scholarly journals Severe hyponatremia with seizures and confirmed mild brain edema by hysteroscopic myomectomy: a case report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Haruko Okazaki ◽  
Norikazu Miura ◽  
Yuki Kashima ◽  
Ryoichi Miyashita ◽  
Katsunori Oe ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Brain Edema ◽  
Neurological Deficits ◽  
Plasma Sodium ◽  
Free Fluid ◽  
Severe Hyponatremia ◽  
Hysteroscopic Myomectomy ◽  
Irrigation Fluid ◽  
Hysteroscopic Surgery ◽  
Plasma Sodium Level

Abstract Background Hyponatremia can be developed during hysteroscopic surgery with electrolyte-free irrigation fluid. We experienced severe hyponatremia with postoperative seizures and confirmed mild brain edema. Case presentation A quadragenarian female patient underwent a 2-h hysteroscopic myomectomy with electrolyte-free fluid for uterine distension under general anesthesia. Plasma sodium level of 84.1 mmol/L 100 min after the start of surgery indicated excessive absorption of the irrigation fluid. Acute severe hyponatremia was diagnosed with significant edema in the conjunctiva, lip, and extremities. She was treated with a continuous infusion of hypertonic saline. However, seizures and cerebral edema developed 7 h later. The patient recovered without neurological deficits at postoperative day 2. Conclusion The electrolyte-free irrigation fluid can be absorbed rapidly during hysteroscopic surgery. Its interruption with hyponatremia should be considered against prolonged surgery. Especially under general anesthesia, caution should be exercised because the typical symptoms of hyponatremia such as nausea and confusion are blinded.

scholarly journals Challenges in the diagnostics and management of hydrochlorothiazide-induced severe hyponatremia in a habitual beer drinker

2020 ◽  
Vol 27 (1) ◽  
pp. 39-44
Author(s):  
Gabija Laubner ◽  
Gabija Gintautaitė ◽  
Robertas Badaras
Keyword(s):  
Salt Intake ◽  
Alcohol Concentration ◽  
Infusion Therapy ◽  
Plasma Sodium ◽  
Severe Hyponatremia ◽  
Salt Consumption ◽  
The Third ◽  
Beer Consumption ◽  
Plasma Sodium Level ◽  
Reduced Salt

Introduction. Beer potomania is a syndrome of severe hyponatremia caused by excessive beer consumption. The risk of hyponatremia increases in the case of a combination of beer potomania and the use of thiazide diuretics. Case report. A 55-year-old male patient with the anamnesis of a long-lasting alcohol use disorder was presented to the emergency department after seizures accompanied by an impaired mental status. He had been drinking beer regularly for ten years. On physical examination, the patient was tachypneic, tachycardic, disorientated, restless, the Glasgow Coma Scale score of 9, observed tremor, and the smell of alcohol from the mouth. Laboratory results showed plasma sodium 105 mmol/L, blood urea nitrogen 1.8 mmol/L, the alcohol concentration in the blood 0.06 g/l, and calculated serum osmolality 219 mOsm/kg H2O. After a detailed initial evaluation of the patient and labs for hyponatremia, a diagnosis of beer potomania was established. On the third day of hospitalization, the patient’s anamnesis was filled with information about the use of Valsartan/hydrochlorothiazide, together with reduced salt intake in the diet for three months for arterial hypertension treatment. It was decided that the combination of heavy beer drinking with the use of diuretic and reduced consumption of salt provoked hyponatremia. The patient was treated with infusion therapy of sodium chloride; plasma sodium level reached 136 on the third day of treatment. Conclusions. This case represents an unusual syndrome of beer potomania in conjunction with hydrochlorothiazide usage and reduced salt consumption, which can result in severe hyponatremia that may provoke severe neurologic damage.

PATHOGENESIS OF SEIZURES OCCURRING DURING RESTORATION OF PLASMA TONICITY TO NORMAL IN ANIMALS PREVIOUSLY CHRONICALLY HYPERNATREMIC

PEDIATRICS ◽  
1969 ◽  
Vol 43 (1) ◽  
pp. 54-64
Author(s):  
Gwendolyn R. Hogan ◽  
Philip R. Dodge ◽  
Sheila R. Gill ◽  
Susan Master ◽  
Juan F. Sotos
Keyword(s):  
Sodium Chloride ◽  
Water Content ◽  
Nasogastric Tube ◽  
Chloride Solution ◽  
Sodium Chloride Solution ◽  
Sodium Level ◽  
Plasma Sodium ◽  
Plasma Sodium Level ◽  
The Mean ◽  
The Brain

The present study describes the results of rehydration of rabbits rendered chronically hypernatremic by the administration of one molar sodium chloride solution by nasogastric tube for 23½ to 5 days. When these animals were rehydrated intravenously over a 4-hour period with 2.5% dextrose in water, returning the plasma sodium level to normal, 55% of them developed focal or generalized convulsions. The mean water content of brain tissue of the group of animals who had seizures was significantly greater than that of a normal group of animals and comparable to that found in a water-intoxicated group of animals. This elevation of water content could be accounted for by both an elevated content of potassium and chloride in the brain. The potassium content of the brain was higher in the rehydrated group of animals without than those with seizures. Ways by which the observed changes may be related to the development of seizures are discussed.

scholarly journals Efficacy of Applying Hyaluronic Acid Gels in the Primary Prevention of Intrauterine Adhesion after Hysteroscopic Myomectomy: A Meta-Analysis of Randomized Controlled Trials

Life ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. 285
Author(s):  
Min Cheng ◽  
Wen-Hsun Chang ◽  
Szu-Ting Yang ◽  
Hsin-Yi Huang ◽  
Kuan-Hao Tsui ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Primary Prevention ◽  
De Novo ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Reproductive Age ◽  
Hysteroscopic Myomectomy ◽  
Hysteroscopic Surgery ◽  
Intrauterine Adhesion ◽  
Intrauterine Surgery

Intrauterine adhesion (IUA), which mainly occurs after intrauterine surgery or an inflammatory process, is an important but often neglected condition in women of reproductive age. The presentation of IUA varies greatly, ranging from symptom-free to severe, with amenorrhea or infertility. With much advanced development of intrauterine instruments, more intrauterine diseases can be successfully cured by hysteroscopic surgery. Among these, submucosal myoma is one of the best examples. Submucosal myomas are often related to abnormal bleeding, anemia, and possible infertility or miscarriage. However, submucosal myoma after hysteroscopic myomectomy may be complicated by IUA in various grades of severity, and its incidence and prevalence might be nearly one-quarter to one-third of patients, suggesting an urgent need for efforts to decrease the risk of developing IUA after hysteroscopic myomectomy. Many strategies have been reported to be useful for this purpose, and intrauterine application of anti-adhesive gels, such as polyethylene oxide–sodium carboxymethylcellulose (PEO-NaCMC) or auto-crosslinked hyaluronic acid (ACHA), has become increasingly popular in routine clinical practice. This meta-analysis is aimed at investigating the effect of ACHA on the primary prevention of IUA formation after hysteroscopic myomectomy. A pooled analysis of three studies (hysteroscopic surgeries for fibroids, polyps, and septum) including 242 women showed that using PEO-NaCMC or ACHA gel decreased the IUA rate with an odds ratio (OR) of 0.364 (95% confidence interval (CI) 0.189–0.703, p = 0.03). Pooled analysis of two studies that limited the use of ACHA in 119 women showed that the application of ACHA gel for the primary prevention of IUA in patients after hysteroscopic myomectomy led to a statistically significant reduction of the development of IUA postoperatively (OR 0.285, 95% CI 0.116–0.701, p = 0.006). All of this suggests that the use of ACHA gel in patients after hysteroscopic myomectomy could significantly reduce de novo IUA, although more evidence is needed.

scholarly journals Therapeutic Effects of Tolvaptan, a Potent, Selective Nonpeptide Vasopressin V2 Receptor Antagonist, in Rats with Acute and Chronic Severe Hyponatremia

Endocrinology ◽  
2005 ◽  
Vol 146 (7) ◽  
pp. 3037-3043 ◽  
Author(s):  
Toshiki Miyazaki ◽  
Yoshitaka Yamamura ◽  
Toshiyuki Onogawa ◽  
Shigeki Nakamura ◽  
Shizuo Kinoshita ◽  
...  
Keyword(s):  
Receptor Antagonist ◽  
Water Content ◽  
Animal Behavior ◽  
Neurological Symptoms ◽  
Plasma Sodium ◽  
Severe Hyponatremia ◽  
Vasopressin V2 Receptor ◽  
V2 Receptor ◽  
Vasopressin V2 Receptor Antagonist ◽  
V2 Receptor Antagonist

Abstract The therapeutic efficacy of tolvaptan (OPC-41061), a potent, selective nonpeptide vasopressin V2 receptor antagonist, on acute and chronic severe hyponatremia was assessed in rats. Experiments were designed to demonstrate the efficacy of tolvaptan reducing mortality in an acute model, and controlling the extent of serum sodium elevation without causing abnormal animal behavior suggesting neurological symptoms in a chronic model. In the acute model, rats developed rapidly progressive, severe hyponatremia by continuous sc infusion of [deamino-Cys1, d-Arg8]-vasopressin (10 ng/h) and forced water-loading (additional 10% initial body weight per day). By d 6, untreated rats had a 47% mortality rate. However, rats treated with repeated oral administrations of tolvaptan (1, 3, and 10 mg/kg) produced dose-dependent aquaresis (i.e. urine volume increased and urine osmolality decreased) that resulted in a gradual increase in plasma sodium concentration. Consequently, tolvaptan treatment reduced mortality and, at higher doses, resulted in no observed deaths. In the gradual model, rats receiving a continuous sc infusion of [deamino-Cys1, d-Arg8]-vasopressin (1 ng/h) combined with a liquid diet were induced to stable, severe hyponatremia (∼110 mEq/liter), which lead to increased organ weight and water content. Rats receiving dose titrations of tolvaptan (0.25, 0.5, 1, 2, 4, and 8 mg/kg) increased plasma sodium to healthy levels without causing abnormal animal behavior suggesting neurological symptoms or death, improved hyponatremia-driven increases in wet weight and water content in the organs. Thus, in animal models, analogous to the hyponatremia forms seen in humans, tolvaptan presents exciting therapeutic implications in the management of patients with severe hyponatremia.

Rapid development of an intranidal aneurysm with perifocal brain edema in an unruptured cerebral arteriovenous malformation

2002 ◽  
Vol 97 (6) ◽  
pp. 1436-1440 ◽  
Author(s):  
Atsuya Akabane ◽  
Hidefumi Jokura ◽  
Kuniaki Ogasawara ◽  
Kou Takahashi ◽  
Kazuyuki Sugai ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Arteriovenous Malformation ◽  
Brain Edema ◽  
Rapid Development ◽  
Brain Parenchyma ◽  
Neurological Deficits ◽  
High Signal ◽  
Surgical Removal ◽  
Content Type ◽  
Signal Void

✓ The authors present the case of a 22-year-old man with an unruptured arteriovenous malformation (AVM) in which an intranidal aneurysm had grown in the course of 3 months and was complicated by perifocal brain edema. A left parietal AVM was incidentally diagnosed on magnetic resonance (MR) imaging. No aneurysms were noted on cerebral angiograms obtained simultaneously. Three months later, T2-weighted MR imaging revealed perifocal brain edema (increased signal intensity in the brain parenchyma adjacent to the nidus). An aneurysm-like signal void was demonstrated in the center of the high-signal area, but no previous hemorrhages could be detected. Angiographic studies revealed an intranidal aneurysm 4 mm in diameter projecting anterolaterally from the nidus. Surgical removal was performed without incident, and no neurological deficits or postoperative complications were observed. An MR image obtained 2 weeks postsurgery revealed complete resolution of the perifocal brain edema. To the authors' knowledge, this is the first reported case of an unruptured AVM in which an intranidal aneurysm with perifocal brain edema developed rapidly (within a few months).

scholarly journals 17β-Estradiol Attenuates Intracerebral Hemorrhage-Induced Blood–Brain Barrier Injury and Oxidative Stress Through SRC3-Mediated PI3K/Akt Signaling Pathway in a Mouse Model

ASN NEURO ◽  
2021 ◽  
Vol 13 ◽  
pp. 175909142110384
Author(s):  
Han Xiao ◽  
Jianyang Liu ◽  
Jialin He ◽  
Ziwei Lan ◽  
Mingyang Deng ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Brain Injury ◽  
Mouse Model ◽  
Intracerebral Hemorrhage ◽  
Signaling Pathway ◽  
Brain Edema ◽  
Akt Signaling ◽  
Neurological Deficits ◽  
Akt Signaling Pathway ◽  
And Oxidative Stress

Estrogen is neuroprotective in brain injury models, and steroid receptor cofactor 3 (SRC3) mediates estrogen signaling. We aimed to investigate whether and how SRC3 is involved in the neuroprotective effects of 17ß-estradiol (E2) in a mouse model of intracerebral hemorrhage (ICH). Ovariectomized female mice were treated with E2 after autologous blood injection-induced ICH. Brain damage was assessed by neurological deficit score, brain water content, and oxidative stress levels. Blood–brain barrier (BBB) integrity was evaluated by Evan's blue extravasation and claudin-5, ZO-1, and occludin levels. SRC3 expression and PI3K/Akt signaling pathway were examined in ICH mice treated with E2. The effect of SRC3 on E2-mediated neuroprotection was determined by examining neurological outcomes in SRC3-deficient mice undergone ICH and E2 treatment. We found that E2 alleviated ICH-induced brain edema and neurological deficits, protected BBB integrity, and suppressed oxidative stress. E2 enhanced SRC3 expression and PI3K-/Akt signaling pathway. SRC3 deficiency abolished the protective effects of E2 on ICH-induced neurological deficits, brain edema, and BBB integrity. Our results suggest that E2 suppresses ICH-induced brain injury and SRC3 plays a critical role in E2-mediated neuroprotection.

scholarly journals A comparative analysis of hydrochlorothiazide and chlorthalidone induced hyponatremia at the dose commonly prescribed in clinical practice

2018 ◽  
Vol 7 (5) ◽  
pp. 935
Author(s):  
Sura Kishore Mishra ◽  
Abinash Panda
Keyword(s):  
Sodium Level ◽  
Dose Range ◽  
Treated Group ◽  
Relative Difference ◽  
Cross Sectional Study ◽  
Plasma Sodium ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Treatment Of Hypertension ◽  
Plasma Sodium Level

Background: Despite the differences in cardiovascular outcomes, pharmacokinetics, pharmacodynamics, the diuretics, chlorthalidone (CTD) and hydrochlorothiazide (HCTZ) are often considered as interchangeable. There is an on-going debate whether CTD should be preferred over HCTZ, because it appears to be more effective in the prevention of cardiovascular events. The relative difference in the incidence of hypokalemia and hyponatremia, is also a topic of debate. With this background, the study was carried out to compare the prevalence of hyponatremia between CTD and HCTZ used in the treatment of hypertension at the dose commonly prescribed in clinical practice.Methods: This was a cross sectional study carried out on a convenience sample of 74 adult patients with provisional diagnosis of hyponatremia or with a plasma sodium level of less than 135mmol/L and having a history of anti-hypertensive use of HTCZ or CTD in the dose range of 12.5-25mg/day and 6.25-12.5mg/day respectively. Chi square test and independent samples ‘t’ test were used analyse the results in GraphPad Prism 6.0.Results: HCTZ was found to be the preferred diuretic in hypertension, whereas CTD was preferred in the age group of 65-74 years. The symptoms indicative of hyponatremia as well as a lower plasma sodium level were more common in the HTCZ treated group. Patients of hypertension using CTD were less predisposed to hyponatremia (OR 0.804, 95% CI 0.207-3.12).Conclusions: Chlorthalidone, when used at a lower dose of 6.25-12.5mg/day for the treatment of hypertension cause a lesser risk of hyponatremia than hydrochlorothiazide.

scholarly journals Plasma Sodium Level Is Associated With Bone Loss Severity in Women With Anorexia Nervosa

2012 ◽  
Vol 73 (11) ◽  
pp. e1379-e1383 ◽  
Author(s):  
Elizabeth A. Lawson ◽  
Pouneh K. Fazeli ◽  
Genevieve Calder ◽  
Hannah Putnam ◽  
Madhusmita Misra ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Bone Loss ◽  
Sodium Level ◽  
Plasma Sodium ◽  
Plasma Sodium Level ◽  
Loss Severity

scholarly journals Glymphatic Drainage Blocking Aggravates Brain Edema, Neuroinflammation via Modulating TNF-α, IL-10, and AQP4 After Intracerebral Hemorrhage in Rats

2021 ◽  
Vol 15 ◽  
Author(s):  
Xichang Liu ◽  
Gang Wu ◽  
Na Tang ◽  
Li Li ◽  
Cuimin Liu ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Brain Edema ◽  
Neuronal Apoptosis ◽  
Caspase 3 ◽  
Neurological Deficits ◽  
Protective Mechanism ◽  
Cervical Lymph Nodes ◽  
Glymphatic System ◽  
Tnf Α ◽  
Active Caspase

Objective: The “Glymphatic” system, a network of perivascular tunnels wrapped by astrocyte endfeet, was reported to be closely associated with the diseases of the central nervous system. Here, we investigated the role of the glymphatic system in intracerebral hemorrhage (ICH) and its protective mechanism.Method: Experimental ICH model was induced by type IV collagenase in rats. Cerebral lymphatic blockage was induced by ligation and removal of cervical lymph nodes. The experimental rats were divided into sham-operated (SO) group, ICH group, and cerebral lymphatic blocking and ICH (ICH + CLB) group. Neurological scores were measured using the Garcia scoring system on the third and seventh day after ICH. Active caspase-3 was immunostained to evaluate neuronal apoptosis. Brain water content was calculated using the dry-wet specific gravity method. The expression of inflammatory factors TNF-α, IL-1β, and IL-10 were detected using ELISA. Aquaporins-4 (AQP-4) and glial fibrillary acidic protein (GFAP) were detected using western blot analysis.Results: The neurological scores of rats in the CLB + ICH group were significantly lower than those in the in ICH group. The number of active caspase-3 neurons was significantly higher in the CLB + ICH group compared to the ICH group. CLB significantly aggravated ICH-induced brain edema 3 d after ICH. There was an increase in the expression of TNF-α, IL-1β, IL-10, AQP-4, GFAP after ICH. The expression of TNF-α was significantly higher in the CLB + ICH group compared to ICH group 3 d after ICH while there was no difference 7 d after ICH. There was no statistical difference in the expression of IL-1β between the ICH group and CLB + ICH group. However, the expression of IL-10 in the CLB + ICH group was significantly lower than that in the ICH group. Lastly, AQP-4 expression was significantly lower in the CLB + ICH group compared to the ICH group while the expression of GFAP was higher in the CLB + ICH group compared to the ICH group.Conclusion: CLB exacerbated cerebral edema, neuroinflammation, neuronal apoptosis and caused neurological deficits in rats with ICH via down-regulating AQP-4, up-regulating inflammatory TNF-α and inhibiting IL-10 expression. The glymphatic drainage system protects against neurologic injury after ICH induction in rats under normal physiological conditions.

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