Hiponatremia relacionada con el uso de quetiapina: reporte de caso clínico

La hiponatremia es la alteración electrolítica más frecuente en el anciano y puede ser asintomática o producir un espectro de síntomas, especialmente del sistema nervioso central, tales como alteración del estado de conciencia, letargia, cefalea, convulsiones y alteraciones en la marcha, los cuales son un motivo frecuente de consulta de esta población. Esta entidad tiene un alto impacto en la funcionalidad del paciente, pues requiere múltiples hospitalizaciones, e incluso en mortalidad. Su etiología es multifactorial; entre sus causas más comunes están la baja ingesta de sal, las enfermedades crónicas como la nefropatía y la insuficiencia cardiaca y el síndrome de secreción inadecuada de hormona antidiurética (SIADH), que a su vez se produce comúnmente por el uso crónico de determinados fármacos, como los antidepresivos, los diuréticos y los antipsicóticos, que son los más olvidados en el abordaje clínico. Se presenta en este caso clínico el abordaje diagnóstico de la hiponatremia y la importancia de la anamnesis como instrumento clave para detectar la etiología de esta entidad clínica.

Hyponatraemia is the most common electrolyte disturbance in the elderly. It can be asymptomatic or produce a spectrum of symptoms, particularly in the central nervous system, such as altered state of consciousness, lethargy, headache, seizures and gait disturbances, all of which are a common reason for consultation in this population. This condition has a high impact on the functionality of the patient given the need formultiple hospital stays, as well as on mortality. Its aetiology ismultifactorial and its most common causes include low salt intake, chronic diseases such as kidney disease and heart failure, and the syndrome of inappropriate antidiuretic hormone secretion (SIADH), which is commonly caused by the chronic use of certain drugs, such as antidepressants, diuretics and antipsychotics, which are the most forgotten in clinical practice. The following clinical case presents the diagnostic approach of hyponatraemia and the importance of the medical history as a key tool to detect the aetiology of this clinical entity.

Bioequivalence and pharmacokinetic comparison of two fixed dose combination of Metformin/Glibenclamide formulations in healthy subjects under fed condition

@#Aim: This study is conducted to compare the pharmacokinetic profiles of two fixed dose combination of metformin/glibenclamide tablets (500mg/5 mg per tablet). Materials and Methods: This is a single-center, single-dose, open-label, randomized, 2-treatment, 2-sequence and 2- period crossover study with a washout period of 7 days. All 28 adult male subjects were required to fast for at least 10 hours prior to drug administration and they were given access to water ad libitum during this period. Thirty minutes prior to dosing, all subjects were served with a standardized high-fat and high-calorie breakfast with a total calorie of 1000 kcal which was in accordance to the EMA Guideline on the Investigation of Bioequivalence. Subsequently, subjects were administered either the test or reference preparation with 240mL of plain water in the first trial period. During the second trial period, they received the alternate preparation. Plasma levels of glibenclamide and metformin were analysed separately using two different high performance liquid chromatography methods. Results: The 90% confidence interval (CI) for the ratio of the AUC0-t, AUC0-∞, and Cmax of the test preparation over those of the reference preparation were 0.9693–1.0739, 0.9598– 1.0561 and 0.9220 – 1.0642 respectively. Throughout the study period, no serious drug reaction was observed. However, a total of 26 adverse events (AE)/side effects were reported, including 24 that were definitely related to the study drugs, namely giddiness (n=17), while diarrheoa (n=3), headache (n=2) and excessive hunger (n=2) were less commonly reported by the subjects. Conclusion: It can be concluded that the test preparation is bioequivalent to the reference preparation.

A Case Report on Biochemical Aberrations in Disseminated Histoplasmosis: The Clues Toward Addison’s Disease

@#The incidence of Addison’s disease (AD) is rare. One of the most common causes of AD in developed countries is autoimmune. On the other hand, in developing countries, infective causes still predominate. The symptoms are mostly insidious in onset and non-specific, making it challenging to diagnose AD. The delay in starting the right treatment predisposes to high mortality due to Addison’s crisis. Hence, biochemical parameters play a vital role in diagnosing AD since they usually will present with prominent hyponatraemia, hyperkalaemia and hypoglycaemia. Here, we report a case of a 66-year-old man with multiple co-morbidities and disseminated histoplasmosis who presented with asymptomatic hyponatraemia and hyperkalaemia and was eventually diagnosed with Addison’s disease. Although the non-specific symptoms from his multiple co-morbidities obscured the diagnosis of AD, comprehensive biochemical tests have helped in establishing the diagnosis.

A Case of Unrecognized Psychogenic Polydipsia

@#Psychogenic polydipsia is prevalent among people with schizophrenia. Although its pathophysiology is relatively unknown, it causes life threatening complications due to acute or severe hyponatraemia.. This report illustrates a patient with schizophrenia who had unrecognized psychogenic polydipsia and developed severe complication. It also highlights the clinical salience of its management.

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.

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.

Changes in Serum Electrolyte Levels in Typhoid Fever Patients Attending Minna General Hospital, Nigeria.

Objective: This study was designed to evaluate the effect of Typhoid fever on the serum levels of electrolytes in patients attending Minna General Hospital, Nigeria. Materials and Methods: Blood samples were obtained from sixty patients with established typhoid fever attending General Hospital Minna, Nigeria. Serum sodium, potassium, chloride, and bicarbonate levels were determined in the samples using Spectrophotometric method. The case studies included 15 adult males and 15 adult females; 15 male and 15 female children of junior secondary school age (9 – 14 years). Widal test was carried out to ascertain the presence of Salmonella enterica serotype Typhi. Results: The mean ± standard deviations of serum Na+, K+, Cl-, and HCO3- in the sixty patients were 116.11±20.65 mmol/L; 3.40±0.90 mmol/L; 87.13±16.34 mmol/L; and 24.10±5.54 mmol/L respectively. When compared with the controls and the laboratory reported normal values, 50% of the patients were found to be hyponatraemic, 51% were hypochloraemic, 36% were hypokalaemic, while 11% had metabolic acidosis. Results based on sex showed insignificant differences between males and females for all electrolytes determined (p< 0.05). Insignificant differences were also observed between children and adult patients for all parameters determined (p< 0.05). In addition, weak positive correlations were observed between cations and anions determined in this study. Conclusion: The results obtained in this study showed that electrolytes’ abnormalities exist in patients with established typhoid fever attending General Hospital Minna, Niger state, Nigeria.

A Rare Case of Acute Psychosis as an Isolated Manifestation of Extrapontine Myelinolysis.

Aims and Background: Central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM) are recognized as osmotic demyelination syndrome (ODS). ODS is pathologically characterized by non-inflammatory demyelination of several brain structures with sparing of axons. This condition is usually associated with overzealous correction of hyponatraemia. Acute psychosis as the sole clinical manifestation is extremely rare. Presentation of Case: Hence, we report an interesting case of a middle-aged man who was diagnosed with EPM, following rapid correction of hyponatraemia and subsequently developed acute psychosis. He made a good recovery with supportive treatment alone. Discussion and Conclusion: The possibility of psychosis as a manifestation of ODS, particularly in patients with recent correction of hyponatraemia. The rate of correction of plasma sodium level is the key point for preventing ODS and its complications.

Soft drinks: Are they really soft.

We report a case of epileptic seizures following heavy consumption of a cola and caffeine containing soft drink. The probable cause for seizures could be due to a combination of hyponatraemia, water intoxication, and high dose of caffeine and aspartame from the soft drink.

Clinical and imageological features of delayed encephalopathy caused by pituitrin / 临床神经病学杂志

Objective To investigate the clinical and imageological features of pituitrin-induced delayed encephalopathy. Methods Clinical data of 8 patients with delayed encephalopathy caused by pituitrin were analyzed retrospectively. Results All of the 8 patients presented diffent degree neuropsychic symptoms at 4～12 d after stop using the pituitrin. The extrapyramidal and psychiatric symptoms of the cases were found,such as hypermyotonia(8 cases),hypokinesia(6 cases),extremity buffeting(3 cases),emotional and behavior disorder(6 cases). The 8 cases with EEG examination showed:there were gently to midrange widespread dysfunction in 4 cases,severe widespread dysfunction in 1 case. The levels of serum Na+ in 5 cases were decrease slightly. The 8 cases with brain MRI examination showed that the abnormal signals were mainly located in lentiform nucleus and head of caudate nucleus with long T1 and T2-weighted images,and including thalamus or midbrain abnormalities signal in 1 case,respectively. Conclusions The manifestations of pituitrin-induced delayed encephalopathy are extrapyramidal symptoms and cerebral disorders. The characteristics of brain MRI are abnormal signals in lentiform nucleus and head of caudate nucleus with long T1 and T2-weighted images. The supposed pathogenesis may be nerve necrosis induced by Charcot's artery spasm and hyponatremia.