Refractory hyponatremia caused by acute intermittent porphyria / 中华内分泌代谢杂志

Hyponatremia is common in the attack of acute intermittent porphyria(AIP), which can cause epilepsy, coma and other adverse events and endanger the life of patients. Carbohydrate loading therapy is applied to control the attack of AIP in the clinic. But the application of glucose can exacerbate hyponatremia. It is difficult for clinicians to effectively correct hyponatremia while treating AIP with glucose. We reported a case of AIP whose refractory hyponatremia was corrected with short-term low-dose tolvaptan to improve knowledge in management.

Escitalopram-Induced Chronic Euvolemic Hyponatremia

Selective serotonin reuptake inhibitors (SSRIs), through the recent years have seen an increase in the number of prescriptions for a spectrum of mood disorders, especially in the geriatric population. Despite being a well-tolerated antidepressant, SSRIs have been associated with hyponatremia, a rare, but fatal adverse effect and the incidence ranges from 0.5%–32% in literature. Euvolemic hyponatremia is most commonly associated with syndrome of inappropriate secretion of antidiuretic hormone. An extensive review of literature was carried out, and we came across a total of 20 cases where escitalopram was reported as the causative agent of hyponatremia. We report a case of an 82-year-old female patient who had a history of acute onset, progressive memory impairment, and behavioral changes with depressive cognition precipitated by the death of her husband, for which she was treated with escitalopram 5 mg/day and clonazepam 0.5 mg/day. She was admitted to the hospital with presenting complaints of gait imbalance, tremors, irritability, confusion, decreased speech output and persecutory delusions. She was diagnosed with late-onset organic psychosis, precipitated and worsened by escitalopram-induced chronic uncontrolled euvolemic hyponatremia, with a sodium level of 115 mmol/L. On discontinuation of escitalopram, the patient’s serum sodium level improved gradually, and her consciousness became better. This is the second case with recurrent hyponatremia in the literature up to this date, with the other being reported by Tsai et al., in 2012. Furthermore, the dose of escitalopram was only 5 mg/day compared to other reported cases where the dose ranged between 10–20 mg/day.

Experiencia clínica con el uso ambulatorio de tolvaptan. Costes y efectividad en nueve casos / Clinical experience with Tolvaptan outpatient use. Cost and effectiveness in 9 cases

Resumen Introducción: La introducción de tolvaptan ha supuesto la principal novedad en el tratamiento de la hiponatremia en los últimos años. Objetivo: Describir la experiencia con tolvaptan en el Complejo Asistencial Universitario de León, España. Método: Estudio observacional retrospectivo de utilización ambulatoria de tolvaptan en un hospital de tercer nivel, de marzo de 2014 a agosto de 2017. Resultados: Fueron tratados con tolvaptan de forma ambulatoria nueve pacientes, 23.1 % alcanzó eunatremia en 24 horas. Posterior a la administración de tolvaptan se registró reducción en días de hospitalización (361 versus 70, p = 0.007), especialmente por hiponatremia (306 versus 49, p = 0.009). Conclusiones: El uso a largo plazo de tolvaptan parece ser seguro y se relaciona con descenso en los días de hospitalización.

Abstract Introduction: Tolvaptan introduction has constituted the main therapeutic novelty in the management of hyponatremia in recent years. Objective: To describe the experience with this drug at Complejo Asistencial Universitario de León, Spain. Method: Retrospective, observational study of tolvaptan outpatient use in a tertiary care hospital from March 2014 to August 2017. Results: A total of 9 patients were treated with tolvaptan in the outpatient setting. Eunatremia was reached in 24 h by 23.1%. After tolvaptan administration, a reduction in days of hospitalization was recorded (361 vs. 70; p = 0.007), especially in those days of hospitalization that were attributable to hyponatremia (306 vs. 49; p = 0.009). Conclusions: Long-term use of tolvaptan appears to be safe and is associated with a decrease in days of hospitalization.

Diabetes insípida nefrogénica inducida por litio: reporte de 2 casos en niños con trastorno del ánimo / Lithium-induced Nephrogenic Diabetes Insipidus: Report of 2 Cases in Children with Mood Disorder

La diabetes insípida (DI) es un síndrome caracterizado por poliuria y polidipsia asociado a la producción crónica de grandes volúmenes de orina diluida, secundario a una disminución de la secreción o acción de la hormona antidiurética (ADH) [1]. El litio es el principal fármaco implicado en la inducción de esta patología cuando se presenta de forma secundaria. [2]. Se presentan 2 reportes de casos de niños de 10 y 12 años con uso de litio por diagnóstico de trastorno del ánimo. Palabras Clave: Diabetes Melitus, trastornos del ánimo, nefrogénica, litio, hormona antidiurética

Diabetes insipidus (DI) is a syndrome characterized by polyuria and polydipsia associated with the production of large volumes of diluted urine, secondary to a decrease in the secretion or action of antidiuretic hormone (ADH) [1]. Lithium is the main drug involved in the induction of this pathology when it appears with a preventable cause [2]. Two case reports of children 10 and 12 years old with mood disorder and lithium use are presented with the intention of being alert to clinical manifestations and observation by caregivers.Key words: Diabetes insipidus, mood disorders, nephogenic, lithium, antidiuretic hormone.

Syndrome of inappropriate antidiuretic hormone secretion in neonates with birth asphyxia at tertiary care centre

Background: Syndrome of inappropriate antidiuretic hormone is an important metabolic complication of perinatal asphyxia. This study aims to study the occurrence of syndrome of inappropriate antidiuretic hormone in different grades of perinatal asphyxia and to find out the correlation of syndrome of inappropriate antidiuretic hormone to gestational age and birth weight in birth asphyxiated babies.Methods: It was a hospital-based cohort study. 50 neonates with different grades of asphyxia were enrolled in the study and 50 controls were taken. Syndrome of inappropriate antidiuretic hormone was diagnosed based on calculated plasma osmolality, serum and urine sodium, urine specific gravity and analyzed with different grades of birth asphyxia and birthweight and gestation age.Results: The occurrence of SIADH in birth asphyxiated babies was 26% and none of the babies in control group developed SIADH. The occurrence was more in the severely asphyxiated babies (53.8%), followed by moderate (30.8%) and then mildly asphyxiated babies (15.4%). Hyponatremia was seen in 26% of birth asphyxiated babies and can be used as a marker of SIADH. In relation to gestation age and birth weight there was no statistically significant correlation between SIADH and different grades of asphyxia. Mortality was high among the neonates who developed SIADH.Conclusions: The occurrence of SIADH was 26% in asphyxiated neonates and high in severe asphyxia and gestation age and birth weight beard no significant co relation.

Hyponatremia in children with severe pneumonia and its effect on overall outcome

Background: Severe pneumonia is often associated with dyselectrolytemia, most commonly hyponatremia and the level of sodium significantly correlates to the overall outcome of the patient. The present study was conducted to identify the incidence of hyponatremia in children with Severe Pneumonia and to identify its association with Syndrome of Inappropriate secretion of Anti Diuretic Hormone (SIADH) and the effect on morbidity, mortality and duration of hospital stay.Methods: This study was conducted on 102 children between the age group of 6 months to 5 years admitted to the Upgraded Department of Pediatrics, Patna Medical College and Hospital with clinically and radiologically confirmed severe pneumonia from March 2017 to September 2018.Results: There were 33(32.4%) cases of hyponatremia out of which 26(25.5%), 5(4.9%) and 2(1.9%) had mild, moderate and severe hyponatremia respectively. 19(57.6%) cases of hyponatremia were due to SIADH out of which the duration of hospital stay was prolonged in 10(52.6%) cases, 10(52.6%) cases developed complications and 7(36.8%) patients died. The mortality of patients with hyponatremia was significantly higher (p<0.05) in the group with SIADH when compared to those without SIADH. The average duration of stay in hospital also was significantly higher (p<0.05) for the group with hyponatremia i.e. 8.2'4.5 days when compared to the group with normnatremia i.e. 7.3'1.7 days.Conclusions: Hyponatremia is commonly associated with Severe Pneumonia. Hyponatremia is usually mild and results in prolonged hospital stay, increased complications and mortality especially when associated with SIADH.

Unusual paraneoplastic syndrome of inappropriate antidiuretic hormone secretion with gastric cancer

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) results in impaired water excretion and consequent water intoxication and hyponatremia. In patients with cancer, SIADH is most commonly driven by ectopic ADH production, a paraneoplastic syndrome frequently seen in small cell lung cancer. A 63 year old male presented with loss of appetite, vomiting and hiccups. No abnormalities were detected on physical examination. Upper gastrointestinal endoscopy showed a proliferative growth in the stomach and histopathology report confirmed gastric adenocarcinoma. His laboratory investigations revealed low serum sodium and further work up for SIADH confirmed the diagnosis. The patient was treated with hypertonic saline and he improved symptomatically. He was subsequently treated with two cycles of capecitabine and oxaliplatin. The patient was asymptomatic and maintained a serum sodium in the range of 120 to 130 mEq/L, with a serum sodium of 127 mEq/L on follow up.

Acute Intermittent Porphyria: A rare cause of hyponatraemia

@#Introduction: Hyponatraemia is one of the most frequent laboratory findings in hospitalised patients. We present an unusual case of hyponatraemia in a 23-year-old female secondary to acute intermittent porphyria (AIP), a rare inborn error of metabolism. Case Report: The patient presented with upper respiratory tract infection, fever, seizures and abdominal pain. An initial diagnosis of encephalitis was made. In view of the unexplained abdominal pain with other clinical findings such as posterior reversible encephalopathy syndrome by CT brain, temporary blindness as well as hyponatraemia, acute intermittent porphyria was suspected. Urine delta aminolaevulinic acid (δ-ALA) and porphobilinogen were elevated confirming the diagnosis of AIP. Genetic studies were done for this patient. The patient had a complete resolution of her symptoms with carbohydrate loading and high caloric diet. Conclusion: Although rare, AIP should be considered as a cause of hyponatraemia in a patient who presents with signs and/or symptoms that are characteristic of this disease.

Carcinoma de próstata y síndrome de secreción inadecuada de hormona antidiurética / Prostate carcinoma and syndrome of inappropriate antidiuretic hormone secretio

El cáncer de próstata es una causa extremadamente rara de síndrome de secreción inadecuada de hormona antidiurética (SIADH). Se trata de tumores agresivos asociados a un síndrome que puede aparejar consecuencias graves. Un paciente de 64 años fue diagnosticado de adenocarcinoma de próstata Gleason 4+3: 7 en 2014 y recibió terapia de bloqueo hormonal. En 2015 debió ser ingresado por hiponatremia sintomática y se le diagnosticó un SIADH, sin otra causa probable más que el cáncer de próstata. Sufrió rápida progresión de su enfermedad oncológica, llamativamente cuando su PSA se encontraba en valores normales, y falleció al corto plazo. Existe gran variabilidad clínica e histopatológica de los casos informados en la literatura de asociación de carcinoma de próstata y SIADH, sin embargo, todos coinciden en la agresividad de estos tumores. Estas características se presentan en tumores con diferenciación neuroendocrina, frecuentemente resistentes al tratamiento hormonal y que pueden presentar síndromes paraneoplásicos como el SIADH. El perfil de sus alteraciones moleculares se encuentra en estudio para el desarrollo de terapias target. La asociación de adenocarcinoma de próstata y SIADH es muy infrecuente y podría implicar diferenciación neuroendocrina. Por tal motivo es esencial una nueva biopsia del tumor o de sus metástasis a la progresión de la enfermedad para poder conducir un tratamiento adecuado de acuerdo a sus características morfológicas, inmunohistoquímicas y, en un futuro, moleculares.

Prostate cancer is an extremely rare cause of syndrome of inappropriate antidiuretic hormone (SIADH) secretion. These tend to be aggressive tumors and SIADH can carry serious clinical consequences. A 64 years old patient was diagnosed with Gleason 4+3: 7 prostate adenocarcinoma in December 2014 and received hormonal blockade therapy. By March 2015 he was admitted for symptomatic hyponatremia and SIADH secretion was diagnosed, with no other probable cause than prostate cancer. He suffered a rapid progression of his oncologic disease, surprisingly with PSA in normal range, and died in the short term. There is great clinical and histopathological variability in the cases reported in the literature of association of prostate carcinoma and SIADH. However, they all agree on the aggressiveness of these tumors. This characteristic is present in tumors that have neuroendocrine features. They are frequently resistant to hormonal treatment and may present with paraneoplastic syndromes such as SIADH. The profile of its molecular alterations is under study for the development of target therapies. The association of prostate adenocarcinoma and SIADH is very uncommon and could involve neuroendocrine differentiation. For this reason, it is essential to perform a new biopsy of the tumor or its metastases at the progressive disease in order to conduct an appropriate treatment according to its morphological, immunohistochemical and, in the future, molecular characteristics.

Extranodal nasal type natural killer/T-cell lymphoma with refractory hyponatremia: A case report and literature review / 肿瘤

Objective: To improve the understanding of the dilutional hyponatremia caused by syndrome of inappropriate antidiuretic hormone (SIADH) in extranodal nasal type natural killer (NK)/T cell lymphoma. Methods: The clinical manifestations and the diagnosis and treatment process of one case of extranodal nasal type NK/T cell lymphoma with SIADH were reported, and the related literatures were reviewed. Results: A 71 year-old male patient presented with testicular enlargement, multiple rashes with eschar and obstinate hyponatremia as the main features. The results of pelvic MRI examination and the pathological biopsy of skin rash suggested extranodal NK/T cell lymphoma (nasal type) which caused SIADH, excluding other diseases related to hyponatremia. The incidence rate of extranodal nasal type NK/T cell lymphoma was very low; however, it had features of rapid progression and higher mortality rate. Conclusion: The most important treatment of SIADH is etiological treatment. Patients with obvious skin rash, obstinate hyponatremia and testicular enlargement may be suspected of NK/T cell lymphoma. Pathological biopsy should be performed timely to avoid misdiagnosis.

Progress of hyponatremia treatment in cancer patients / 肿瘤研究与临床

Hyponatremia is the most common electrolyte abnormality in cancer patients, which is usually related to the syndromes of inappropriate antidiuretic hormone secretion (SIADH). Despite not frequent life-threatening, it mostly causes prolonged hospitalization, delaying in scheduled chemotherapy, reducing of the efficacy, worsening of patients' prognosis and quality of life. The optimal treatment strategy should be chosen based on the severity and the onset time of the symptoms in clinic. Hypertonic saline solution is appropriate for acute, symptomatic patients with hyponatremia caused by SIADH, nevertheless fluid restriction is advised to chronic symptomless hyponatremia which recommends correcting at a slower rate. When fluid restriction is limited, pharmacological therapy should be a necessary choice. This review summarizes the recent progress of hyponatremia in international guidelines and discusses the defect of hyponatremia managements and the research prospect in the future.

Hyponatremia in Liver Cirrhosis / 대한소화기학회지

Hyponatremia is a commonly observed complication that is related to hypoalbuminemia and portal hypertension in patients with advanced liver cirrhosis. Hyponatremia in patients with liver cirrhosis is mostly dilutional hyponatremia and is defined when the serum sodium concentration is below 130 meq/L. The risk of complications increases significantly in cirrhotic patients with hyponatremia, which includes spontaneous bacterial peritonitis, hepatorenal syndrome, and hepatic encephalopathy. In addition, hyponatremia is associated with increased morbidity and mortality in patients with cirrhosis, and is an important prognostic factor before and after liver transplantation. The conventional therapies of hyponatremia are albumin infusion, fluid restriction and loop diuretics, but these are frequently ineffective. This review investigates the pathophysiology and various therapeutic modalities, including selective vasopressin receptor antagonists, for the management of hyponatremia in patients with liver cirrhosis.

Diabetes mellitus vs diabetes insípida y un factor común: la poliuria. Presentación de un caso / Diabetes mellitus versus diabetes insipidus and a common factor: polyuria. Case presentation

La diabetes mellitus es una enfermedad crónica no trasmisible muy frecuente en la ciudad de Matanzas, se presenta en cualquier grupo etáreo, siendo tipo I o tipo II. En la diabetes tipo I, el cuerpo no produce insulina. En la diabetes tipo II, la más común, el cuerpo no produce o no usa la insulina adecuadamente. Sin suficiente insulina, la glucosa permanece en la sangre, provocando múltiples complicaciones tanto agudas como crónicas. La diabetes insípida es un trastorno poco común del metabolismo del agua. Esto quiere decir que el balance entre la cantidad de agua o líquido que usted toma no corresponde con el volumen de excreción urinaria. Es causada por una falta de respuesta o una respuesta deficiente a la hormona antidiurética vasopresina. Esta hormona controla el balance hídrico mediante la concentración de orina. Los pacientes con diabetes insípida orinan mucho, por lo cual necesitan beber bastantes líquidos para reemplazar los que pierden. Se presenta un paciente de 45 años con antecedentes de salud que debutó con una diabetes insípida y un año más tarde con una diabetes mellitus tipo II concomitando ambas, corroborándose por los complementarios correspondientes y mejorando con tratamiento (AU).

Diabetes mellitus is a non-transmissible chronic disease, very frequent in the city of Matanzas, which is present in any age group, and is classified as type I and type II. In the type I diabetes, the body does not produce insulin. In the type II diabetes, the most common one, the body does not produce or does not use it effectively. Without enough insulin, glucose remains in the blood, causing several complications, both acute and chronic. The diabetes insipidus is a few common disorder of the water metabolism. That means that the balance between the quantity of water or any other fluid someone drinks does not coincide with the volume of the urinary excretion. It is due to a lack of answer or a deficient answer to the anti-diuretic hormone vasopressin. This hormone controls the water balance through the urine concentration. The patients with diabetes insipidus urinate a lot, so they need to drink many liquids to replace those they lose. It is presented the case of a patient aged 45 years, with health antecedents, that debuted with diabetes insipidus and a year later with a concomitant type II diabetes mellitus. The complementary tests confirmed that and the patient got better with the treatment (AU).

Encephalitis associated with inappropriate antidiuretic hormone secretion due to chikungunya infection in Recife, State of Pernambuco, Brazil

Abstract The symptoms of chikungunya virus (CHIKV) infection include fever, headache, muscle aches, skin rash, and polyarthralgia, characterized by intense pain, edema, and temporary functional impairment. This is the first report of encephalitis caused by CHIKV infection associated with an atypical presentation of syndrome of inappropriate antidiuretic hormone secretion, evolving to cognitive impairment and apraxia of speech.

Utility and Safety of Tolvaptan in Cirrhotic Patients with Hyponatremia: a Prospective Cohort Study

Abstract: Introduction and aim. Hyponatremia is common in patients with decompensated cirrhosis and is associated with increased mortality. Tolvaptan, a vasopressor V2 receptor antagonist, can increase free wáter excretion, but its efficacy and safety in cirrhotic patients remain unclear. Material and methods. We studied the usage and safety of tolvaptan in cirrhotic patients in a real-life, non-randomized, multicenter prospective cohort study. Forty-nine cirrhotic patients with hyponatremia were treated with tolvaptan 15 mg daily, and 48 patients not treated with tolvaptan in the same period served as controls. Improvement in serum sodium level was defined as an increase in serum sodium from < 125 to ≥ 125 mmol/L or from 125-134 to ≥ 135 mmol/L on day 7. Results. Twenty-three (47%) patients in the tolvaptan group and 17 (35%) in the control group had normal serum sodium on day 7 (p = 0.25). Serum sodium improved in 30 (61%) patients in the tolvaptan group and 17 (35%) patients in the control group (p = 0.011). Adverse events occurred in 46-47% of patients in both groups, and tolvaptan was not associated with worsened liver function. No patient with normal serum sodium on day 7 died within 30 days of treatment, whereas 16% of those with persistent hyponatremia died (p = 0.0019). Conclusion. In conclusion, short-term tolvaptan treatment is safe and can improve serum sodium level in cirrhotic patients with hyponatremia. Normalization of serum sodium level is associated with better survival.

Lung cancer complicated with syndrome of inappropriate secretion of antidiuretic hormone:A report of 2 cases and literature review / 吉林大学学报(医学版)

Objective:To analyze the clinical materials of 2 patients with lung cancer complicated with syndrome of inappropriate secretion of antidiuretic hormone (SIADH),and to improve the clinical awareness and management.Methods:One patient was treated with lung cancer chemotherapy alone for 7 courses.The other patient received the strictly limited for liquid intake and tolvaptan by oral against hyponatremia without chemotherapy.Results:With the relapsing and advancing of lung cancer,the hyponatremia and its relevant symptoms of the first patient were poorly relieved.While the level of serum sodium of the second patient returned to the normal level 3 d after administration of tolvaptan.Conclusion:About one-third of the patients with hyponatremia have SIADH.The etiological treatment and symptomatic therapy of hyponatremia should be given to the patients in clinical treatment.

Syndrome of inappropriate antidiuretic hormone secretion associated with seronegative neuromyelitis optica spectrum disorder

The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a potential cause of hyponatremia of the central nervous system (CNS). Although SIADH has been reported to be associated with many other central nervous disorders, its association with neuromyelitis optica (NMO) or NMO spectrum disorders are rare. NMO is a demyelinating disorder characterized by optic neuritis and transverse myelitis. Aquaporin-4 (AQP4), which is the target antigen for a NMO autoantibody, is the predominant CNS water channel. However, some NMO patients show seronegative AQP4 antibody results. The spectrum of NMO has been changed, and new findings about the disease have been reported. Here, we report a case of seronegative NMO spectrum disorder associated with SIADH.

SIADH secundario a adenocarcinoma seroso de ovario tratado con tolvaptán / SIADH secondary to serous ovarian adenocarcinoma treated with tolvaptan

La hiponatremia es la alteración electrolítica más frecuente en el medio hospitalario, y en un 30% de los casos se debe a un síndrome de secreción inapropiada de vasopresina (SIADH). El SIADH está descrito como cuadro paraneoplásico endocrinológico en múltiples tumores, entre los que excepcionalmente se encuentra el de ovario y las neoplasias ginecológicas en general. Presentamos un caso de SIADH paraneoplásico por un citoadenocarcinoma seroso de ovario de alto grado, estadio IV. Se trata del primer caso de SIADH crónico por cáncer de ovario tratado con Tolvaptán. En el presente caso el objetivo de eunatremia se alcanzó con una dosis baja de acuarético, lo que apoya la elevada sensibilidad, ya previamente documentada, de los SIADH tumorales al tratamiento con Tolvaptán.

Hyponatremia is the most common electrolyte disturbance in hospitals, and 30% of cases are due to syndrome of inappropriate secretion of antidiuretic hormone (SIADH). SIADH is described as an endocrine paraneoplastic syndrome in multiple tumors including, ovary and gynecological malignancies in general, although these are exceptional. We report a case of paraneoplastic SIADH for high-grade serous ovarian cystoadenocarcinoma stage IV. This is the first case of chronic SIADH for ovarian cancer treated with Tolvaptan. In this case the target of eunatremia was reached with a low dose of aquaretic, which supports the high sensitivity, as previously documented, of paraneoplasic SIADH to Tolvaptan.

Hiponatremia luego de uso de cisplatino: a propósito de un caso / Hyponatraemia after cisplatin use: a case report

Paciente de 26 años con diagnóstico de teratoma inmaduro de ovario derecho. Se le realizó resección del tumor más salpingooforectomía en junio de 2014. Recibió manejo adyuvante con carboplatino y ciclofosfamida por un ciclo en enero de 2015, pero sin respuesta. Se realizó laparotomía exploradora por obstrucción intestinal evidenciándose masa pélvica e implantes peritoneales a nivel hepático. Valoró oncología clínica del INC en febrero del 2015, se inicia manejo con esquema PEB; recibió el primer ciclo sin complicaciones. El segundo ciclo fue retrasado por infección en la pared abdominal. Empezó tratamiento con sodio sérico normal, con posterior descenso sin alteración en el resto de electrolitos, función renal, ni estado ácido base. La paciente no presentó síntomas neurológicos y estuvo euvolémica. Se inició estudio de hiponatremia haciéndose diagnóstico de SIADH. Se indicó manejo con restricción hídrica y dieta hipersódica, con posterior ascenso gradual de niveles séricos de Na, considerándose SIADH secundario a uso de cisplatino.

The case is presented of a 26 year-old patient diagnosed with an immature teratoma of the right ovary. Tumour resection plus salpingo-oophorectomy was performed in June 2014. She received one cycle of adjuvant treatment with carboplatin and cyclophosphamide, but with no response. An exploratory laparotomy was performed due to an intestinal obstruction, which showed a pelvic mass and peritoneal implants at hepatic level. She was assessed in the oncology clinic of the Colombian National Institute (INC) in February 2015, and treatment with a platinol (cisplatin), etoposide, and bleomycin (PEB) scheme was started. She received the first cycle without complications, but the second cycle was delayed due to an infection in the abdominal wall. She started the treatment with a normal serum sodium, with a subsequent decrease with no changes in the rest of the electrolytes, kidney function, or acid-base status. The patient showed no neurological signs and was euvolaemic. A hyponatraemia study was performed, ending up making the diagnosis of inappropriate antidiuretic hormone secretion (IADHS). A water restriction and high sodium diet was indicated, with the subsequent gradual increase in the serum Na levels. The IADHS was considered secondary to the use of cisplatin.

Comparison of Antidiuretic Activity of Ootheca Mantidis before and after Processing and Its Medicinal Part against Insufficiency of Kidney-Yang and Diuresis Rats / 中国药房

OBJECTIVE:To compare antidiuretic activity of Ootheca Mantidis before and after processing,and to explore the best medicinal part and mechanism of Ootheca Mantidis. METHODS:96 rats were randomly divided into blank group,model group,positive group,Ootheca Mantidis group,Ootheca Mantidis stir-fried with salt group,steamed Ootheca Mantidis group, crude product eggs and egg shell groups,processed product eggs and egg shell groups,with 8 rats in each group,12 groups in to-tal. Except blank group,other groups were given adenine 250 mg/kg,ig,for 4 weeks to induce kidney-yang and diuresis model. From third week,Ootheca Mantidis crude drug group and processed Ootheca Mantidis group were all given relevant medicine 0.11 g(crude drug)/ml i.g,and crude product eggs and egg shell groups and processed product eggs and egg shell groups were given rel-evant medicine,ig,once a day,by mass ratio of eggs to egg shell(cude drug 1∶2.4,salt stir-fried product 1∶1.7,steamed prod-uct 1∶2.1)for consecutive 4 weeks. The urinary volume,body weight,renal index and the serum contents of ADH and ALD were all determined. RESULTS:Compared with blank group,body weight and serum content of ADH and ALD decreased in model group,while renal index and urinary volume increased(POotheca Mantidis stir-fried with salt group>Ootheca Mantidis group,and steamed Ootheca Mantidis shell group had best exchange. CONCLUSIONS:The an-tidiuretic activity of Ootheca Mantidis has been enhanced after processing. The egg shell of steamed Ootheca Mantidis is main me-dicinal part. To increase the serum content of ADH might be one of the main mechanism of arresting polyuria.