Hydroelectrolytic Disorders Research Articles

Use of posaconazole in children: Experience in a tertiary pediatric hospital

There is limited information on the use of posaconazole in children. This retrospective and descriptive study was conducted to evaluate the clinical, microbiological characteristics and evolution of patients treated with posaconazole between August 2010 and March 2017. We included 16 children. Median age: 161 months (interquartile range -IQR- 69-173 m). All had underlying disease and a proven invasive fungal infection. The most frequent isolated were Mucor spp. and Aspergillus spp. The mean posaconazole dose was 600 mg/day (400-800 mg/day) and the median duration of treatment was 223 days (IQR 48-632). Ten patients had adverse effects, but only one required suspension of the antifungal treatment due to hydroelectrolytic disorders.

Quels paramètres biologiques pour estimer le statut volémique ?

IntroductionEstimation of volemic status can be useful in the diagnosis of some hydro-electrolytic disorders such as hyponatremia and dyskalemia. As a matter of fact, clinical examination and classical biological parameters are not discriminant enough. The aim of this study was to determine the biological parameters that are better correlated to volemic status. MethodVolemic status was established using extracellular fluid volume, measured by apparent distribution of inuline, in non-edematous patients and without cardiac or hepatic insufficiency. Patients were split in three groups according to their extracellular fluid volume: hypovolemic, normovolemic, and hypervolemic. Clinical and biological parameters were compared between the three groups and were correlated to extracellular fluid volume. ResultsData of 91 explorations were collected. There were no difference between groups regarding clinical parameters, plasma proteins, and urinary sodium excretion. Parameters better correlated to extracellular fluid volume were fasting calcium/creatinine ratio (r=0.51; P<0.0001), fasting urinary pH (r=0.43; P<0.0001), and plasma uric acid (r=−0.39; P=0.002). ConclusionIn addition to uric acid, already proposed as a biological marker to estimate volemic status, fasting calciuria and fasting urinary pH could also be useful.

Predisposing and precipitating factors for delirium in community-dwelling older adults admitted to hospital with this condition: A prospective case series.

BackgroundFactors associated with delirium among community-dwelling older adults have been poorly studied. Our aim was to describe the prevalence of predisposing and precipitating factors for delirium among patients admitted for delirium and to assess whether these factors were appropriately recognized at the first patient assessment at hospital.MethodsConsecutive community-dwelling individuals admitted to three geriatric acute care units with a confirmed initial diagnosis of delirium were prospectively included. An independent investigator recorded, using a predefined form, any acute medical condition considered by the attending geriatrician to be a precipitating factor, at the first patient assessment and at the end of his stay in acute care.ResultsA total of 208 patients were included, 80.0% had a pre-existing cognitive or neurological disorder, or both. The most frequent precipitating factor found were infections (49.0% of all patients, mainly lung and urinary tract infections), followed by drugs (30.8%), dehydration (26.4%) and electrolytic disturbances (18.7%, mostly hyponatremia). 91% of patients had a cerebral imagery, but acute neurological conditions were found in only 18.3%. Fewer precipitating factors were found at first than at final assessment (1.4 (95%CI 1.3–1.6) versus 1.9 (95%CI 1.8–2.0) respectively, p<0.001). This difference was significant for all main categories of precipitating factors.ConclusionsInfections, followed by drugs and hydro-electrolytic disorders seem to be the most frequent precipitating factors for delirium in community-dwelling elderly individuals. Early diagnostic and management of precipitating factors in these patients should be improved, as a significant number of them are missed at the initial assessment.

Use of acetazolamide in lithium-induced nephrogenic diabetes insipidus: a case report.

SummaryLithium-induced nephrogenic diabetes insipidus (Li-NDI) is a rare and difficult-to-treat condition. A study in mice and two recent papers describe the use of acetazolamide in Li-NDI in 7 patients (a case report and a 6 patient series). We describe the case of a 63-year-old woman with bipolar disorder treated with lithium and no previous history of diabetes insipidus. She was hospitalized due to a bowel obstruction and developed severe dehydration after surgery when she was water deprived. After desmopressin administration and unsuccessful thiazide and amiloride treatment, acetazolamide was administrated to control polyuria and hydroelectrolytic disorders without significant side effects. To our knowledge, this is the third publication on acetazolamide use in Li-NDI patients.Learning points:Treatment of lithium-induced nephrogenic diabetes insipidus might be challenging.Vasopressin, amiloride and thiazide diuretics have been used in lithium-induced nephrogenic diabetes insipidus treatment.Acetazolamide might be an option to treat lithium-induced nephrogenic diabetes insipidus patients who fail to respond to standard treatment.The use of acetazolamide in lithium-induced nephrogenic diabetes insipidus must be monitored, including its effects on glomerular filtration rate.

Repercussões Clínicas Associadas à Esquizofrenia Infantil: Relato de Caso

Introdução: A esquizofrenia infantil é um fenômeno raro e grave, tendo como principal característica sintomas psicóticos pré-puberais1-3. Manifesta-se em menos de 1/40.000 crianças1-2 de forma insidiosa e progressiva. Entretanto, cenários pré-mórbidos são observados, como: isolamento social; atraso motor e verbal; déficit de atenção, agressividade e recusa alimentar1-4. Considerando as alterações clínicas que podem associar-se a psicopatologias e/ou ao uso de psicotrópicos, em alguns casos, faz-se necessária a internação hospitalar com o objetivo de tratar tais sintomas. Os leitos psiquiátricos propostos para os Hospitais Gerais tendem a romper com o manicômio, diminuindo o estigma da doença mental; cessar a dicotomia mente/corpo proposta pelo modelo cartesiano e efetivar a Política Pública de Saúde Mental no Brasil. Objetivos: Relatar um caso de esquizofrenia infantil associado às repercussões clínicas desencadeadas pela psicopatologia de base. Expor a importância do processo de trabalho em rede e a atenção à saúde de forma integral dentro do Hospital Geral, tendo como base a Política Nacional de Saúde Mental. Descrição: Adolescente, 17 anos, pré-diagnosticada com esquizofrenia, em tratamento irregular. Apresentou há 10 dias: recusa alimentar e hídrica, isolamento social, agressividade e alterações no sono. Deu entrada no CAPSI onde foi administrado Haldol Decanoato e encaminhada para internação hospitalar, objetivando correção de distúrbios hidroeletrolíticos. Conclusão: Espera-se determinar uma variável que compreenda a condição de base de pacientes psiquiátricos e, elucide a coexistência de processos fisiopatológicos orgânicos. Desse modo, ressaltar a importância de integrar os objetivos da Reforma Psiquiátrica no que tange o acompanhamento terapêutico de pacientes implicados nesse contexto evoluti

Post Autologous Stem Cell Transplantation Complication Management in Case of Malignant Lymphoma Patients

Abstract Introduction: Autologous hematopoietic stem cell transplantation (ASCT) represents a standard therapy in the management of hematologic malignancies such as malignant lymphomas and has used for approximately three decades. The aim of this study was to determine the occurring post-ASCT complications and their impact on the patients’ recovery for a better management. Material and methods: An observational retrospective study was performed during a five-year period between 2012 and 2017, involving 58 classical Hodgkin lymphoma and 36 non-Hodgkin lymphoma patients, who underwent ASCT in the Bone Marrow Transplantation Unit of Tîrgu Mureş. The main analyzed complications were: infections, bleeding, hydroelectrolytic disorders, and hypoalbuminemia. Results: After data analysis we found that 17 patients (18%) presented microbiologically confirmed infection, 10 patients (11%) presented clinically non-significant bleeding, 39 patients (42%) presented electrolyte disorders, and 33 patients (36%) presented hypoalbuminemia, obtaining a positive correlation between the rate of adverse events after ASCT with age (r = 0.9914, p = 0.0009) and the average hospitalization period (r = 1, p &lt;0.00001). Conclusions: The identification of adverse events and their correlation with the patients’ clinical outcome can lead to better patient management and a faster recovery after ASCT.

Hypernatremia and acute pancreatitis in chronic kidney disease: back to the salt mines. Answers

Acute pancreatitis can be a life-threatening complication in patients with chronic kidney disease (CKD), especially in kidney transplant recipients. The patient was 7 years old when he received renal transplantation for CKD secondary to posterior urethral valves. Two years later, he presented with severe necrotizing pancreatitis (Ranson’s score 5, Balthazar’s score 8). Viral and genetic testing came back negative; pancreatitis was attributed to the patient’s treatments (prednisone, trimethoprim-sulfamethoxazole, and everolimus). Twenty days later, necrotized pancreatic cysts had formed. Two drains were surgically inserted into the abdomen, and continuous cyst lavage was started with normal saline solution. Two days later, blood tests revealed severe hypernatremia and hypokalemia. We suspected unwanted peritoneal dialysis had occurred because of the high sodium chloride content and the absence of potassium in the normal saline solution being used for cyst lavage. We switched to a peritoneal dialysis solution for the lavage, leading to complete correction of hydroelectrolytic disorders. Acute pancreatitis is a frequent and potentially severe complication in CKD patients. It should be suspected in the presence of nonspecific symptoms, such as abdominal pain or vomiting. Rigorous monitoring of electrolytes is also mandatory for managing CKD patients with acute pancreatitis.

Elderly Severe Hyponatremia: Case Report and Literature Review

This article describes hydroelectrolytic disorder in a 77-years-old patient accepted at an emergency room with atypical hyponatremia that has been analyzed through laboratory tests. The aim of this study is to understand cause and proper care in cases of abnormal variations of sodium levels in the body and review the literature about severe hyponatremia.

Motifs de primo-consultations de néphrologie en 2014 dans le territoire de santé 5 de Bretagne

BackgroundIn France, the coordinated healthcare circuit means that patients should be referred to specialists, for example nephrologists, by another physician. However, there are no recommendations concerning the reasons justifying the referral to a nephrologist. The main purpose of our study is to describe the motif of first consultations in nephrology in the health area 5 of Brittany. MethodsWe retrospectively collected medical reports of first consultations by 17 nephrologists in the 4 centers of the study area, during the year 2014. In these letters, we noted the consultation motif, the specialty of the physician who refers the patient, and main characteristics of patients. ResultsWe included 662 first consultations. The main reason for consultations was chronic kidney disease (68.7%), including chronic renal insufficiency (56.9%), proteinuria (7.3%), microscopic hematuria (3.3%) and searching for chronic kidney disease in the presence of risk factor (1.2%). Other frequent reasons were the follow-up consultation after a pregnancy complicated by preeclampsia (9.5%), urinary lithiasis (5.7%), hypertension (3.8%) and hydroelectrolytic disorder (3.5%). Non-nephrology reasons represent 3.2% of first consultations. Almost all patients have been referred by a physician (99.7%), mainly a general practitioner (71.9%). ConclusionNephrology first consultations are realized according to the coordinated healthcare circuit since almost all are requested by another physician. The reasons are adapted to the specialty. The main reason is chronic kidney disease, often already associated with renal insufficiency chronic.

Case Report: A Severe Hypernatremia with Multiple Organ Failure, about a Clinical Observation

A hypernatremia severity is often associated with a poor prognosis, especially if it is associated with multiple organ failure. In a country with very limited resources, the prognosis may be favorable in the absence of renal replacement. We report the case of a 63 years old woman, hypertensive and diabetic, admitted to the ICU for unconsciousness. Clinically, neurological examination notes a Glasgow of 8/15 (Y2, V2, M4) and a left hemiplegia. Temperature was 39°C. Diuresis was 100 ml during the first 24 hours. Blood pressure was 90/60 mmHg, tachycardia at 133/min. Cardiac auscultation is normal. Vascular axes were weakly perceptible. Oxygen saturation was 95%. The skin examination notes a dry skin and mucous membranes, a flattening of the superficial veins, sunken eyes and a persistent skin fold. There is no hepatomegaly or splenomegaly, or jaundice. Biological point of view note natremia: 176 mmol/L; osmolarity: 390 mosmol/kg; creatinin: 300 μmol/L; glycemia > 6 g/L; transaminases 217 UI. Diagnostics: malignant hypernatremia with a high plasma osmolarity associated with an acute anuric renal failure, hydro electrolytic disorders, an abnormal liver function, a fever of central origin and a stroke. The treatment consisted of a correction of the electrolyte disorders by infusion of isotonic and hypotonic fluids with insulin. In a country with very limited resources, the severe hypernatremia prognosis associated with anuric acute renal failure may be favorable in the absence of renal replacement.

Desidratação hipernatrémica no recém-nascido

Hypernatremia occurred frequently erstwhile when infant formula with high sodium concentration were given to neonates. Today, the most common cause of hypernatremic dehydration in the healthy term newborn is the low volume intake of breast milk. The diagnosis is usually performed accidentally in cases of important weight loss in the newborn. Other clinical manifestations, when present, are usually nonspecific, with prevalence of neurologic symptoms that reflect intracellular dehydration. Some complications, especially seizures, occur most frequently during treatment. Therefore, the management and treatment of this condition should be cautious and requires a thorough understanding of the underlying hydroelectrolytic disorder to prevent the brain cells´ overhydration. The practitioners should continue to recommend breastfeeding as the best method of nourishing healthy infants. There should be a high level of suspicion and early recognition of the underlying breastfeeding problems before the onset of serious and sometimes life-threatening dehydration.

Acute Tubular Necrosis as a Complication of Collagenous Colitis

Introduction: Microscopic colitis is a subdiagnosed cause of chronic diarrhea, especially among the elderly, although it can occur in patients of any age. This case evidences the potential seriousness of the pathology, in particular, the development of acute tubular necrosis which could be prevented by an early diagnosis. Case Report: An 80-year-old man, previously healthy, with a history of watery diarrhea, anorexia occasional abdominal cramps and weight loss (9 kg), in the last 5 months. He was submitted to a colonoscopy 1 month before, which did not showed endoscopic lesions, and treated with loperamide, but without improvement. There was no history of joint pains or swelling, fever or use of non-steroidal antiinflammatory drugs. He recurred to the emergency department due to worsening diarrhea, asthenia and dizziness. On the physical exam he was pale and dehydrated. Laboratory tests showed iron deficiency anemia, acute tubular necrosis (creatinine of 12.8mg/dL, eGFR of 4ml/min (1.73m2) and hypokalemia (K+ 2.4mEq/L). Urinary tract infection and obstruction were excluded and he was admitted on an intensive care unit. Stool cultures were negative, including specific tests forbacteria or parasites. The presence of celiac disease was excluded with normal duodenal biopsies and negative serologic testing. An ileocolonoscopy was performed, revealing a mucosa with normal appearance. Biopsies of the right and left colon were taken and the histopathological exam was consistent with the diagnosis of collagenous colitis. He presented progressive improvement of the renal impairment, with fluids and correction of the hydroelectrolytic disorders, without the need of haemodialysis. The patient was treated with oral budesonide with resolution of diarrhea. Budesonide was stopped after 1 year of treatment. Eighteen months after the diagnosis, he is currently being followed in outpatient clinic, asymptomatic, but complaining of occasional constipation.

SEOM guidelines on hydroelectrolytic disorders.

Hydroelectrolytic disorders are one of the most common metabolic complications in cancer patients. Although often metabolic alterations affecting various ions are part of the manifestations of the oncological disease, even in the form of paraneoplastic syndrome, we must not forget that very often, these disorders could be caused by various drugs, including some of the antineoplastic agents most frequently used, such as platin derivatives or some biologics. These guidelines review major management of diagnosis, evaluation and treatment of the most common alterations of sodium, calcium, magnesium and potassium in cancer patients. Aside from life-sustaining treatments, we have reviewed the role of specific drug treatments aimed at correcting some of these disorders, such as intravenous bisphosphonates for hypercalcemia or V2 receptor antagonists in the management of syndrome of inappropriate antidiuretic hormone secretion-related hyponatremia.

Spontaneous Late Onset OHSS in Singleton Pregnancy in 2nd Trimester: A Rare Case.

Ovarian hyperstimulation syndrome (OHSS) is a potentially life‐threatening complication of pharmacological ovarian stimulation. It is seen in approximately 2 % of all IVF cycles. The prevalence of moderate to severe OHSS ranges from 1 to 10 % in major IVF programs. Severe forms complicate 1 % of IVF cycles and are characterized by massive ovarian enlargement together with a fluid shift into extravascular compartments responsible for the development of ascites, sometimes pleural and/or pericardial effusion, hypovolemia, oliguria, and hydroelectrolytic disorders. In the most marked cases, thromboembolic phenomena may occur as a result of hemoconcentration and coagulation disturbances (Hollemaert et al. [1]). Spontaneous ovarian hyperstimulation (spontaneous OHSS) is extremely rare in naturally conceived pregnancies. OHSS in the absence of exogenous gonadotropins is very rare, and only a few cases have been reported in the literature. Spontaneous OHSS likely to occur at 8–14 weeks of gestation, while iatrogenic OHSS usually occurs earlier at 3–8 weeks of gestation [2]. Human chorionic gonadotropin (hCG) is thought to play a crucial role in the development of the syndrome. Severe forms are indeed restricted to cycles with exogenous hCG to induce ovulation or as luteal phase support or with endogenous pregnancy‐derived hCG (Delbaere et al. [3]). Here, we report a rare case of spontaneous 2nd trimester OHSS in 22-year-old primigravida.

Renal complications in anorexia nervosa.

Anorexia nervosa is a malady with possible long-lasting physiological consequences. Among these, little is known about the renal effects, which remain rarely investigated. A literature review was conducted using electronic databases and manual search of relevant articles, discussing the renal impacts of anorexia nervosa. Renal failure has been described in malnourished patients, but the optimal non-invasive tool to assess the glomerular function rate in this population needs to be further evaluated. Significant disruptions in osmolar regulation, even in the absence of potomania, arise from multiple factors: hypothalamic dysfunction, intrinsic renal insufficiency, and use of psychotropic medications. Urinary urgency and nocturnal enuresis are frequent symptoms, rarely reported by patients. Among hydroelectrolytic disorders, hypokalemia is the most frequent, especially in settings of vomiting or medication misuse. Hyponatremia, hypomagnesemia, and hypophosphatemia may also be encountered. Urinary lithiases are relatively frequent as a consequence of dehydration, laxative use, or both. Investigation and follow-up of the renal function are essential in patients with an eating disorder, especially when the illness has been present for a long time.

Usefulness of Syndromic Surveillance during Ultra-endurance Running Races: Example with the “Grand Raid de la Réunion” Ultra Trail

The "Grand Raid de la Réunion" is one of the hardest ultra trails in the world. This endurance running race has consequences on health's runners. We used syndromic surveillance to estimate the health impact of this sporting event on the Emergency Departments (ED) of Reunion Island. During the race's period, a global increase of the ED visits all causes was observed. The syndromic surveillance system detected a significant ED visits' increase for hydro-electrolytic disorders. These results highlight the usefulness of syndromic surveillance to estimate the impact on health of a mass gathering on a sporting event of great magnitude.

GW24-e3511 Efficacy and prognosis of low molecular weight heparin (LMWH) in the treatment for the patients with chronic cor pulmonale during acute attack

ObjectivesTo investigate the efficacy and prognosis of low molecular weight heparin (LMWH) in the treatment for the patients with chronic cor pulmonale during acute attack.Methods320 cases patients with chronic cor...

Multiple electrolyte disorders in a neurosurgical patient: solving the rebus

BackgroundIt is important to ensure an adequate sodium and volume balance in neurosurgical patients in order to avoid the worsening of brain injury.Indeed, hyponatremia and polyuria, that are frequent in this patient population, are potentially harmful, especially if not promptly recognized.Differential diagnosis is often challenging, including disorders, which, in view of similar clinical pictures, present very different pathophysiological bases, such as syndrome of inappropriate antidiuresis, cerebral/renal salt wasting syndrome and diabetes insipidus.Case presentationHere we present the clinical report of a 67-year-old man with a recent episode of acute subarachnoid haemorrhage, admitted to our ward because of severe hyponatremia, hypokalemia and huge polyuria.We performed a complete workup to identify the underlying causes of these alterations and found a complex picture of salt wasting syndrome associated to primary polydipsia. The appropriate diagnosis allowed us to correct the patient hydro-electrolyte balance.ConclusionThe comprehension of the pathophysiological mechanisms is essential to adequately recognize and treat hydro-electrolyte disorders, also solving the most complex clinical problems.

Clinical and laboratorial characterization and post-surgical follow-up of 87 patients with non-functioning pituitary macroadenomas

It was to assess the main characteristics of patients undergoing pituitary tumor surgery. Eighty-seven patients (44 men; 44.8±13 years old) were included. The main symptoms were visual alterations (87.3%), headache (70.1%), diminished libido (34.4%), galactorrhea (22.9%) and hair loss (19.5%). The axes affected were gonadotropic (72.6%), thyrotropic (48.4%) and corticotropic (38.7%), without significant changes after surgery. The average largest tumor diameter was 3.1 cm before surgery and 1.56 cm after surgery. The most frequent postoperative complications were hydro-electrolyte and acid-base disorders (12%), diabetes insipidus (9%), visual field alterations (9%), liquoric fistula (8%) and nasal obstruction (7%). The patients were affected by more than one complication. Although a decrease in tumor volume was achieved through surgery, hormonal deficiencies persisted in most of the patients and new surgical approaches were necessary for dealing with tumor recurrence or persistence.

Hydroelectrolytic disorders secondary to refeeding syndrome.

Hydroelectrolytic disorders secondary to refeeding syndrome.