Assuntos
Diuréticos , Edema/tratamento farmacológico , Rim/efeitos dos fármacos , Transporte Biológico , Cardiomiopatia Dilatada/tratamento farmacológico , Diurese/fisiologia , Diuréticos/uso terapêutico , Humanos , Rim/fisiopatologia , Masculino , Pessoa de Meia-Idade , Natriurese/fisiologia , Equilíbrio Hidroeletrolítico/efeitos dos fármacosRESUMO
Hyponatremia and hypernatremia are among the most common electrolyte disorders. Since the plasma sodium level is determined by the ratio between the total quantity of effective solutes (primarily sodium and potassium salts) and the total body water, abnormalities in the plasma sodium level must be produced by a change in one or more of these parameters. In most patients, alterations in body water are of primary importance because the plasma sodium level is normally regulated by changing water intake and water excretion. Measurement of free water excretion has traditionally been calculated by using a formula that includes the urine osmolality. However, urea is a major urinary solute but does not contribute to regulation of the plasma sodium level, since it is an ineffective osmole. As a result, urinary solute excretion is best expressed as 2 X UNa+K. Making this important correction allows solute and water intake and excretion to be compared, thereby leading to a better understanding of both the development and correction of disturbances in the plasma sodium level.
Assuntos
Água Corporal/metabolismo , Hipernatremia/sangue , Hiponatremia/sangue , Diarreia/sangue , Diurese , Diuréticos/farmacologia , Humanos , Hiponatremia/induzido quimicamente , Síndrome de Secreção Inadequada de HAD/sangue , Concentração Osmolar , Volume PlasmáticoRESUMO
Five patients with carcinoma developed thrombotic microangiopathy (characterized by renal insufficiency, microangiopathic hemolytic anemia, and usually thrombocytopenia) after treatment with cisplatin, bleomycin, and a vinca alkaloid. One patient had thrombotic thrombocytopenic purpura, three the hemolytic-uremic syndrome, and one an apparent forme fruste of one of these disorders. Histologic examination of the renal tissue showed evidence of intravascular coagulation, primarily affecting the small arteries, arterioles, and glomeruli. Because each patient was tumor-free or had only a small tumor at the onset of this syndrome, the thrombotic microangiopathy may have been induced by chemotherapy. Diagnosis of this potentially fatal complication may be delayed or missed if renal tissue or the peripheral blood smear is not examined, because renal failure may be ascribed to cisplatin nephrotoxicity and the anemia and thrombocytopenia to drug-induced bone marrow suppression.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Nefropatias/induzido quimicamente , Trombose/induzido quimicamente , Adulto , Idoso , Bleomicina/administração & dosagem , Bleomicina/efeitos adversos , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Feminino , Síndrome Hemolítico-Urêmica/induzido quimicamente , Humanos , Rim/irrigação sanguínea , Nefropatias/patologia , Masculino , Microcirculação/efeitos dos fármacos , Pessoa de Meia-Idade , Púrpura Trombocitopênica Trombótica/induzido quimicamente , Vimblastina/administração & dosagem , Vimblastina/efeitos adversos , Vincristina/administração & dosagem , Vincristina/efeitos adversosRESUMO
The diagnostic value of a strikingly elevated serum lactate dehydrogenase (LDH) level in association with only small or no increases in SGOT and alkaline phosphatase levels was noted in five patients with proved renal infarction. Four had renal artery embolism and infarction in association with atrial arrhythmias; one had an acute extension of an abdominal aortic aneurysm occluding the renal artery. Other causes of a considerable isolated increase in the serum LDH level such as hemolysis and myocardial infarction can usually be easily excluded.