ABSTRACT
Los niños con lesiones selares y/o supraselares pueden presentar diabetes insípida central con posterior secreción inadecuada de hormona antidiurética. Nosotros observamos, en algunos casos, aumento de la incidencia de poliuria, natriuresis e hiponatremia, tríada diagnóstica del síndrome cerebral perdedor de sal. Aquí comunicamos la evolución de 7 pacientes con antecedentes de daño agudo del sistema nervioso central y diabetes insípida central seguida por síndrome cerebral perdedor de sal. Como tratamiento aportamos secuencialmente fluidos salinos parenterales, cloruro de sodio oral, desmopresina, mineralocorticoides e incluso tiazidas. Ante la persistencia de poliuria con hiponatremia, agregamos ibuprofeno. Como resultado de este esquema terapéutico secuencial, este grupo redujo significativamente los valores de diuresis diaria de 10 ml/kg/h a 2 ml/kg/h en un tiempo promedio de 5 días, normalizando también las natremias (de 161 mEq/L a 143 mEq/L) en un tiempo promedio de 9 días. En ningún caso observamos efectos adversos asociados al tratamiento.
Children with sellar and/or suprasellar lesions may develop central diabetes insipidus with subsequent inappropriate antidiuretic hormone secretion. An increased incidence of polyuria, natriuresis, and hyponatremia has been reported in some cases, which make up the diagnostic triad of cerebral salt wasting syndrome. Here we report the clinical course of 7 patients with a history of acute central nervous system injury and central diabetes insipidus followed by cerebral salt wasting syndrome. Treatment included the sequential use of parenteral saline solution, oral sodium chloride, desmopressin, mineralocorticoids, and even thiazides. Due to persistent polyuria and hyponatremia, ibuprofen was added. As a result of this sequential therapeutic regimen, daily urine output reduced significantly from 10 mL/ kg/h to 2 mL/kg/h over an average period of 5 days, together with a normalization of natremia (from 161 mEq/L to 143 mEq/L) over an average period of 9 days. No treatment-related adverse effects were observed in any case.
Subject(s)
Humans , Child, Preschool , Child , Adolescent , Diabetes Insipidus, Neurogenic , Hyponatremia/etiology , Hyponatremia/drug therapy , Polyuria/complications , Polyuria/etiology , Research , Ibuprofen/therapeutic useABSTRACT
Infundibuloneurohypophysitis is a rare condition, which is part of the group of hypophysitis, of relatively recent description (1993). The main clinical manifestation is diabetes insipidus, whose natural evolution is towards chronicity. The differential diagnosis with other thickening of the hypophysial stem is very important, where the clinic, imaging, laboratory and eventually biopsy are a main support for a correct diagnosis. We present a clinical case that shows the usual picture of infundibuloneurohypophysitis, and illustrates the imaging evolution in a female patient, with diabetes insipidus as the main clinical manifestation
Subject(s)
Humans , Female , Adult , Pituitary Diseases/complications , Pituitary Diseases/diagnosis , Diabetes Insipidus/etiology , Pituitary Diseases/diagnostic imaging , Polyuria/etiology , Polyuria/drug therapy , Deamino Arginine Vasopressin/therapeutic use , Diabetes Insipidus/drug therapy , Diuresis/drug effects , Antidiuretic Agents/therapeutic use , Polydipsia/etiology , Polydipsia/drug therapyABSTRACT
Classic Bartter syndrome, depending on the severity, presents during childhood or adolescence as failure to thrive and may be incorrectly labelled as protein–energy malnutrition, particularly in children from a low socioeconomic stratum. We encountered a 5-year-old boy who was asymptomatic till the age of 3 years. Despite adequate dietary intake, he was admitted and managed in various hospitals as a case of protein–energy malnutrition. On evaluation, he had unusual features in the form of persistent hypokalaemia and polyuria leading us to suspect a renal tubular disorder. Treatment of the condition resulted in good weight gain and normalization of serum electrolytes.
Subject(s)
Bartter Syndrome/complications , Bartter Syndrome/diagnosis , Child, Preschool , Diagnosis, Differential , Failure to Thrive/diagnosis , Failure to Thrive/etiology , Humans , Hypokalemia/diagnosis , Hypokalemia/etiology , Male , Polyuria/diagnosis , Polyuria/etiology , Protein-Energy Malnutrition/diagnosisABSTRACT
A esclerose múltipla (EM) é uma doença crônica e progressiva que se caracteriza por surtos de desmielinização que podem atingir qualquer topografia do cérebro, medula espinhal e nervo óptico. Sendo o diabetes insípido (DI) central causado, principalmente, em virtude de danos do sistema nervoso central (tais como trauma, cirurgia, tumor, infecção, sarcoidose), a EM está inclusa entre suas possíveis etiologias. Entretanto, a ocorrência dessa associação não é comumente descrita. A suspeita clínica deve ser feita na presença de poliúria e polidipsia ou hipernatremia refratária (em pacientes privados do acesso à água) durante a evolução da EM. Descreveremos um caso em que essa associação ocorreu e, após o início da terapêutica com desmopressina, a paciente reverteu o quadro clínico.
Multiple Sclerosis (ME) is a chronic progressive disease characterized by relapses of demyelination that can occur anywhere in the brain stem, spinal cord and optic nerve. Since central diabetes insipidus (DI) is mainly caused by central nervous system damage (such as trauma, surgery, tumor, infection, sarcoidosis), ME is included among its possible etiologies. However, this association is not commonly described. The clinical suspicion must be made in the presence of polyuria and polydipsia or refractory hypernatremia (in patients without free access to water) during the evolution of ME. We will describe a clinical report in which this association occurred and, after the beginning of desmopressin therapy, the clinical findings were reverted.
Subject(s)
Adult , Female , Humans , Diabetes Insipidus, Neurogenic/etiology , Multiple Sclerosis/complications , Antidiuretic Agents/therapeutic use , Diagnosis, Differential , Deamino Arginine Vasopressin/therapeutic use , Diabetes Insipidus, Neurogenic/diagnosis , Magnetic Resonance Spectroscopy , Polyuria/etiologyABSTRACT
Acute-onset polyuria, with urine volumes exceeding 3 litres per day, is a relatively uncommon clinical condition. If managed on appropriate guidelines, an excellent recovery is expected
Subject(s)
Humans , Male , Diabetes Insipidus/diagnosis , Deamino Arginine Vasopressin , Administration, Oral , Polyuria/etiology , Deamino Arginine Vasopressin/administration & dosageABSTRACT
Se sospecha Síndrome Poliúrico (SP) cuando el volumen urinario excede en 2 a 3 veces lo esperado para la edad o cuando a raíz de una deshidratación o restricción hídrica no se produce concentración urinaria adecuada. El volumen y la osmolaridad de los líquidos orgánicos se regulan con gran precisión gracias a la actividad de la hormona antidiurética (HAD), producida en el eje hipotálamo hipofisiario, que maneja la permeabilidad del agua de los túbulos distales y colectores renales. El SP se clasifica en dos grandes grupos: 1) con niveles plasmáticos bajos de HAD (diabetes insípida central DIC o neurogénica y polidipsia primaria) y 2) con niveles plasmáticos normales de HAD (diuresis osmótica y diabetes insípida nefrogénica DIN). El diagnóstico diferencial se hace con la prueba de deprivación acuosa y el tratamiento consiste en reemplazo hormonal con HAD en DIC y en la DIN reducción del aporte calórico proteico con la ingesta libre de agua, más diuréticos tiazídicos y antiinflamatorios. En el presente artículo se hace una revisión actualizada del SP.
Subject(s)
Humans , Renal Agents/therapeutic use , Polyuria/diagnosis , Polyuria/etiology , Polyuria/drug therapy , Hormone Replacement Therapy , Vasopressins/biosynthesis , Vasopressins/therapeutic use , Diagnosis, Differential , Diabetes Insipidus, Nephrogenic/therapy , Polyuria/classification , SyndromeABSTRACT
Celiac crisis is a life-threatening cause of acute diarrhea and multiple metabolic emergencies. It is extremely rare these days. We successfully managed a 5-year old girl with celiac crisis for multiple metabolic problems viz., hyponatremia, hypokalemia, metabolic acidosis, hyperglycemia and polyuria in Pediatric Intensive Care Unit. Steroid therapy was life saving. The case may serve as a reminder of the condition, which presents a difficult therapeutic challenge.
Subject(s)
Acidosis/etiology , Acute Disease , Celiac Disease/complications , Child, Preschool , Diarrhea/etiology , Female , Humans , Hyperglycemia/etiology , Hypokalemia/etiology , Hyponatremia/etiology , Polyuria/etiologyABSTRACT
The present investigation was undertaken to study the effects of chronic oral ramipril (1 mg/kg) treatment in streptozotocin (STZ) induced diabetic rats. Single tail vein injection of STZ (45 mg/kg, i.v.) produced a diabetic state exhibiting all the cardinal symptoms such as loss of body weight, polydipsia, polyuria, glucosuria, polyphagia, hypoinsulinaemia and hyperglycaemia. The diabetic state was also found to be associated with bradycardia, hypothyroidism, cardiac depression and cardiomyopathy. Ramipril treatment prevented STZ-induced hypertension, bradycardia, hypothyroidism, hyperchosesterolaemia and partially the cardiomayopathy. Ramipril treatment could not, however prevent STZ-induced loss of body weight, polyuria, polydipsia, polyphagia, hyperglycaemia, hypoinsulinaemia, hypertriglyceridaemia and cardiac depression. Our data suggests that ramipril has a few beneficial effects in the STZ-treated diabetic rats.
Subject(s)
Animals , Antihypertensive Agents/pharmacology , Blood Pressure/drug effects , Body Weight/drug effects , Diabetes Mellitus, Experimental/chemically induced , Female , Heart/drug effects , Heart Rate/drug effects , Hypertension/drug therapy , Polyuria/etiology , Ramipril/pharmacology , Rats , Rats, Wistar , StreptozocinABSTRACT
Los pacientes con EP pueden presentar poliaquiuria y poliuria nocturna en un 38 a 71 por ciento, un síntoma que interfiere con el sueño. Material y métodos: Se evaluaron 3 pacientes con enfermedad de Parkinson idiopática, que presentaban poliaquiuria nocturna. Se descartó infección urinaria y enfermedades nefrourológicas. Dos hombres y una mujer de 67, 67 y 77 años de edad, con entre 14 y 17 años de enfermedad de Parkinson y en tratamiento con levodopa. Todos los casos eran avanzados con Hoehn y Yahr, 4 con complicaciones evolutivas de la EP. Se le prescribe desmopresina ascetato en spray nasal, 10 µg intranasal por una semana al acostarse, la segunda semana 20 µg. Resultados. Nuestros dos casos presentaron una buena respuesta sintomática con una disminución del número de veces que orinaron en la noche. Em ambos casos hubo una clara redistribución del volumen de orina de 24 horas, con una disminución del 30 por ciento del volumen nocturno. En ambos casos no hubo cambios significativos en el sodio y la osmolaridad plasmática. Caso 3. Este caso suspendió la terapia por presentar severa exacerbación de las distonías dolorosas que el paciente presentaba previamente. Si bien el número de pacientes estudiados en esta experiencia no permite conclusiones definitivas, los resultados obtenidos hacen plantear que el uso de desmopresina intranasal en algunos pacientes parkinsonianos puede ser una herramienta terapéutica útil, la cual debe ser monitorizada clínicamente y con el laboratorio, para prevenir desequilibrio hidroelectrolítico como la hiponatremia
Subject(s)
Humans , Male , Female , Aged , Deamino Arginine Vasopressin/pharmacology , Parkinson Disease/complications , Polyuria/drug therapy , Administration, Intranasal , Deamino Arginine Vasopressin , Levodopa/therapeutic use , Osmolar Concentration , Parkinson Disease/drug therapy , Polyuria/etiologyABSTRACT
Siempre que sea posible es aconsejable observar la orina como parte del examen físico (micción en el pañal, micción espontánea en el lactante, muestra ex profeso y datos de información anamnésticos en el niño mayor). Normalmente la orina es de color amarillo ámbar más o menos pálido con variaciones del matiz por circunstancias diversas. Recién emitida es límpida y transparente
Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Glomerulonephritis, IGA/diagnosis , Hematuria/urine , Munchausen Syndrome by Proxy/diagnosis , Urine/chemistry , Diagnosis, Differential , Diuresis/physiology , Oliguria/etiology , Polyuria/etiology , Kidney Function TestsSubject(s)
Humans , Male , Female , Renal Dialysis/methods , Kidney Failure, Chronic/complications , Hematuria/etiology , Polyuria/etiologySubject(s)
Humans , Male , Female , Child, Preschool , Urologic Diseases/urine , Hematuria/etiology , Polyuria/etiologyABSTRACT
La hipertensión arterial asociada a sed intensa y poliuria se ha descripto en niños con tumores de Wilms e hiperreninemia. Se presentan dos pacientes con hipertensión arterial renovascular que consultaron por poliuria y polidipsia en los primeros meses de vida. Los síntomas desaparecieron al controlar la tensión arterial con inhibidores de la enzima convertidora de la angiotensina II (captopril). Los valores plasmáticos aumentados de renina y aldosterona se normalizaron luego de la cirugía. Se discute la fisiopatología de esta forma de presentación no habitual de la hipertensión arterial hiperreninémica