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.

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.

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).

Diagnosis and Treatment of Hypopituitarism

Hypopituitarism is a chronic endocrine illness that caused by varied etiologies. Clinical manifestations of hypopituitarism are variable, often insidious in onset and dependent on the degree and severity of hormone deficiency. However, it is associated with increased mortality and morbidity. Therefore, early diagnosis and prompt treatment is necessary. Hypopituitarism can be easily diagnosed by measuring basal pituitary and target hormone levels except growth hormone (GH) and adrenocorticotropic hormone (ACTH) deficiency. Dynamic stimulation tests are indicated in equivocal basal hormone levels and GH/ACTH deficiency. Knowledge of the use and limitations of these stimulation tests is mandatory for proper interpretation. It is necessary for physicians to inform their patients that they may require lifetime treatment. Hormone replacement therapy should be individualized according to the specific needs of each patient, taking into account possible interactions. Long-term endocrinological follow-up of hypopituitary patients is important to monitor hormonal replacement regimes and avoid under- or overtreatment.

Idiopathic central diabetes Insipidus.

Idiopathic central diabetes insipidus (CDI) is a rare disorder characterized clinically by polyuria and polydipsia, and an abnormal urinary concentration without any identified etiology. We report a case of central diabetes insipidus in a 60-year-old lady in the absence of secondary causes like trauma, infection, and infiltrative disorders of brain.

A Case of Hyponatremia with Generalized Convulsion Following Sinus Surgery / 대한이비인후과학회지

Post-operative hyponatremia is associated with fluid overload and inappropriate secretion of antidiuretic hormone (ADH), which is related to stress, pain and others. Hyponatremia is a frequently encountered condition in clinical practice but severe post-operative hyponatremia has rarely been reported. Hyponatremia is curable; but severe hyponatremia is a fatal and emergency. Therefore, we should be aware of this phenomenon, diagnosis and management. We experienced one case of severe hyponatremia with generalized convulsion and neurologic symptoms in post-operative period.

Post-operative SIADH(syndrome of inappropriate anti-diuretic hormone): A case report

The Expression of Aquaporin-2,3,4 in Rats' Endolymphatic Sac and Kidney / 听力学及言语疾病杂志

Objective To confirm the expression of Aquaporin2,3,4(AQP2,3,4,water channel protein) in rats'endolymphatic sacs(ES)and kidneys and to investigate and to compare the effects of anti-diuretic hormone(AVP) and DDAVP([deamino-Cys1,D-Arg8]-Vasopressin,V2-receptor agonist)on the expression of AQP2 in rats' ESs and kidneys.Methods 30 healthy Swards white rats were divided into the negative control,AVP group and dDAVP group respectively.The animals were cardiacally perfused.The temporal bones and kidneys were taken out and sectioned by means of the paraffin-embedded technique.The sections of ESs were labeled with fluorescent antibody by immunohistochemical method,and the kidneys' with avidin-biotin-peroxidase complex method(ABC).The expressions of AQP-2 were confirmed in the ESs of the rats while the different effects of the AVP and DDAVP on the ESs and the kidneys were observed.The slides used were analyzed by the image-analyzer and the subsequent data were statistically studied.Results In the cytomembrane and cytoplasm of ESs' epithelia,the constant and clear fluorescent reaction could be observed in the normal control group with the first antibody of AQP2.Significant feeble fluorescent reaction of the first antibody of AQP-2 was revealed in AVP group and DDAVP group.In comparison with the control group,significant stain was found in AVP group and DDAVP group.Noted were also lower gray(P

Diurnal Variation of Plasma Anti-Diuretic Hormone and Relationship to Nocturnal Polyuria after Spinal Cord Injured Patients

OBJECTS: To investigate the effect of anti-diuretic hormone (ADH) on nocturnal polyuria in spinal cord injured patients. METHODS: Eleven quadriplegics, seven paraplegics, and nine normal person participated in this study. Quadriplegics and paraplegics ranged from A to C grades according to the ASIA classification. All participants were independent in activities of daily living on wheelchair level. Their intake and output were measured at every 6 hours for 24 hours. The level of ADH was measured by the radioimmunoassay method. RESULTS: 1) Urine output from midnight to 6:00 A.M. was increased in quadriplegics, but not in paraplegics. 2) ADH at 6:00 A.M. and midnight was decreased in quadriplegics than in controls. No significant change of ADH level was noted in paraplegics. 3) Serum osmolality was higher in quadriplegics than in controls at 6:00 A.M. and midnight. CONCLUSION: This study indicates that the nocturnal polynuria in spinal cord injured patient is partly due to a decreased ADH.