Pre-eclampsia complicated by severe hyponatraemia

2020 ◽  
Vol 13 (12) ◽  
pp. e237827
Author(s):  
Annalisa Montebello ◽  
John Thake ◽  
Sandro Vella ◽  
Josanne Vassallo
Keyword(s):  
Caesarean Section ◽  
Sodium Level ◽  
Hormone Secretion ◽  
Fetal Distress ◽  
Emergency Caesarean Section ◽  
Fluid Restriction ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
Severe Hyponatraemia ◽  
Fetal Tachycardia

A 41-year-old woman was diagnosed with pre-eclampsia at 35 weeks gestation. She was treated with antihypertensives but, unfortunately, her condition became complicated by severe hyponatraemia. Her sodium levels rapidly dropped to 125 mmol/L. The cause for the hyponatraemia was the syndrome of inappropriate antidiuretic hormone secretion. She was initially managed with fluid restriction, but an emergency caesarean section was necessary in view of fetal distress. Her sodium levels returned to normal within 48 hours of delivery.Pre-eclampsia is rarely associated with hyponatraemia. A low maternal sodium level further increases the mother’s risk for seizures during this state. Additionally, the fetal sodium rapidly equilibrates to the mother’s and may result in fetal tachycardia, jaundice and polyhdraminios. All these factors may necessitate an emergency fetal delivery.

scholarly journals SIADH in COVID 19 infection, an association or cause : A case report

2020 ◽  
Vol 8 (2) ◽  
pp. 126-128
Author(s):  
Karishma Shamarukh ◽  
Sharmin Rahman ◽  
Umme Kulsum Chy ◽  
Amina Sultana ◽  
Mohammad Omar Faruq
Keyword(s):  
Case Report ◽  
Antidiuretic Hormone ◽  
Hypertonic Saline ◽  
Sodium Level ◽  
Hormone Secretion ◽  
Fluid Restriction ◽  
Laboratory Parameters ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
Low Sodium

One of the leading cause of hyponatremia is syndrome of inappropriate antidiuretic hormone secretion (SIADH). Various etiologies of hyponatraemia have been observed till today but its association with Covid leading to SIADH is rare. Therefore, we present a case where SIADH was associated with Covid-19 pneumonia. This was a case of a 66 years old male with multiple co-morbidities presenting with symptoms of Covid infection including generalized weakness. After confirming Covid 19 infection management was started accordingly but patient’s weakness seemed to increase. He was found to have low sodium level of 105 mmol /L and investigations confirmed that he was having SIADH. He was treated with hypertonic saline, fluid restriction and his symptoms and laboratory parameters gradually improved. Bangladesh Crit Care J September 2020; 8(2): 126-128

scholarly journals Hyponatremia in Acute Stroke Patients: Pathophysiology, Clinical Significance, and Management Options

2019 ◽  
Vol 82 (1-3) ◽  
pp. 32-40 ◽  
Author(s):  
George Liamis ◽  
Fotios Barkas ◽  
Efstathia Megapanou ◽  
Eliza Christopoulou ◽  
Andromachi Makri ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Sodium Level ◽  
Hormone Secretion ◽  
Fluid Restriction ◽  
Hypertonic Solution ◽  
Stroke Patients ◽  
Volume Depletion ◽  
Management Options ◽  
Cerebral Salt Wasting ◽  
Inappropriate Antidiuretic Hormone Secretion

Background: Hyponatremia is frequent in acute stroke patients, and it is associated with worse outcomes and increased mortality. Summary: Nonstroke-related causes of hyponatremia include patients’ comorbidities and concomitant medications, such as diabetes mellitus, chronic kidney disease, heart failure, and thiazides. During hospitalization, “inappropriate” administration of hypotonic solutions, poor solute intake, infections, and other drugs, such as mannitol, could also lower sodium levels in patients with acute stroke. On the other hand, secondary adrenal insufficiency due to pituitary ischemia or hemorrhage, syndrome of inappropriate antidiuretic hormone secretion, and cerebral salt wasting are additional stroke-related causes of hyponatremia. Although it is yet unclear whether the appropriate restoration of sodium level improves outcomes in patients with acute stroke, the restoration of the volume depletion remains the cornerstone of treatment in hypovolemic hyponatremia. In case of hyper- and euvolemic hyponatremia, apart from the correction of the underlying cause (e.g., withdrawal of an offending drug), fluid restriction, administration of hypertonic solution, loop diuretics, and vasopressin-receptor antagonists (vaptans) are among the therapeutic options. Key Messages: Hyponatremia is frequent in patients with acute stroke. The plethora of underlying etiologies warrants a careful differential diagnosis which should take into consideration comorbidities, concurrent medication, findings from the clinical examination, and laboratory measurements, which in turn will guide management decisions. However, it is yet unclear whether the appropriate restoration of sodium level improves outcomes in patients with acute stroke.

scholarly journals Efficacy and safety of oral tolvaptan therapy in patients with the syndrome of inappropriate antidiuretic hormone secretion

2011 ◽  
Vol 164 (5) ◽  
pp. 725-732 ◽  
Author(s):  
Joseph G Verbalis ◽  
Suzanne Adler ◽  
Robert W Schrier ◽  
Tomas Berl ◽  
Qiong Zhao ◽  
...  
Keyword(s):  
Antidiuretic Hormone ◽  
Health Survey ◽  
Hormone Secretion ◽  
Fluid Restriction ◽  
Efficacy And Safety ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
Days Of Therapy ◽  
Positive Treatment Effect ◽  
Positive Treatment

ObjectiveTolvaptan, an oral antagonist of the vasopressin V2 receptor, has been found to improve hyponatremia in patients with mixed etiologies. This study analyzed a subgroup of patients with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) to evaluate the efficacy and safety of tolvaptan in this group.Design and patientsHyponatremic patients in the SALT-1 and SALT-2 studies with a diagnosis of SIADH were identified based on clinical diagnosis by individual study investigators. Subjects were randomized to receive oral placebo (n=52) or tolvaptan 15 mg daily, with further titration to 30 and 60 mg daily, if necessary, based on the response of serum [Na+] (n=58).ResultsIn patients with SIADH, improvement in serum [Na+] was significantly greater (P<0.0001) with tolvaptan than placebo over the first 4 days of therapy as well as the entire 30-day study, with minimal side effects of increased thirst, dry mouth, and urination. Only 5.9% of tolvaptan-treated patients had overly rapid correction of hyponatremia as defined by current guidelines. After discontinuation of tolvaptan, serum [Na+] declined to values similar to placebo. A significant positive treatment effect favoring tolvaptan on the physical component, and a near-significant trend on the mental component, was found using the SF-12 Health Survey. Tolvaptan was associated with a significantly reduced incidence of fluid restriction.ConclusionsResults for the SIADH subgroup were analogous to those of the combined SALT population regarding efficacy and safety but demonstrated a greater improvement in the physical component of the SF-12 Health Survey than in the full mixed etiology SALT patient group.

scholarly journals Syndrome of recurrent increased secretion of antidiuretic hormone following multiple doses of vincristine

Blood ◽  
1975 ◽  
Vol 45 (3) ◽  
pp. 315-320 ◽  
Author(s):  
MJ Stuart ◽  
C Cuaso ◽  
M Miller ◽  
FA Oski
Keyword(s):  
Antidiuretic Hormone ◽  
Hormone Secretion ◽  
Fluid Restriction ◽  
Repeated Treatment ◽  
Acute Lymphatic Leukemia ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
Lymphatic Leukemia ◽  
Specific Radioimmunoassay ◽  
Repeated Use

The syndrome of inappropriate antidiuretic hormone secretion (SIADH) has been recognized to occur following treatment with vincristine. None of the reports have provided information regarding its potential for recurrence on further challenge with vincristine (VCR), an agent generally required for repeated use in patients with malignancies. Symptomatic hyponatremia and SIADH that occurred 8 days following administration of VCR in a child with acute lymphatic leukemia was documented with specific radioimmunoassay of urinary ADH levels. The further occurrence of recurrent elevations in ADH excretion 8–10 days following repeated treatment with VCR was also observed. However, SIADH was prevented by prophylactic rigorous fluid restriction. The occurrence of SIADH following VCR therefore does not preclude the further safe usage of this drug.

scholarly journals Asymptomatic meningitis diagnosed by positron emission tomography in a patient with syndrome of inappropriate antidiuretic hormone secretion: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Masanori Hasebe ◽  
Jun Shirakawa ◽  
Daisuke Miyashita ◽  
Rieko Kunishita ◽  
Mayu Kyohara ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Antidiuretic Hormone ◽  
Arginine Vasopressin ◽  
Hormone Secretion ◽  
Emission Tomography ◽  
Plasma Sodium ◽  
Fluid Restriction ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
Positron Emission

Abstract Background Syndrome of inappropriate antidiuretic hormone secretion can be caused by arginine-vasopressin-producing tumors or enhanced arginine vasopressin secretion from the posterior pituitary gland due to central nervous system disorders and intrathoracic diseases. Case presentation A 53-year-old Asian man was hospitalized with complaints of tremor and hiccups. Laboratory examination revealed findings suggestive of hypotonic hyponatremia due to syndrome of inappropriate antidiuretic hormone secretion. The patient did not complain of headache or photophobia, and showed no signs of meningeal irritation. Positron emission tomography–computed tomography revealed 18F-fluoro-deoxy-glucose accumulation along the cervical spinal cord, based on which the patient was diagnosed as having aseptic meningitis. The hyponatremia was treated successfully by fluid restriction, and optimum plasma sodium concentration was maintained by tolvaptan administration. Conclusions This case underscores the need to consider the possibility of mild meningitis as the cause of syndrome of inappropriate antidiuretic hormone secretion in patients without other identifiable cause.

scholarly journals Tolvaptan use during hyperhydration in paediatric intracranial lymphoma with SIADH

2016 ◽  
Vol 2016 ◽  
Author(s):  
Ruben H Willemsen ◽  
Violeta Delgado-Carballar ◽  
Daniela Elleri ◽  
Ajay Thankamony ◽  
G A Amos Burke ◽  
...  
Keyword(s):  
Fluid Balance ◽  
Fluid Intake ◽  
Hormone Secretion ◽  
B Cell Lymphoma ◽  
Urinary Output ◽  
Fluid Restriction ◽  
List Type ◽  
Close Monitoring ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Severe Hyponatraemia

Summary An 11-year-old boy developed severe syndrome of inappropriate antidiuretic hormone secretion (SIADH) after diagnosis of an intracranial B-cell lymphoma. His sodium levels dropped to 118–120 mmol/L despite 70% fluid restriction. For chemotherapy, he required hyperhydration, which posed a challenge because of severe hyponatraemia. Tolvaptan is an oral, highly selective arginine vasopressin V2-receptor antagonist, which has been licensed in adults for the management of SIADH and has been used in treating paediatric heart failure. Tolvaptan gradually increased sodium levels and allowed liberalisation of fluid intake and hyperhydration. Tolvaptan had profound effects on urinary output in our patient with increases up to 8 mL/kg/h and required close monitoring of fluid balance, frequent sodium measurements and adjustments to intake. After hyperhydration, tolvaptan was stopped, and the lymphoma went into remission with reversal of SIADH. We report one of the first uses of tolvaptan in a child with SIADH, and it was an effective and safe treatment to manage severe SIADH when fluid restriction was not possible or effective. However, meticulous monitoring of fluid balance and sodium levels and adjustments of fluid intake are required to prevent rapid sodium changes. Learning points: Tolvaptan can be used in paediatric patients with SIADH to allow hyperhydration during chemotherapy. Tolvaptan has profound effects on urinary output and meticulous monitoring of fluid balance and sodium 
levels is therefore warranted. Tolvaptan was well tolerated without significant side effects.

Routine postoperative fluid restriction to prevent syndrome of inappropriate antidiuretic hormone secretion after transsphenoidal resection of pituitary adenoma

2021 ◽  
pp. 1-8
Author(s):  
M. Harrison Snyder ◽  
David T. Asuzu ◽  
Dawn E. Shaver ◽  
Mary Lee Vance ◽  
John A. Jane
Keyword(s):  
Pituitary Adenoma ◽  
Antidiuretic Hormone ◽  
Hormone Secretion ◽  
Pituitary Surgery ◽  
Fluid Restriction ◽  
Readmission Rates ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
History Of ◽  
Transsphenoidal Resection

OBJECTIVE Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a common problem during the postoperative course after pituitary surgery. Although treatment of this condition is well characterized, prevention strategies are less studied and reported. The authors sought to characterize outcomes and predictive factors of SIADH after implementation of routine postoperative fluid restriction for patients undergoing endoscopic transsphenoidal surgery for pituitary adenoma. METHODS In March 2018, routine postoperative fluid restriction to 1000 ml/day for 7 days was instituted for all patients who underwent surgery for pituitary adenoma. These patients were compared with patients who underwent surgery for pituitary adenoma between March 2016 and March 2018, prior to implementation of routine fluid restriction. Patients with preoperative history of diabetes insipidus (DI) or concern for postsurgical DI were excluded. Patients were followed by neuroendocrinologists and neurosurgeons, and sodium levels were checked between 7 and 10 days postoperatively. SIADH was defined by a serum sodium level less than 136 mmol/L, with or without symptoms within 10 days after surgery. Thirty-day readmission was recorded and reviewed to determine underlying reasons. RESULTS In total, 82 patients in the fluid-unrestricted cohort and 135 patients in the fluid-restricted cohort were analyzed. The patients in the fluid-restricted cohort had a significantly lower rate of postoperative SIADH than patients in the fluid-unrestricted cohort (5% vs 15%, adjusted OR [95% CI] 0.1 [0.0–0.6], p = 0.01). Higher BMI was associated with lower rate of postoperative SIADH (adjusted OR [95%] 0.9 [0.9–1.0], p = 0.03), whereas female sex was associated with higher rate of SIADH (adjusted OR [95% CI] 3.1 [1.1–9.8], p = 0.03). There was no difference in the 30-day readmission rates between patients in the fluid-unrestricted and fluid-restricted cohorts (4% vs 7%, adjusted OR [95% CI] 0.5 [0–5.1], p = 0.56). Thirty-day readmission was more likely for patients with history of hypertension (adjusted OR [95% CI] 5.7 [1.3–26.3], p = 0.02) and less likely for White patients (adjusted OR [95% CI] 0.3 [0.1–0.9], p = 0.04). CONCLUSIONS Routine fluid restriction reduced the rate of SIADH in patients who underwent surgery for pituitary adenoma but was not associated with reduction in 30-day readmission rate.

scholarly journals Syndrome of recurrent increased secretion of antidiuretic hormone following multiple doses of vincristine

Blood ◽  
1975 ◽  
Vol 45 (3) ◽  
pp. 315-320 ◽  
Author(s):  
MJ Stuart ◽  
C Cuaso ◽  
M Miller ◽  
FA Oski
Keyword(s):  
Antidiuretic Hormone ◽  
Hormone Secretion ◽  
Fluid Restriction ◽  
Repeated Treatment ◽  
Acute Lymphatic Leukemia ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
Lymphatic Leukemia ◽  
Specific Radioimmunoassay ◽  
Repeated Use

Abstract The syndrome of inappropriate antidiuretic hormone secretion (SIADH) has been recognized to occur following treatment with vincristine. None of the reports have provided information regarding its potential for recurrence on further challenge with vincristine (VCR), an agent generally required for repeated use in patients with malignancies. Symptomatic hyponatremia and SIADH that occurred 8 days following administration of VCR in a child with acute lymphatic leukemia was documented with specific radioimmunoassay of urinary ADH levels. The further occurrence of recurrent elevations in ADH excretion 8–10 days following repeated treatment with VCR was also observed. However, SIADH was prevented by prophylactic rigorous fluid restriction. The occurrence of SIADH following VCR therefore does not preclude the further safe usage of this drug.

scholarly journals Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) and Subsequent Central Diabetes Insipidus: A Rare Presentation of Pituitary Apoplexy

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
S. B. Smedegaard ◽  
J. O. Jørgensen ◽  
N. Rittig
Keyword(s):  
Diabetes Insipidus ◽  
Antidiuretic Hormone ◽  
Pituitary Apoplexy ◽  
Hormone Secretion ◽  
Central Diabetes Insipidus ◽  
Plasma Sodium ◽  
Fluid Restriction ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
Pituitary Dysfunction

Pituitary apoplexy (PA) is a rare endocrine emergency that occasionally presents with sodium disturbances. Here we present a rare case with a previously healthy 41-year-old female who presented with acute onset headache and nausea without visual impairment or overt pituitary dysfunction. Plasma sodium concentrations declined abruptly during the first two days of admission to a nadir of 111 mmol/l. Urine and blood chemistry were consistent with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Magnetic resonance imaging revealed recent bleeding into a pituitary cystic process. Hyponatremia was successfully corrected with fluid restriction and both visual function and anterior pituitary function remained intact. Subsequently, the patient developed central diabetes insipidus (CDI), which responded well to desmopressin substitution. To our knowledge, this is the first case of PA presenting predominantly with posterior pituitary dysfunction that transitioned from SIADH to permanent CDI.

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