Triamterene in lithium-induced nephrogenic diabetes insipidus: a case report.

Lithium-induced nephrogenic diabetes insipidus (NDI) is a rare and difficult-to-treat condition. We describe the case of an 81-year-old woman with bipolar treated with lithium and no previous history of diabetes insipidus. She was hospitalized due to disturbance of consciousness and was diagnosed with, hypercalcemia, hyperparathyroidism, and NDI. Parathyroidectomy was contraindicated and parathyroid hormone level was improved insufficiently after cinacalcet initiation, percutaneous ethanol injection therapy was performed for the enlarged parathyroid gland. After improvement in hypercalcemia and unsuccessful indapamide treatment, triamterene was administrated to control polyuria. Lithium is one of the indispensable maintenance treatment options for bipolar disorder, but it has the side effect of NDI. Lithium enters the collecting duct's principal cells mainly via the epithelial sodium channel (ENaC) located on their apical membranes, ENaC shows high selectivity for both sodium and lithium, is upregulated by aldosterone, and inhibited by triamterene. To our knowledge, this is the first publication on triamterene use in lithium-induced NDI patients.

Fluconazole affects the alkali-metal-cation homeostasis and susceptibility to cationic toxic compounds of Candida glabrata.

Candida glabrata is a salt-tolerant and fluconazole (FLC)-resistant yeast species. Here, we analyse the contribution of plasma-membrane alkali-metal-cation exporters, a cation/proton antiporter and a cation ATPase to cation homeostasis and the maintenance of membrane potential (ΔΨ). Using a series of single and double mutants lacking CNH1 and/or ENA1 genes we show that the inability to export potassium and toxic alkali-metal cations leads to a slight hyperpolarization of the plasma membrane of C. glabrata cells; this hyperpolarization drives more cations into the cells and affects cation homeostasis. Surprisingly, a much higher hyperpolarization of C. glabrata plasma membrane was produced by incubating cells with subinhibitory concentrations of FLC. FLC treatment resulted in a substantially increased sensitivity of cells to various cationic drugs and toxic cations that are driven into the cell by negative-inside plasma-membrane potential. The effect of the combination of FLC plus cationic drug treatment was enhanced by the malfunction of alkali-metal-cation transporters that contribute to the regulation of membrane potential and cation homeostasis. In summary, we show that the combination of subinhibitory concentrations of FLC and cationic drugs strongly affects the growth of C. glabrata cells.

Use of reconstituted waters to evaluate effects of elevated major ions associated with mountaintop coal mining on freshwater invertebrates.

In previous laboratory chronic 7-d toxicity tests conducted with the cladoceran Ceriodaphnia dubia, surface waters collected from Appalachian sites impacted by coal mining have shown toxic effects associated with elevated total dissolved solids (TDS). The objective of the present study was to evaluate the effects of elevated major ions in chronic laboratory tests with C. dubia (7-d exposure), a unionid mussel (Lampsilis siliquoidea; 28-d exposure), an amphipod (Hyalella azteca; 28-d exposure), and a mayfly (Centroptilum triangulifer; 35-d exposure) in 3 reconstituted waters designed to be representative of 3 Appalachian sites impacted by coal mining. Two of the reconstituted waters had ionic compositions representative of alkaline mine drainage associated with mountaintop removal and valley fill-impacted streams (Winding Shoals and Boardtree, with elevated Mg, Ca, K, SO4, HCO3), and a third reconstituted water had an ionic composition representative of neutralized mine drainage (Upper Dempsey, with elevated Na, K, SO4, and HCO3). The waters with similar conductivities but, with different ionic compositions had different effects on the test organisms. The Winding Shoals and Boardtree reconstituted waters were consistently toxic to the mussel, the amphipod, and the mayfly. In contrast, the Upper Dempsey reconstituted water was toxic to the mussel, the amphipod, and the cladoceran but was not toxic to the mayfly. These results indicate that, although elevated TDS can be correlated with toxicity, the specific major ion composition of the water is important. Moreover, the choice of test organism is critical, particularly if a test species is to be used as a surrogate for a range of faunal groups.

The importance of atmospheric deposition, charge and atomic mass to the dynamics of minor and rare elements in developing, ageing, and wilted leaves of beech (Fagus sylvatica L.).

The amounts of sixty elements in developing, maturing, senescent and wilting leaves, and in the wintering dead leaves attached to the branches, are reported for a beech (Fagus sylvatica) forest on mor Podzol in south Sweden, a site with no local sources of pollution or geological anomalies. The amounts (contents per leaf) of K (potassium), Rb (rubidium), Cs (caesium), Cu (copper) and P (phosphorus) were highest in young leaves, decreasing throughout the growing season and usually in the subsequent winter. The entirely opposite pattern with a continuous, mostly even increase of the amounts was measured with Be (beryllium), Ba (barium), Hg (mercury), Al (aluminium), Tl (thallium), Pb (lead), Bi (bismuth), V (vanadium), W (tungsten), As (arsenic), Sb (antimony), and Se (selenium). Amounts of rare-earth elements and some transition metals, such as Co (cobalt), Ti (titanium), and the actinides Th (thorium) and U (uranium) were more stable during the growing season, after an initial increase in early summer, but increased greatly in the winter. This winter increase in dead attached leaves has to be accounted for by uptake from long-distance transported constituents in dry and wet deposition. It was similar to deposition rate estimates using moss carpets from the same locality. A passive uptake was positively related to ionic charge and atomic mass. However, the amounts of several, mainly non-essential elements, such as Ni (nickel), Sc (scandium), Zr (zirconium), Cr (chromium), Ag (silver), and Cd (cadmium) were not much lower in the young or maturing leaves than in the wintered dead leaves of this deciduous (hardwood) forest and a proportion apparently originated from internal translocation in the trees. Seasonal fluxes or cycling of many of the scarce or rare elements reported here have never been studied before in forest ecosystems.

[Mechanism of induction of cytogenetic damage in plant meristematic cells caused by combined effect of heavy natural radionuclides and heavy and alkaline metals]. / Zakonomernosti induktsii tsitogeneticheskikh narushenii v kletkakh meristem rastenii pri sochetannom deistvii tiazhelykh estestvennykh radionuklidov, tiazhelykh i shchelochnykh metallov.

The analysis of experimental data on the combined effect of 232Th and water from melted snow containing metal ions from industrally loaded territories on Tradescantia (clone 02) and on Allium shoenoprasum meristematic root tip cells treated with heavy natural radionuclides from natural water sources in the area of radioactive wastes storehouse is presented. It was demonstrated that plant meristematic cells response to heavy metals and heavy natural radionuclides, both from two-component model system and from natural water sources, have commom features.

Assessment of the sensitization potential of five metal salts in the murine local lymph node assay.

The murine local lymph node assay (LLNA) has been proposed as a predictive test for the identification of sensitizing agents. We used this test to compare the sensitization potential of NiSO4, K2Cr2O7, CoCl2, Na2PtCl6 and BeSO4, salts of metals which have all been associated with allergic contact dermatitis and either bronchial asthma orinterstitial lung disease, by either humoral or cell-mediated allergic mechanisms. BALB/c mice (n = 3 per concentration studied, three concentrations studied per metal) received three daily applications of the metal salt (in DMSO) on the dorsum of both ears. On the fourth day the draining auricular lymph nodes were removed and the incorporation of [3H]-thymidine in the lymphocytes in culture was compared to that of concurrent vehicle-treated control mice, thus enabling to derive a stimulation index (SI), indicative of immunological sensitization potential. Each experiment was performed three times. Oxazolone and toluene diisocyanate, chosen as positive controls, yielded strongly positive SI values (> 20 and > 30 respectively). Na2PtCl6 (SI 2.6 +/- 1.0 at 2.5%), CoCl2 (SI 2.8 +/- 0.5 at 5%) and possibly also K2Cr2O7 (SI 2.1 +/- 1.2 at 0.5%) were positive in the LLNA, whereas NiSO4 (SI 0.9 +/- 0.2 at 5%) and BeSO4 (SI 1.3 +/- 0.6 at 4%) were negative. Although our results are still limited by the fact that only one mice strain was tested, they indicate that there is no strict relationship between the sensitization potential of metal salts, as evaluated in the murine LLNA, and their potential to cause either respiratory or dermal allergic disease. Consequently, caution should be exercised before proposing the murine LLNA as a valid test to predict the sensitization potential of low molecular weight chemicals.

Effect of separate and combined maternal ingestion of alkali metals on the developing mouse.

The effect of postnatal maternal ingestion of LiCl, CsCl or both during weaning period on the developing newborn was studied in the albino mouse. Maternal exposure to CsCl alone or in combination with LiCl reduced the weanling body weight from corresponding control which persisted for a subsequent 2 weeks after separation of the offspring from maternal breast feeding. This was compared to a moderate reduction in offspring growth by maternal Li-exposure during alkali metal-free period. Exposure of nursing dams to either alkali metals studied, but not their combination, decreased brain weight of the developing mouse. The maternal Li-exposure caused a marked increase in female but not male offspring spleen weight as compared to a reduction of kidney weight from corresponding controls. Coadministration of CsCl with LiCl negated this sex-dependent Li-mediated changes of the offspring's tissue weights. The maternal Li-treatment caused sex-dependent induction of offspring hepatic aldehyde dehydrogenase but not alcohol dehydrogenase. The results suggest that breast feeding by nursing dams ingesting these alkali metals could cause retarded growth during development. The Cs+ appears to negate some of the changes produced by Li on brain and kidney weights. The interaction between Cs+ and Li+ may prove useful in minimizing some of the neonatal toxicity studied.