Excessive Excretion Research Articles

SETD2 regulates SLC family transporter-mediated sodium and glucose reabsorptions in renal tubule

A regulatory mechanism for SLC family transporters, critical transporters for sodium and glucose reabsorptions in renal tubule, is incompletely understood. Here, we report an important regulation of SLC family transporter by SETD2, a chromatin remodeling gene whose alterations have been found in a subset of kidney cancers. Kidney-specific inactivation of Setd2 resulted in hypovolemia with excessive urine excretion in mouse and interestingly, RNA-sequencing analysis of Setd2-deficient murine kidney exhibited decreased expressions of SLC family transporters, critical transporters for sodium and glucose reabsorptions in renal tubule. Importantly, inactivation of Setd2 in murine kidney displayed attenuated dapagliflozin-induced diuresis and glucose excretion, further supporting that SETD2 might regulate SLCfamily transporter-mediated sodium and glucose reabsorptions in renal tubule. These data uncover an important regulation of SLC family transporter by SETD2, which may illuminate a crosstalk between metabolism and epigenome in renal tubule.

Mucopolysaccharidosis-Plus Syndrome: Is This a Type of Mucopolysaccharidosis or a Separate Kind of Metabolic Disease?

Several years ago, dozens of cases were described in patients with symptoms very similar to mucopolysaccharidosis (MPS). This new disease entity was described as mucopolysaccharidosis-plus syndrome (MPSPS). The name of the disease indicates that in addition to the typical symptoms of conventional MPS, patients develop other features such as congenital heart defects and kidney and hematopoietic system disorders. The symptoms are highly advanced, and patients usually do not survive past the second year of life. MPSPS is inherited in an autosomal recessive manner and is caused by a homozygous-specific mutation in the gene encoding the VPS33A protein. To date, it has been described in 41 patients. Patients with MPSPS exhibited excessive excretion of glycosaminoglycans (GAGs) in the urine and exceptionally high levels of heparan sulfate in the plasma, but the accumulation of substrates is not caused by a decrease in the activity of any lysosomal enzymes. Here, we discuss the pathomechanisms and symptoms of MPSPS, comparing them to those of MPS. Moreover, we asked the question whether MPSPS should be classified as a type of MPS or a separate disease, as contrary to 'classical' MPS types, despite GAG accumulation, no defects in lysosomal enzymes responsible for degradation of these compounds could be detected in MPSPS. The molecular mechanism of the appearance of GAG accumulation in MPSPS is suggested on the basis of results available in the literature.

The Evolving Role of Genetic Testing in Monogenic Kidney Stone Disease: Spotlight on Primary Hyperoxaluria.

Multiple factors are thought to give rise to common, recurrent kidney stone disease, but for monogenic stone disorders a firm diagnosis is possible through genetic testing. The autosomal recessive primary hyperoxalurias (PH) are rare forms of monogenic kidney stone disease. All 3 types of PH are caused by inborn errors of glyoxylate metabolism in the liver, leading to hepatic oxalate overproduction and excessive renal urinary oxalate excretion. These conditions are characterized by kidney stones, nephrocalcinosis, progressive chronic kidney disease, and kidney failure. Systemic oxalosis, the extra-renal deposition of oxalate resulting in severe morbidity and mortality, occurs in chronic kidney disease when oxalate clearance by the kidneys declines. Novel small interfering RNA-based therapeutics targeting the liver to reduce urinary oxalate excretion have been approved, introducing precision medicine to treat primary hyperoxaluria type 1. The goal of this narrative review is to address the benefits and practicalities of genetic testing for suspected monogenic kidney stone disease and the critical roles of a multidisciplinary team. We collated our procedures, education, training, and workflows to help other clinicians integrate genetic assessment into their diagnostic routines. In our experience, increased access to genetic testing facilitates early detection of PH and other monogenic causes of kidney stone disease so that individualized care can be instituted promptly. Alongside biochemical assessments, more widespread genetic testing may ensure more timely diagnoses so that patients with suspected monogenic kidney stone disease gain access to an expanded range of services and enrollment in clinical trials and registries.

Ghrelin enhances tubular magnesium absorption in the kidney.

Osteoporosis after bariatric surgery is an increasing health concern as the rate of bariatric surgery has risen. In animal studies mimicking bariatric procedures, bone disease, together with decreased serum levels of Ca2+, Mg2+ and the gastric hormone Ghrelin were described. Ghrelin regulates metabolism by binding to and activating the growth hormone secretagogue receptor (GHSR) which is also expressed in the kidney. As calcium and magnesium are key components of bone, we tested the hypothesis that Ghrelin-deficiency contributes to osteoporosis via reduced upregulation of the renal calcium channel TRPV5 and the heteromeric magnesium channel TRPM6/7. We expressed GHSR with TRPV5 or TRPM6/7 channel in HEK293 cells and treated them with purified Ghrelin. Whole-cell current density was analyzed by patch-clamp recording. Nephron-specific gene expression was performed by tubular microdissection followed by qPCR in wild-type (WT) mice, and immunofluorescent imaging of GHSR-eGFP mice. Tubular magnesium homeostasis was analyzed in GHSR-null and WT mice at baseline and after caloric restriction. After Ghrelin exposure, whole-cell current density did not change for TRPV5 but increased for TRPM6/7 in a dose-dependent fashion. Applying the Ghrelin-mimetic (D-Trp7, Ala8,D-Phe10)-α-MSH (6-11) amide without and with the GHSR antagonist (D-Lys3)-GHRP6, we confirmed the stimulatory role of Ghrelin towards TRPM6/7. As GHSR initiates downstream signaling via protein kinase A (PKA), we found that the PKA inhibitor H89 abrogated TRPM6/7 stimulation by Ghrelin. Similarly, transfected Gαs, but not the Gαs mutant Q227L, nor Gαi2, Gαq, or Gα13 upregulated TRPM6/7 current density. In microdissected TALs and DCTs similar levels of GHSR mRNA were detected. In contrast, TRPM6 mRNA was expressed in the DCT and also detected in the TAL at 25% expression compared to DCT. Immunofluorescent studies using reporter GHSR-eGFP mice showed a strong eGFP signal in the TAL but surprisingly displayed no eGFP signal in the DCT. In 3-, 6-, and 9-month-old GHSR-null and WT mice, baseline serum magnesium was not significantly different, but 24-h urinary magnesium excretion was elevated in 9-month-old GHSR-null mice. In calorically restricted GHSR-null mice, we detected excess urinary magnesium excretion and reduced serum magnesium levels compared to WT mice. The kidneys from calorically restricted WT mice showed upregulated gene expression of magnesiotropic genes Hnf1b, Cldn-16, Cldn-19, Fxyd-2b, and Parvalbumin compared to GHSR-null mice. Our in vitro studies show that Ghrelin stimulates TRPM6/7 via GHSR and Gαs-PKA signaling. The murine studies are consistent with Ghrelin-GHSR signaling inducing reduced urinary magnesium excretion, particularly in calorically restricted mice when Ghrelin levels are elevated. This effect may be mediated by Ghrelin-upregulation of TRPM6 in the TAL and/or upregulation of other magnesiotropic genes. We postulate that rising Ghrelin levels with hunger contribute to increased renal Mg2+ reabsorption to compensate for lack of enteral Mg2+ uptake.

Feed efficiency of dairy cattle as genetic trait

This review article is devoted to the use of feed efficiency traits in dairy cattle breeding. An efficient cow is defined as the one that produces the same amount of milk and milk solids while consuming less feed and remaining healthy and fertile; thus, allowing to reduce costs without decrease in production. Improving feed efficiency is economically important due to the increasing price of fodder. Feed efficiency is a genetically complex trait that can be described as units of product output (e.g., milk yield) per unit of feed input. Nowadays genetic evaluation of dairy cattle for feed efficiency is routinely conducted in several countries, including Australia, USA, Canada, Netherlands, Denmark, Sweden, Finland, Norway and United Kingdom. Different countries use different measures of feed efficiency of dairy cows. The main feed efficiency traits are dry matter intake, gross feed efficiency, residual feed intake, energy balance and feed saved. Genome-wide association studies demonstrated that feed efficiency in polygenic trait. Nevertheless, several genes with large effects on feed efficiency were identified. Estimates of heritability of these traits vary from 0.07 to 0.49 and show the presence of considerable genetic variation of these traits and therefore, the possibility of their genetic improvement under the conditions of inclusion in breeding programs. Changes in diet and rumen microbiome substantially impact feed efficiency of dairy cows. Feed efficiency is related to methane emissions and excess nitrogen excretion. Genetic improvement of feed efficiency requires recording of individual data on feed intake in cows. Such data are limited. Two options exist to solve this problem: use of indirect predictors and genomic prediction. Accuracy of genomic prediction varies from 0.21 to 0.61 across countries. International cooperative pro­jects such as Efficient Dairy Genome Project in Canada were launched to establish large databases and to increase accuracy of feed efficiency traits genomic prediction. Future directions of research are the use of novel technologies: mid-infrared spectroscopy, artificial intelligence, holo-omics.

MANAGEMENT OF ASRIGDRA W.S.R. TO DUB- CASE STUDY

In Ayurveda, the most common bleeding disorders in women are referred to as Asrigdara and are characterised by Pradirana (excess excretion) of Raja (menstrual blood). In modern medicine, it is called "Dysfunctional Uter-ine Bleeding." Despite their high costs, hormonal therapy, anti-prostaglandins, and anti-fibrinolytic agents have not proven their definitive efficacy in modern medicine; their side effects have resulted in hormonal imbalances. In Ayurvedic classics, all gynaecological disorders are classified as Yonivyapad. Charaka Acharya Raktapra-dara is described as Pradara Roga by Charaka Aacharya. Excessive vaginal white discharge is referred to as Shweta Pradara and excessive or heavy menstrual bleeding is referred to as Raktapradara. It is known as Pra-dara due to pradirana (excessive excretion) of raja (menstrual blood) and Asrigdara due to dirana (excessive excretion) of Asrk (menstrual blood). Menorrhagia is treated with Haemostatic, analgesic, and hormonal thera-pies in modern medicine, which has limitations. As a result, an integrated and comprehensive therapeutic inter-vention in Ayurveda is required to prevent recurrence. Sodhana and Shamana therapies are recommended, but if Rugnabala is low, only Shamana is recommended. Many herbals and herbo-mineral preparations are mentioned in Ayurveda to treat Asrgdara and related symptoms, and these can be used according to Anubandha Dosha and Lakshana. Because Asrgdara is primarily caused by Vata Pitta Dosha, Kashaya Rasa and Pittashamaka Chikitsa may be used. Ayurvedic formulations aid in the breakdown of Asrgdara pathogeneses and their recur-rence.

Simultaneous Occurrence of Hyponatremia and Hypokalemia in a Patient with Herpes Zoster: A Case Report with a Review of the Literature.

We herein report a patient with herpes zoster (HZ), severe hyponatremia, and hypokalemia. Syndrome of inappropriate antidiuresis (SIAD) leads to euvolemic hyponatremia and hypoosmotic plasma due to inadequate diuresis. Hyponatremia in the current patient was caused by SIAD and associated with HZ of the trigeminal facial nerve (V1). The patient also had hypokalemia, with excessive urinary potassium excretion and elevated cortisol levels. Hypokalemia is caused by hypercortisolemia, which is stimulated by HZ pain. Adequate treatment for HZ and comprehensive pain control play pivotal roles in improving SIAD, cortisol hypersecretion, and the subsequent electrolyte abnormalities.

A case of giardiasis diagnosed from a high output stoma after surgery for obstructive colorectal cancer

This report describes a case of giardiasis detected through stool smear analysis of postoperative stool fluid collected from a high output stoma for obstructive colorectal cancer. The patient, a 67-year-old male, underwent right hemicolectomy with ileostomy for obstructive colorectal cancer. The persistent excessive excretion of postoperative stool fluid from the stoma prompted a stool smear test. The findings revealed the presence of Giardia intestinalis. Fecal output decreased when metronidazole was administered orally. The study strongly recommends that patients with prolonged gastrointestinal symptoms need to undergo stool smear tests.

Psychogenic polydipsia: A diagnostic challenge

ABSTRACT Primary polydipsia (PP) is a disorder that is clinically characterised by excessive thirst accompanied by increased fluid intake and subsequent excessive excretion of urine without an obvious cause. PP in childhood due to psychogenic causes is a rare condition and may be more prevalent than thought. The differential diagnosis of polydipsia and polyuria is broad due to extensive associated disease spectrum, including renal, endocrine, and neurological diseases. Furthermore, differentiating PP from diabetes insipidus (DI) is essential because the treatment of the latter could be deleterious in patients with PP. We present the case of a 3-year-old boy who presented with psychogenic polydipsia. In the present case, the child was started on desmopressin, considering it a case of DI, in view of the history of increased water intake and urinary output. However, a detailed psychological assessment of the child revealed the case to be an autism spectrum disorder. Subsequently, desmopressin was discontinued, and there was a rapid normalisation of fluid intake along with significant reduction in the urine output after starting psychological intervention and implementing strict water restriction. This confirmed the diagnosis as a case of psychogenic polydipsia, which is a common occurrence in children with developmental disorders.

Mean-Variance Serum Sodium Associations with Diabetes Patients

Serum sodium (SNa) is a critically significant component of hyponatremia and bones, has firmly been established as a risk factor correlated with many diseases such as diabetes, heart, anaemia, etc and the incidence of fragility fractures. Note that the fragility fractures are a general complication in type 2 diabetes (T2D) patients, contributing to high rates of mortality and morbidity together with mounting public health costs. SNa is a fundamental component for normal physiological processes, and T2D patients may experience osmotic diuresis as a consequence of disease-related hyperglycemia, contributing to the excess excretion of sodium in the urine and resulting in hyponatremia. Dysnatremias [hyponatremia (<136 mmol/L) and hypernatremia (>145mmol/L)] can severely affect several physiologic organ systems and functions. Diabetes is correlated with many important electrolyte disorders, predominantly affecting magnesium, SNa, and potassium. However, the correlation/ association of SNa with diabetes patients is not clear. This can be confirmed based on the proper probabilistic model of SNa with diabetes status along with the other explanatory factors of the disease. On the other hand, this type of association can be obtained based on the models of fasting glucose/post glucose/random glucose/HbA1c level with SNa and other explanatory factors of the diabetes disease.

Real-Time Monitoring of Fecal Nitrogen Excretion to the Environment Using Near-Infrared Reflectance Spectroscopy: A Preliminary Study in Rabbits

The excessive excretion of nitrogen (N) by farm animals can pose severe environmental risks. In this study, near-infrared reflectance (NIR) spectroscopy (NIRS) was used to explore the feasibility of developing a real-time in situ monitoring tool for fecal N excretion in rabbits. A total of 70 feed and 282 fecal samples from an in vivo digestibility experiment were used. Feed and fecal NIR spectra were employed to develop chemometric models using modified partial least squares (MPLS) for feed and feces, and artificial neural networks (ANN) for feces to predict dietary and fecal N content and fecal N digestibility. Very good accuracy was achieved in predicting feed N (R2val = 0.96; standard error of prediction, SEP = 0.15) and fecal N (R2val = 0.88; SEP = 0.44) content, whereas N digestibility models from wet fecal spectra had a relatively low precision (R2val = 0.70; SEP = 0.018) with MPLS methodology. In contrast, ANNs yielded more robust prediction models for fecal (R2val = 0.98; SEP = 0.25) N content and N digestibility (R2val = 0.91; SEP = 0.012) using wet feces. In conclusion, NIRS calibration with ANNs can be a suitable tool for monitoring the environmental load of N with high precision and accuracy.

A COMPARATIVE CLINICAL STUDY TO EVALUATE THE EFFICACY OF JEERAKAWLEHA AND YASTIMADHU CHOORNA IN THE MANAGEMENT OF ASRUGDARA

Women is endowed with energy of procreation for which menarche is the first step. Menstrual cycle commences with this and ends with menopause and having normal menstruation depicts the wellbeing of female. In normal menstruation the duration of menstruation is about 4-5 days, and the amount of blood loss is estimated to be 20- 80ml with an average 35 ml. Due to pradirana(excessive excretion) of raja (menstrual blood), it is named as pradara/asrugdara. Asrugdara characterized by excessive prolonged menstrual or intermenstrual bleeding due to Pradirana (excessive excretion) of raja (Menstrual blood), it is named as Pradara and or Asrugdara. As heavy menstrual bleeding is a debilitating disorder, the woman requires rapid, safe and effective treatment. In ayurvedic classicc a variety of treatments in the management of asrugdarahas been described. Out of them, the subject is selected to compare efficacy of Jeerakavaleha mentioned by Yogratnakara, with effect of Yastimadhu choornamentioned by Bhavaprakasha which is already proved in the previous study. Jeerakavaleha has Gerbhashyashodhaka, stambhaka, raktapittahara property.

138 Sire Differences for Blood Urea Nitrogen (BUN) in Hereford Cattle

Abstract Excess Nitrogen excretion is a growing concern worldwide within animal agriculture, and blood urea nitrogen (BUN; mg/dL) is known as a predictor of nitrogen excretion in cattle. The objective of this study was to determine sire differences in BUN within a population of Hereford steers. Steers (n = 74) were born between March and June of 2021 from a reference sire herd for The American Hereford Association in Western Nebraska. Sixteen different Hereford sires from The American Hereford Association reference sire program produced offspring used in this study. The steers entered an on-site feed intake unit and were fed a finishing diet consisting predominantly of corn, corn distiller grain, and corn silage. Animals were subjected to a 21-d warm-up period with a 55-d individual feed intake test period. Blood samples were collected on day 43 of the test period. Blood samples were then centrifuged to extract serum. The Urea Nitrogen (BUN) Colorimetric Detection Kit by Invitrogen was used for the assay. The average BUN concentration for all animals in this study was (0.492 ± 0.061 mg/dL). A generalized linear regression model was used to determine sire differences in BUN concentrations. Factors considered were sire and pen group. The sire with lowest least squared mean progeny BUN concentration estimate was (0.0362 ± 0.08 mg/dL; n = 4), and the highest was (0.605 ± 0.03 mg/dL; n = 7). Sire differences (P < 0.05; r2 = 0.36) were found to be important sources of variation as evidenced by its r2; however, pen group (P = 0.65; r2 < 0.05) appeared to have little impact on variation. The differences in sires indicate genetic differences could be leveraged to reduce excess nitrogen excretion in cattle populations.

Surgical treatment of tertiary hyperparathyroidism: does one fit for all?

Tertiary hyperparathyroidism (3HPT) is defined as a condition of excessive autonomous excretion of intact parathyroid hormone (iPTH) with persistent hypercalcemia (>10.5 mg/dL) that lasts for more than 12 months after a successful kidney transplantation, in the context of a long course secondary hyperparathyroidism (2HPT). The chronic high levels of iPTH cause a worsening of graft function, accompanied by systemic symptoms of hypercalcemia. The only curative therapy is parathyroidectomy (PTX). It remains unclear whether total parathyroidectomy with autotransplantation (TPTX-AT) or subtotal parathyroidectomy (SPTX) lead to better outcomes. The aim of this retrospective, single-institution cohort study is to evaluate the rate of persistent or recurrent disease and postoperative calcium/iPTH disturbances in patients treated with TPTX-AT or SPTX for 3HPT. A single-center retrospective analysis of 3HPT patients submitted to TPTX-AT or SPTX between 2007-2020 with at least 24 months follow-up was conducted. The outcome parameters included persistence/recurrence of disease, incidence of transitory hypocalcemia, and temporary/permanent hypoparathyroidism. A cohort of 52 patients was analyzed and divided in two groups: 38 (73%) were submitted for TPTX-AT, and 14 patients (27%) were submitted for SPTX. The TPTX-AT population showed lower plasmatic calcium concentrations compared with the SPTX group during the entire follow-up period (p<0.001). There were eight cases (21%) of transitory hypocalcemia in the TPTX-AT group and none in the SPTX group, with p=0.065. Two cases (5%) of temporary hypoparathyroidism occurred in the TPTX-AT group and none in the SPTX group, with p= 0.530. There were no cases of permanent hypoparathyroidism and no cases of persistent disease. No statistical difference was assessed for the recurrence of 3HPT between the TPTX-AT group and the SPTX group (N=1, 3% vs N=1, 7%) (p=0.470). No significative difference was registered between the TPTX-AT and SPTX groups in terms of persistence/recurrence of disease, incidence of transitory hypocalcemia, and temporary/permanent hypoparathyroidism. Mean calcium levels iPTH values were statistically lower among the TPTX-AT group compared with the SPTX group while remaining always in the range of normality.

Role of Fluid Resuscitation and Supportive Management of Diarrhea

The pediatric population is sensitive in every aspect. There are several parts of their bodies that need extreme levels of care and support until these children have reached a mature age. Similarly, there are several aspects of health that require immediate and urgent intervention, particularly in the pediatric population for better care and management. The reason behind this is the delicate and sensitive nature of the children’s health. Compromising any aspect of pediatric care might lead to severe consequences, which could be life-threatening too. Therefore, it is in the best interest of both the parents of the children and the physicians to be vigilant about the affected children’s symptoms just so they do not miss out on any important signs that could be transient or short-lived. Diarrhea is among the pediatric conditions that can very easily take a turn for the worse if it is not managed appropriately. Diarrhea can lead to severe consequences, including death in children, especially the malnourished ones. Diarrhea results in the excessive excretion of water, and electrolytes including sodium, potassium, bicarbonate, and zinc through watery stools. Dehydration ensues when these losses are not sufficiently replenished, leading to deficits in both water and electrolytes. The extent of dehydration is categorized based on symptoms and signs that mirror the quantity of fluid expelled. Depending upon these extents and degrees of dehydration, performing immediate resuscitation measures might be necessary. Among these measures, oral rehydration therapy is considered to be one of the most useful ones. It helps replenish the electrolytes rapidly and without causing any life-threatening consequences, especially when done within the specified time. On the brighter side, these fluid resuscitative measures might be the only interventions required to stop the child's progression further towards a severe form of the disease. This review is based on this fact only, and it revolves around the importance of performing fluid resuscitation and other elementary-level supportive measures that might be the only shot at saving the life of the child if done at an early stage. Thai review will help take action under the right circumstances if such a case arises in the clinical setting.

CONCEPT OF ABNORMAL UTERINE BLEEDING IN AYURVEDA: A REVIEW

Abnormal Uterine Bleeding is one of the most common problems seen in a gynecological OPD. It is characterized by excessive bleeding per vaginum in amount and duration both. Asirgdhara is a condition in which there is Dirana (excess excretion) of Raja (menstrual blood). Abnormal Uterine Bleeding is almost parallel to Asrigdhar mentioned in Ayurvedic classics. Vata and Pitta Dosha vitiation mainly leads to Asrigdhar hence drugs predominant in Kashaya Rasa and Pitta Shamak properties are used. Kashaya Rasa plays an important role in relieving bleeding due to Stambhak property. Rakta Dhatu Poshak Ahar should be advised. Therefore, treatment line should be Raktavardhaka and Raktasthambhak. Hence this study aims in understanding what is Abnormal Uterine Bleeding, it's pathogenesis and treatment modalities according to both Ayurveda and modern science.

Adherence to the Mediterranean Diet and Urinary Sodium Excretion in people at high risk of dementia

Abstract Background Both adequate sodium intake and adherence to the Mediterranean Diet (MedDiet) are largely described as important factors for the prevention and control of hypertension and cerebrovascular diseases. However, data regarding sodium intake in the MedDiet is scarce. This study aims to quantify the association between the MedDiet adherence and sodium excretion. Methods This cross-sectional analysis was carried out under the MIND-Matosinhos randomized controlled trial, a community-based program for Portuguese adults at high risk of dementia. The adherence to the MedDiet was assessed through the Portuguese version of the Mediterranean Diet Adherence Screener questionnaire, and a score ≥10 indicated a high adherence. A 24h urine collection was used to evaluate creatinine and sodium excretion. Excessive sodium excretion was defined as ≥ 2000 mg/day. Sociodemographic, lifestyle and health-related data were obtained through structured questionnaires. The association between the adherence to the MedDiet and urinary sodium excretion (recoded into two categories by the median) was quantified by calculating Odds Ratios (OR) and respective 95% Confidence Intervals (95% CI) using a binary logistic regression. Results A total of 126 individuals (24 to 83 years old; median age of 70.0) was included in this study (58.7% female). High adherence to the MedDiet was observed among 15.9% of the sample whereas excessive sodium excretion was reported by 84.1%. After adjusting for confounders, participants with high adherence to the MedDiet showed a higher sodium excretion (OR = 4.05; 95% CI: 1.33-12.37). Conclusions A high adherence to the MedDiet was associated with a higher sodium excretion. Thus, an increased adherence to this dietary pattern seems to have limited effects on the adequacy of sodium intake. This highlights the importance of public health measures to reduce sodium intake when following a MedDiet namely by improving consumer empowerment. Key messages • Despite the well-known protective effect of the Mediterranean Diet on hypertension and cerebrovascular diseases, the role of sodium intake within this dietary pattern is still understudied. • The Mediterranean Diet can be an important source of hidden sodium, which enhances the need to invest in public health measures to reduce sodium intake, namely through culinary medicine education.

THU239 Tolvaptan For SIADH Management In Children

Abstract Disclosure: M. Igarashi: None. T. Kashima: None. H. Doi: None. K. Yoshii: None. Y. Naiki: None. R. Horikawa: None. [Background] Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is common after brain surgery and its’ management is difficult. In Japan, tolvaptan was approved for SIADH management in adults, but there are limited reports on the use of tolvaptan for SIADH in children.We presented two cases which showed triphasic response after neurosurgery and was treated with tolvaptan for SIADH phase. We will also summarize other cases which were treated with tolvaptan for SIADH phase after neurosurgery in discussion. [Case] Case1 is a 5-month-old boy with choroid plexus papilloma.A tumor resection was performed after chemotherapy. After tumor resection, serum sodium level went up to 171 mEq/L with diluted polyuria. So he was diagnosed as diabetes insipidus and treated with vasopressin. The dose of vasopressin was decreased and it was stopped on postoperative day (POD) 6, but serum sodium level further decreased and he was diagnosed as SIADH. Water restriction and hypertonic saline administration were performed. Tolvaptan at a dose of 0.1mg/kg was administered and sodium level improved from 123 mEq/L to 137 mEq/L.However, urine volume was decreased again and sodium level went down to 132 mEq/L, so tolvaptan was administered again. After second administration of tolvaptan, polyuria lasted and sodium level went up to 145 mEq/L, which was managed with temporary use of vasopressin. Case 2 is a 6-year-old girl with craniopharyngioma. After tumor resection, polyuria was observed and she was diagnosed as diabetes insipidus, which was treated with vasopressin.On POD 4, she was diagnosed as SIADH. Since water restriction was not effective, tolvaptan was administered twice (0.1mg/kg and 0.4mg/kg respectively). After second administration of tolvaptan, due to polyuria and diluted urine sodium level went up to 161 mEq/L, which was treated with vasopressin. Diluted urine and polyuria lasted, so finally she was diagnosed as diabetes insipidus. [Discussion] Tolvaptan was used for the management of SIADH that was resistant to water restriction or salt supplementation and it was useful for improving or maintaining sodium level. However, in some case, hypernatremia due to excessive free water excretion was caused after the dose of tolvaptan was increased. The appropriate dosage of tolvaptan has not yet been established. The risk of rapid sodium elevation should be considered and monitoring of water balance and sodium level was needed after using tolvaptan. [Conclusion] Tolvaptan could be an effective option for the management of SIADH, but frequent monitoring of sodium level is needed. Presentation: Thursday, June 15, 2023

A Case Study in Asrigdara with Shodhana and Shamana Chikitsa

Asrigdara is a condition that physician to face in day-to-day practice. It is a common medical disease seen in women. Which can cause significant disturbances physically as well as mentally. Asrigdara characterized by excessive excretion of Asrik. Abnormal uterine bleeding includes both cyclic and noncyclic bleeding. Acharya Charaka has explained many causative factors for like Ati Lavana, Amla, Guru, Katu, Vidahi, Krushara, Payasa, Saktu, Mastu etc. aggravates Vata withholds Rakta, vitiated due to above mentioned reasons. Increases its amount reaching the Rajovaha Sira (uterine vessels) which further increases Rajas (menstrual blood). Normalizing the amount of flow and curing the associated symptoms are fundamental principles of treatment to be adopted. A married female patient of 31 years attended the OPD with the complaint of increased duration of menstruation associated with excessive flow with lower abdominal pain; pain was spasmodic in nature along with generalized weakness. With the aim to minimize the cyclic blood loss and regularize the cycle the Shodhana Chikitsa (detoxification) i.e., Virechana Karma and Shamana Chikita (palliative treatment) with Shalmali Ghrita. This therapy, helped to cure the heavy flow during menses and regularize the cycle.

REVIEW ARTICLE ON RAKTAPRADARA (DYSFUNCTIONAL UTERINE BLEEDING)

Raktapradara is one of the most common gynecological disorders. According to Charaka, due to Pradirana (excessive excretion) of Raja (menstrual blood), it is named Pradara, or there is excessive excretion or Asruk (menstrual blood); hence it is known as Raktapradara. According to modern, it can be correlated with DUB (Dysfunctional Uterine Bleeding). In modern medicine, Haemostatic, analgesic, &amp; hormonal therapies are advised for D.U.B., which has limitations, but in our Ayurvedic text, many drugs are advised for the management of Raktapradara. These are Raktashodaka (blood purifier), Stambhak (Haemostatic), and Balya (reduces weakness). D.U.B. can be cured with an Ayurvedic regimen &amp; can avoid hysterectomy or other surgical interventions.