scholarly journals Elderly with refractory chronic severe hyponatremia and anesthesia management dilemma: a case report with literature review

2021 ◽  
Vol 7 (3) ◽  
Author(s):  
Manish Keshwani ◽  
Habib Md Reazaul Karim ◽  
Suresh Nagalikar ◽  
Deepak Kumar Biswal ◽  
Samarjit Dey
Keyword(s):  
Conventional Treatment ◽  
Elderly Population ◽  
Low Dose ◽  
The Elderly ◽  
Fluid Restriction ◽  
Severe Hyponatremia ◽  
Perioperative Morbidity ◽  
Electrolyte Disorder ◽  
Anesthesia Management ◽  
Chronic Hyponatremia

Hyponatremia is a common electrolyte disorder, especially in the frail elderly population. With the increasing number of surgeries in the aging population, hyponatremia is frequently encountered by anesthesiologists and surgeons. Unfortunately, management of hyponatremia is often complex in the elderly population as it is often multifactorial, and they are physiologically susceptible. While it is well known that preoperative hyponatremia is associated with increased perioperative morbidity and mortality, a lack of recommendations or guidelines adds to the dilemma in managing such cases. The most common cause of chronic hyponatremia in the elderly is the syndrome of inappropriate antidiuretic hormone (SIADH), which can be resistant to conventional treatment. On the other hand, paraneoplastic SIADH leading to hyponatremia is rare, and surgery may be the only option available for its correction. We present a case of a 78- years-gentleman to highlight such a dilemma. He was diagnosed with renal cell carcinoma and had chronic refractory severe hyponatremia despite treatment with fluid restriction, low dose hydrocortisone, tolvaptan, and 3% sodium chloride.

scholarly journals Complications of Extended Endoscopic Endonasal Surgery in Elderly Patients

2018 ◽  
Vol 79 (S 03) ◽  
pp. S287-S288 ◽  
Author(s):  
Tyler Kenning ◽  
Carlos Pinheiro-Neto
Keyword(s):  
Cerebrospinal Fluid ◽  
Elderly Population ◽  
Operative Time ◽  
The Elderly ◽  
High Flow ◽  
Endoscopic Endonasal ◽  
Surgical Interventions ◽  
Perioperative Morbidity ◽  
Increased Risk ◽  
Cerebrospinal Fluid Leaks

AbstractExtended endoscopic endonasal procedures are not unique among surgical interventions in carrying increased risk in the elderly population. There are, however, components of the procedure, namely high-flow cerebrospinal fluid leaks, that do result in the potential for increased perioperative morbidity for these patients. We present the case of a 77-year-old male with a large invasive pituitary macroadenoma resected through a transplanum-transtuberculum-transsellar endonasal approach. A gross total resection was obtained with resolution of the patient's preoperative ophthalmologic deficits. One month postoperatively, the patient developed progressive lethargy and cranial imaging demonstrated a left convexity subacute subdural hematoma. This was evacuated through a twist drill craniostomy. Despite measures to limit the operative time of the initial endonasal procedure as well as the absence of a postoperative cerebrospinal fluid fistula, the patient still developed this complication. Along with more typical potential causes of postoperative decline following extended endonasal procedures, problems from high-flow intraoperative cerebrospinal fluid leaks alone can result in morbidity in the elderly population. This should be acknowledged preoperatively and a high suspicion should exist for the presence of intracranial hemorrhage in these patients with any postoperative deficits. Additional intraoperative measures can be utilized to minimize such risks.The link to the video can be found at: https://youtu.be/EkLmt2T8_UE.

An Unusual Cause of Refractive Chronic Bilateral Leg Ulceration

2004 ◽  
Vol 8 (6) ◽  
pp. 432-437 ◽  
Author(s):  
Laila M. Sabet ◽  
Denise Wexler ◽  
Samih Salama ◽  
Bing Siang Gan
Keyword(s):  
Conventional Treatment ◽  
Elderly Population ◽  
Unusual Case ◽  
The Elderly ◽  
Complete Healing ◽  
Venous Hypertension ◽  
Histopathologic Examination ◽  
Knee Amputation ◽  
History Of ◽  
The Right

Background: Ulceration of the lower extremities is a common disorder that can be very painful. It occurs most frequently in the elderly population as a result of venous hypertension. We report an unusual case of a 32-year-old man with an 11-year history of extensive, painful, bilateral leg ulcers resistant to conventional treatment necessitating above-knee amputation of the left leg. Eventually, the patient was treated with prednisone, which led to almost complete healing of the ulcers of the right leg. Objective: The objective of this report is to discuss a rare cause of chronic bilateral leg ulceration. Methods: Detailed histopathologic examination showed a complex pattern of overlapping features of several specific dermatologic conditions, including necrobiosis lipoidica (NL), necrobiotic xanthogranuloma (NXG), and the destructive form of granuloma annulare (GA). Conclusion: The characteristics of our patient suggest a variant of a cutaneous necrobiotic disorder that has not been previously reported. When clinicians are confronted with recalcitrant ulcerations in the lower extremity, this group of disorders should be considered in the differential diagnosis.

scholarly journals Treatment of Severe Hyponatremia: Conventional and Novel Aspects

2001 ◽  
Vol 12 (suppl 1) ◽  
pp. S10-S14 ◽  
Author(s):  
PETER GROSS ◽  
DOREEN REIMANN ◽  
JANA HENSCHKOWSKI ◽  
MAXWELL DAMIAN
Keyword(s):  
Brain Edema ◽  
Medical Emergency ◽  
Fluid Restriction ◽  
Water Diuresis ◽  
Severe Hyponatremia ◽  
Electrolyte Disorder ◽  
Initial Imaging ◽  
Permanent Brain Damage ◽  
Near Future ◽  
Number Of Authors

Abstract.Hyponatremia is a frequent electrolyte disorder. A hyponatremia is called acute severe (<115 mM) when the duration has been <36 to 48 h. Such patients often have advanced symptoms as a result of brain edema. Acute severe hyponatremia is a medical emergency. It should be corrected rapidly to approximately 130 mM to prevent permanent brain damage. In contrast, in chronic severe hyponatremia (>4 to 6 d), there is no brain edema and symptoms are usually mild. In such patients, a number of authors have recommended a correction rate <0.5 mM/h to approximately 130 mM to minimize the risk of cerebral myelinolysis. Sometimes it is not possible to diagnose whether a severe hyponatremia is acute or chronic. In such cases, an initial imaging procedure is helpful in deciding whether rapid or slow correction should be prescribed. The modalities of treatment of severe hyponatremia have so far consisted of infusions of hypertonic saline plus fluid restriction. In the near future, vasopressin antagonists will become available. Preliminary experience has already demonstrated their efficiency of inducing a sustained water diuresis and a correction of hyponatremia.

scholarly journals Urea for Chronic Hyponatremia

2019 ◽  
Vol 49 (1-2) ◽  
pp. 212-218 ◽  
Author(s):  
Helbert Rondon-Berrios
Keyword(s):  
Therapeutic Strategy ◽  
Case Series ◽  
The United States ◽  
Efficacy And Safety ◽  
Severe Hyponatremia ◽  
Water Excretion ◽  
Electrolyte Disorder ◽  
Adverse Side Effects ◽  
Chronic Hyponatremia ◽  
Patient Nonadherence

Background: Hyponatremia is the most common electrolyte disorder encountered clinically. While acute and/or severe hyponatremia is commonly associated with significant symptoms, milder and more chronic forms of hyponatremia remain clinically inconspicuous. Recent evidence suggests that even milder forms of hyponatremia are associated with increased morbidity and mortality. Despite this, currently available treatments for chronic hyponatremia lack data on efficacy and/or have important limitations related to patient nonadherence, adverse side effects, and/or significant costs. Consequently, there is a clear need for investigation of alternative treatments for this common condition. Summary: Small case series conducted in Europe since the early 1980s suggest that urea, an oral osmotic diuretic that increases urinary water excretion, is safe and effective for the treatment of chronic hyponatremia. In 2016, a novel formulation of urea became available in the United States. Our group recently reported the first and only study describing the efficacy and safety of this American formulation of oral urea among hospitalized patients with hyponatremia. Key Messages: Oral urea appears to be an effective, safe, and well-tolerated therapeutic strategy in the management of chronic hyponatremia.

scholarly journals Atrioventricular conduction defect associated with severe hyponatremia

2018 ◽  
Vol 91 (3) ◽  
pp. 342-345
Author(s):  
Turgut Karabag ◽  
Belma Kalayci ◽  
Muhammet Rasit Sayin ◽  
Turgay Erten
Keyword(s):  
Elderly Patient ◽  
Heart Disease ◽  
Atrioventricular Block ◽  
The Elderly ◽  
Complete Atrioventricular Block ◽  
Severe Hyponatremia ◽  
Electrolyte Disorder ◽  
Conduction Defect ◽  
Sodium Replacement ◽  
Complete Atrioventricular

Hyponatremia is the most common electrolyte disorder among hospitalized patients and in the clinical setting. Patients with hyponatremia may develop a variety of symptoms, primarily neurological and gastrointestinal. Hyponatremia is more frequently encountered in patients with an underlying heart disease, particularly in the elderly. We hereby present a case of complete atrioventricular block in an elderly patient who had undergone aortic valve replacement and had been using thiazide. Complete atrioventricular block improved after sodium replacement therapy and no other cause of electrolyte disorder was documented. 

Validity and Reliability of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE)

GeroPsych ◽  
2019 ◽  
Vol 32 (3) ◽  
pp. 145-151
Author(s):  
Mahshid Foroughan ◽  
Zahra Jafari ◽  
Ida Ghaemmagham Farahani ◽  
Vahid Rashedi
Keyword(s):  
Psychometric Properties ◽  
Elderly Population ◽  
Formal Education ◽  
The Elderly ◽  
Cognitive State ◽  
Validity And Reliability ◽  
Internal Reliability ◽  
Dsm Iv ◽  
Test Retest Reliability ◽  
Farsi Version

Abstract. This study examines the psychometric properties of the IQCODE and its applicability in the Iranian elderly population. A group of 95 elderly patients with at least 4 years of formal education who fulfilled the criteria of DSM-IV-TR for dementia were examined by the MMSE and the AMTs. The Farsi version of the IQCODE was subsequently administered to their primary caregivers. Results showed a significant correlation ( p = .01) between the score of the questionnaire and the results of the MMSE ( r = −0.647) and AMTs ( r = −0.641). A high internal reliability of the questionnaire was confirmed by Cronbach’s alpha coefficient (α = 0.927) and test-retest reliability by correlation coefficient ( r = 0.81). This study found that the IQCODE has acceptable psychometric properties and can be used for evaluating the cognitive state in the elderly population of Iran.

Spontaneous Intracerebral Hemorrhage in the Elderly Population

2018 ◽  
Author(s):  
S. Sommaruga ◽  
R. Beekman ◽  
S. Chu ◽  
Z. King ◽  
C. Matouk ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Elderly Population ◽  
The Elderly ◽  
Spontaneous Intracerebral Hemorrhage

Percutaneous Sacroplasty for Sacral Insufficiency Fractures: Case Series and Review of Presentation, Diagnosis, and Treatment

2019 ◽  
Vol 3 ◽  
pp. 4
Author(s):  
Andrew C. Clark ◽  
Devang Butani
Keyword(s):  
Low Back Pain ◽  
Elderly Population ◽  
Case Series ◽  
The Elderly ◽  
Treatment Method ◽  
Open Reduction Internal Fixation ◽  
Low Back ◽  
Insufficiency Fractures ◽  
Invasive Treatment ◽  
Sacral Insufficiency Fractures

Sacral insufficiency fractures (SIFs) are a cause of debilitating low back pain that is often difficult to diagnosis and manage. The diagnosis of SIF is often delayed due to inaccurately attributing symptoms to spondylosis, which is a commonly present in the elderly population where SIFs are most prevalent. Historically, treatment consisted of medical management and open reduction internal fixation reserved for severe cases. However, percutaneous sacroplasty has emerged as a minimally invasive treatment option which provides early pain relief without significant complications. The objective of this article is to raise awareness of SIFs and percutaneous sacroplasty as an effective and safe treatment method.

Sign in / Sign up

Export Citation Format

Share Document