative versus non-ablative surgical hysteroscopy and different ethanol concentration].

For answering the question at which hysteroscopical procedures an intraoperative screening method is necessary to avoid a fluid overload and whether a beginning fluid absorption can be diagnosed early by adding ethanol to the distension medium, a prospectively randomised comparative study of ablative versus non-ablative operative hysteroscopy with differing ethanol concentrations was performed (n = 120). Purisole (a mannit/sorbit solution) was used a distension medium. The measuring parameters (breath alcohol, amount of absorbed fluid, haematocrit and haemoglobin values, central venous pressure, heart frequency) were intraoperatively determined at 5-minute intervals. The results of the study show that with those hysteroscopical procedures during which the endometrium is not or only minimally injured (e.g. syneciolysis, hysteroscopic proximal tubal catheterisation). Intraoperative screening is not necessary due to the low absorbing amounts. With hysteroscopical procedures such as resection of myoma, endometrium ablation and septum resection, however, an addition of ethanol of 2% to the distension medium has proved useful, because with this method absorption amounts of 400 ml and more can be detected by positive values of breath alcohol. As the result of a further absorption of fluid, delayed in time compared to the first positive value of breath alcohol, there is an increase in central venous pressure and hyponatraemia. Intraoperative ethanol monitoring is a non-invasive procedure which can be performed during ablative-operative hysteroscopies and has no negative influence on the course of the intervention and the general condition of the patients.

Adult↗