Syndrome Of Inappropriate Antidiuretic Hormone Research Articles

Hyponatremia and Outcome: Is Severity More Important Than Etiology?

Hyponatremia is the most commonelectrolyte abnormality encountered in a hospital setting, and the data regarding the contribution of hyponatremia to overall mortality are conflicting. The study objective was to determine patients' clinical profiles and outcomes with hyponatremia. This prospective cross-sectional study was conducted at Dayanand Medical College and Hospital, Ludhiana, and included 375 adult patients aged more than 18 years with a confirmed diagnosis of hyponatremia. Patients were subdivided into three groups based on the severity of hyponatremia: mild (130-135 mmol/L), moderate (125-129 mmol/L), and profound (<125 mmol/L). The most common symptom was confusion (57.3%) followed by deep somnolence (40%) and nausea (36.8%). The most common cause of hyponatremia was diuretics (30.7%), followed by the syndrome of inappropriate antidiuretic hormone secretion (SIADH) (17.8%) and chronic liver disease (CLD) (14.1%). The severity of hyponatremia did not significantly influence the outcome. Patients with CLD and chronic kidney disease (CKD) as the etiology of hyponatremia had significantly worse outcomes compared to other causes of hyponatremia. The most common type was hypovolemic hypotonic followed by euvolemic hypotonic and hypervolemia hypotonic hyponatremia. Nearly half of the total deaths were observed in the hypervolemic hyponatremia group and were significantly higher compared to the other two groups (p=0.001). Correction of hyponatremia (i.e., serum sodium >135 mmol/L) was significantly linked with good outcomes (p=0.003). Our study showed that the etiology of hyponatremia was a more important prognostic indicator rather than the severity of hyponatremia. Normalization of serum sodium was associated with improved survival.

Takotsubo (stress cardiomyopathy) syndrome and inappropriate antidiuretic hormone secretion

Takotsubo (stress cardiomyopathy) syndrome and inappropriate antidiuretic hormone secretion

Single Dose of Tolvaptan In The Management of Intracranial Haemorrhage Induced Syndrome of Inappropriate Antidiuretic Hormone- A Case Report

Hyponatraemia is a common manifestation of a syndrome of inappropriate antidiuretic hormone secretion in neurological patients admitted to the intensive care unit. We present a case of 62-years old male who presented with loss of consciousness, seizure, and altered mental status and was diagnosed to have right-sided intracranial haemorrhage. The patient underwent evacuation of hematoma and developed persistent hyponatremia secondary to the syndrome of inappropriate antidiuretic hormone. Patient was treated with 3%sodium chloride, loop diuretics, and fluid restriction. There was no improvement in hyponatremia after initial correction and we started on 7.5 milligrams of Tolvaptan. The patient responded within 4 days of starting Tolvaptan. There was no hyponatraemic episode during the follow-up. From this, we want to emphasize that refractory hyponatremia secondary to intracranial haemorrhage should be treated with Tolvaptan.

Inappropriate therapy of euvolemic hyponatremia, the most frequent type of hyponatremia in SARS-CoV-2 infection, is associated with increased mortality in COVID-19 patients.

Admission hyponatremia, frequent in patients hospitalized for COVID-19, has been associated with increased mortality. However, although euvolemic hyponatremia secondary to the Syndrome of Inappropriate Antidiuresis (SIAD) is the single most common cause of hyponatremia in community-acquired pneumonia (CAP), a thorough and rigorous assessment of the volemia of hyponatremic COVID-19 subjects has yet to be described. We sought to identify factors contributing to mortality and hospital length-of-stay (LOS) in hospitalized COVID-19 patients admitted with hyponatremia, taking volemia into account. Retrospective study of 247 patients admitted with COVID-19 to a tertiary hospital in Madrid, Spain from March 1st through March 30th, 2020, with a glycemia-corrected serum sodium level (SNa) < 135 mmol/L. Variables were collected at admission, at 2nd-3rd day of hospitalization, and ensuing days when hyponatremia persisted. Admission volemia (based on both physical and analytical parameters), therapy, and its adequacy as a function of volemia, were determined. Age: 68 years [56-81]; 39.9% were female. Median admission SNa was 133 mmol/L [131- 134]. Hyponatremia was mild (SNa 131-134 mmol/L) in 188/247 (76%). Volemia was available in 208/247 patients; 57.2% were euvolemic and the rest (42.8%) hypovolemic. Hyponatremia was left untreated in 154/247 (62.3%) patients. Admission therapy was not concordant with volemia in 43/84 (51.2%). In fact, the majority of treated euvolemic patients received incorrect therapy with isotonic saline (37/41, 90.2%), whereas hypovolemics did not (p=0.001). The latter showed higher mortality rates than those receiving adequate or no therapy (36.7% vs. 19% respectively, p=0.023). The administration of isotonic saline to euvolemic hyponatremic subjects was independently associated with an elevation of in-hospital mortality (Odds Ratio: 3.877, 95%; Confidence Interval: 1.25-12.03). Hyponatremia in COVID-19 is predominantly euvolemic. Isotonic saline infusion therapy in euvolemic hyponatremic COVID-19 patients can lead to an increased mortality rate. Thus, an exhaustive and precise volemic assessment of the hyponatremic patient with CAP, particularly when due to COVID-19, is mandatory before instauration of therapy, even when hyponatremia is mild.

Associations between neuromyelitis optica spectrum disorder, Sjögren's syndrome, and conditions with electrolyte disturbances

ObjectiveElectrolyte disorders are among the important conditions negatively affecting the disease course of neuromyelitis optica spectrum disorder (NMOSD). Possible mechanisms may include renal tubular acidosis (RTA) accompanying Sjögren's syndrome (SS), syndrome of inappropriate antidiuretic hormone secretion (SIADH), and central diabetes insipidus (DI). Currently, the overlap profiles between these conditions remain uncertain. MethodsThis cross-sectional study collected data from the nationwide administrative Diagnosis Procedure Combination (DPC) database and evaluated the overlap profiles. ResultsAmong the 28,285,908 individuals from 1203 DPC-covered hospitals, 8477 had NMOSD, 174108 had SS, 4977 had RTA, 7640 had SIADH, and 24,789 had central DI. Of those with NMOSD, 986 (12%) had SS. The odds ratio (OR) for a diagnosis of NMOSD in those with SS compared with those without was 21 [95% confidence interval (CI), 20–23]. Overlap between NMOSD and SS was seen both in males (OR, 28 [95% CI, 23–33]) and females (OR, 16 [15–17]) and was more prominent in the younger population. Among patients with SS, the prevalence of RTA was lower in patients with NMOSD compared with those without NMOSD. Patients with NMOSD showed a higher prevalence of SIADH (OR, 11 [7.5–17]; p < 0.0001) and DI (OR, 3.7 [2.4–5.3]; p < 0.0001). Comorbid SS in NMOSD was associated with a higher prevalence of DI. ConclusionsPatients with NMOSD are likely to have SS, SIADH, and central DI. RTA in SS does not facilitate the overlap between NMOSD and SS. SS in NMOSD may predispose patients to DI.

Adult-onset seizures as the initial presentation of acute intermittent porphyria

Acute intermittent porphyria (AIP) is a rare metabolic disorder caused by the deficiency of enzyme porphobilinogen deaminase used in haeme biosynthesis. Nonspecific abdominal pain is the classical presentation of AIP. Patients rarely present with rapid-onset neurological manifestations such as acute peripheral neuropathy or seizures. The knowledge on the management of seizures in AIP is important as some antiepileptic drugs may exacerbate acute attack. Hyponatremia due to the syndrome of inappropriate antidiuretic hormone secretion is a recognised cause of seizures in AIP. We report a case of a 20-year-old woman presenting to a tertiary care hospital in Sri Lanka with seizures due to hyponatremia who was eventually diagnosed with AIP. Although AIP is not frequently reported in Sri Lanka, it’s important to have a strong clinical suspicion as an early diagnosis will reduce mortality and morbidity.

Neuroendocrine-induced hyponatremia in patients with traumatic brain injury: a systematic review and meta-analysis of the epidemiology, factors and prognosis

Abstract Traumatic brain injury (TBI) is a common brain dysfunction due to an external force as opposed to disease-induced brain damage. TBI is a leading global cause of high morbidity and mortality rates in the neurosurgical department. It contributes to ~30% of deaths related to brain damage. A common complication of TBIs is hyponatremia secondary to neuroendocrine causes, including syndrome of inappropriate antidiuretic hormone (SIADH), cerebral salt wasting syndrome and adrenal insufficiency. Most recent studies suggest SIADH as the main cause of hyponatremia in TBI. This study aims to evaluate the effects of neuroendocrine-induced hyponatremia on the prognosis of TBI, demonstrate the epidemiology of hyponatremia in patients with TBI, assess all possible etiologies of hyponatremia in TBI, determine the prognostic outcomes of hyponatremia in TBI and determine the effect of hyponatremia on the prognosis of severe and moderate TBI. This study is in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guideline. A 10-year retrospective analysis of original published studies from January 2013 to January 2023 will be performed. This study will include the adult TBI patients (age ≥ 18 years old) who developed neuroendocrine-induced hyponatremia and original studies, randomized control trials, case controls, cohort studies and studies in English language. This study excludes the pediatric population and animal studies. For information sources, several electronic databases, including EMBASE, Pubmed, SCOPUS and Cochrane, will be searched. No ethical approval is required since the study does not involve human subject participation. However, the study findings will be applied for dissemination at scientific conferences and the manuscript will be submitted for publication to a reputable peer review journal. The research protocol is registered with PROSPERO registration No. CRD42023391854 and is available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023391854.

Transient Pseudohypoaldosteronism: A Rare Cause of Severe Hyponatremia in a Baby

Hyponatremia and dehydration in children represent a medical emergency due to a variety of underlying illness. Other than an evidence of gastroenteritis with diarrhea and vomiting (which is the major cause of hypoosmolar hyponatremia in pediatric age), other causes should be considered, especially if there is evidence of hyperkalemia and high sodium fraction excretion (FENa), like iatrogenic causes (diuretic excess), transient or genetic abnormalities of the renal mineralocorticoid pathway, syndrome of inappropriate anti-diuretic hormone secretion (SIADH), acute renal failure, congenital adrenal hyperplasia (CAH).&#x0D; Here we present a case of transient pseudohypoaldosteronism in a 2 months old baby secondary to urinary tract infection, who presented with a history of poor sucking, fever and dehydration.

Trends in Endoscopic and Microscopic Approaches to Transsphenoidal Pituitary Surgery in the US.

Among the transsphenoidal (TSS) approaches to pituitary tumors, the microscopic approach (MA) has historically been the predominant technique with the increasing adoption of the endoscopic approach (EA). This study investigates national trends in TSS approaches and postoperative outcomes for MA and EA through 2021. The TriNetX database was queried for patients undergoing TSS (MA and EA) between 2010 and 2021. Data were collected on demographics, geographic distribution of surgical centers, postoperative complications, stereotactic radiosurgery (SRT), repeat surgery, and postoperative emergency department (ED) visits. 8644 TSS cases were queried between 2010 and 2021. MA rates were highest until 2013 when rates of EA (52%) surpassed MA (48%) and continued to increase through 2021 (81%). From 2010 to 2015 EA had higher odds of a postoperative CSF leak (OR 3.40) and diabetes insipidus (DI (OR 2.30)) versus MA (p < 0.05); from 2016 to 2021 differences were not significant. Although there was no significant difference among approaches from 2010 to 2015 for syndrome of inappropriate antidiuretic hormone (SIADH), hyponatremia, or bacterial meningitis, from 2016 to 2021 EA had lower odds of SIADH (OR 0.54) and hyponatremia (OR 0.71), and higher odds of meningitis (OR 1.79) versus MA (p < 0.05). EA had higher odds of additional surgery (either EA or MA) after initial surgery from 2010 to 2021. From 2010 to 2015 EA had lower odds of postoperative SRT compared to MA, whereas in 2016-2021 there was no statistical difference among approaches. This study demonstrates increasing EA adoption for TSS in the United States since 2013. Complication rates have overall improved for EA compared to MA, potentially as a result of improving surgeon familiarity and experience. 4 Laryngoscope, 133:2135-2140, 2023.

Real-world safety profile of riluzole: a systematic analysis of data from the FAERS database and case reports

ABSTRACT Background The study aims to obtain the safety profile of riluzole in the real world and provide reference for clinical drug applications. Research design and methods Proportional reporting ratio (PRR) was used to detect riluzole adverse drug reactions (ADRs) from the data between the first quarter of 2004 and the third quarter of 2022 in the FDA adverse event reporting system database (FAERS). Case reports of riluzole published in PubMed, Embase, and Web of Science before November 2022 were reviewed, and patient’s data were extracted. Results FAERS analysis identified 86 ADRs. Gastrointestinal system disorders and respiratory, thoracic, and mediastinal disorders account for 12 of the top 20 most frequent ADRs. Similarly, 9 of the 20 highest PRR ADRs were gastrointestinal system disorders and respiratory, thoracic, and mediastinal disorders. Twenty-two published riluzole-associated cases were identified in the literature. Respiratory, thoracic, and mediastinal disorders were the most commonly reported cases (n = 9), followed by gastrointestinal disorders, pancreatitis (n = 5). Conclusions Strong ADRs between riluzole and pancreatitis were identified, which reminds clinicians to monitor patients carefully. For patients with respiratory symptoms, clinicians should pay attention to distinguish the cause of their occurrence, and take appropriate measures. Beware that riluzole may increase the risk of inflammatory reactions and inappropriate vasopressin secretion and hyponatremia due to respiratory failure.

#4308 EVOLUTION OF HYPONATREMIA IN PATIENTS WITH CHRONIC SIADH TREATED FOR 1 YEAR WITH ORAL UREA

Abstract Background and Aims Hyponatremia (&amp;lt;135mEq/L) is the most common electrolyte disorder observed in clinical practice, associated with increased hospital admissions and mortality. One of its causes is the syndrome of inappropriate antidiuretic hormone secretion (SIADH). In chronic SIADH, urea is considered as a therapeutic possibility among other measures; however, its use is not widespread due to few studies on its efficacy. Objects To evaluate sodium levels in patients with chronic SIADH who received oral urea for at least 12 months. Method Observational, descriptive and retrospective study. Population: 13 patients with SIADH under treatment with urea for 12 months. The relationship between natremia and the rest of the clinical variables was analyzed using Chi-square, Student's T test, and ANOVA or their corresponding non-parametric tests. Results Mean age: 64 years +/-15. Men: 61% (n = 8). Comorbidities: hypertension (50%, n = 6), CKD (30.7%, n = 4), diabetes (15.3%, n = 2). SIADH etiology: Antiepileptics (n = 4), idiopathic (n = 3), intracranial pathologies (n = 5) and cancer (n = 1). 61% required admission for SIADH. Median of 10 ± 26 months from diagnosis to start of treatment. The initial dose was: 15 grams/day (53%, n = 7), 15 grams every 48 hours (30%, n = 4) and 15 grams every 72-96 hours (17%, n = 2). At one year, 61% of patients maintained the same dose (n = 8) and 39% of patients required an increase in the dose (n = 5) and of these 3 patients they increased to 30 grams/day. The treatment was well tolerated, only 1 patient out of 13 (7.6%) reported nausea and dysgeusia, no patient presented hypernatremia (Na &amp;gt;145meq/L), hospital admissions due to SIADH, or adverse effects that led them to discontinue urea. Conclusion After a year of treatment, urea increases and maintains plasma sodium in the normal range safely in chronic SIADH. Treatment with urea is well tolerated, avoids hospitalizations, and is not associated with complications from its use.

Voltage-Gated Potassium Channels (VGKC) Complex-Associated Disorders: Anti-LGI1 Encephalitis and Anti-Caspr2 Encephalitis

Autoantibodies against LGI1 and Caspr2 complexed with voltage-gated potassium channels (VGKC) cause limbic encephalitis. Anti-LGI1 encephalitis progresses in a subacute course with memory impairment, disorientation, and focal epileptic seizures. Anti-LGI1 encephalitis is preceded by faciobrachial dystonic seizures (FBDS), which are specific involuntary movements and frequently complicated by hyponatremia due to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Neutralization of LGI1 by anti-LGI1 antibodies reduces AMPA receptors and induces epileptic seizures and memory impairment. Anti-Caspr2 encephalitis (Morvan's syndrome) is associated with limbic symptoms, severe autonomic disorders, muscle cramps and burning extremity pain due to peripheral nerve hyperexcitability. Thymomas and other malignant tumors may be complicated, and search for them is necessary. Anti-Caspr2 antibodies bind to Caspr2 on the surface of afferent cells in the dorsal root ganglion, and internalization of VGKCs causes a decrease in the K+ current, resulting in neuronal hyperexcitation and severe pain. Early immunotherapeutic intervention may improve the prognosis of these diseases, and measuring these autoantibodies should be performed in the presence of specific clinical signs, even with normal cerebrospinal fluid findings.

Predictors of Delayed Hyponatraemia After Surgery for Pituitary Tumour.

Delayed hyponatraemia(DH) is a common complication following trans-sphenoidal surgery(TSS) for pituitary tumour. We evaluated the prevalence of DH following TSS, and assessed the factors associated with DH, including early post-operative diabetes insipidus(EPDI). This retrospective study included 100 TSS for pituitary tumours in 98 patients, over a period of 26 months. Subjects were divided into two groups: those who developed hyponatraemia and those who did not develop hyponatraemia, during post-operative days 4 to 14. The clinical characteristics and peri-operative parameters were compared between the two groups, to identify factors predicting DH. The mean age of the patients was 42.0±13.6 years, 58 (59%) were females and 61 (61%) had functional tumours. Thirty-six patients(36%) developed DH following TSS of whom majority(58%) were diagnosed on post-operative days 7 and 8; only 8/36 (22%) were symptomatic. Syndrome of inappropriate antidiuretic hormone secretion(SIADH) was found to be the most common aetiology of DH. On logistic regression analysis, intra-operative cerebrospinal fluid(CSF) leak (OR 5.0; 95% CI 1.9-13.8; p=0.002), EPDI (OR 3.4; 95% CI 1.3-9.2; p=0.015) and peri-operative steroid use (OR 3.6; 95% CI 1.3-9.8; p=0.014) were found to be significantly associated with DH. In conclusion, EPDI, intra-operative CSF leak and peri-operative steroid use were significant predictors of DH. EPDI predicts moderate to severe hyponatraemia with 80% specificity but has low sensitivity(47%). As most patients have asymptomatic hyponatraemia, serum sodium measurement on POD 7 to 10 would be helpful to identify DH in patients at increased risk.

Safety and immunogenicity of a single-shot live-attenuated chikungunya vaccine: a double-blind, multicentre, randomised, placebo-controlled, phase 3 trial

VLA1553 is a live-attenuated vaccine candidate for active immunisation and prevention of disease caused by chikungunya virus. We report safety and immunogenicity data up to day 180 after vaccination with VLA1553. This double-blind, multicentre, randomised, phase 3 trial was done in 43 professional vaccine trial sites in the USA. Eligible participants were healthy volunteers aged 18 years and older. Patients were excluded if they had history of chikungunya virus infection or immune-mediated or chronic arthritis or arthralgia, known or suspected defect of the immune system, any inactivated vaccine received within 2 weeks before vaccination with VLA1553, or any live vaccine received within 4 weeks before vaccination with VLA1553. Participants were randomised (3:1) to receive VLA1553 or placebo. The primary endpoint was the proportion of baseline negative participants with a seroprotective chikungunya virus antibody level defined as 50% plaque reduction in a micro plaque reduction neutralisation test (μPRNT) with a μPRNT50 titre of at least 150, 28 days after vaccination. The safety analysis included all individuals who received vaccination. Immunogenicity analyses were done in a subset of participants at 12 pre-selected study sites. These participants were required to have no major protocol deviations to be included in the per-protocol population for immunogenicity analyses. This trial is registered at ClinicalTrials.gov, NCT04546724. Between Sept 17, 2020 and April 10, 2021, 6100 people were screened for eligibility. 1972 people were excluded and 4128 participants were enrolled and randomised (3093 to VLA1553 and 1035 to placebo). 358 participants in the VLA1553 group and 133 participants in the placebo group discontinued before trial end. The per-protocol population for immunogenicity analysis comprised 362 participants (266 in the VLA1553 group and 96 in the placebo group). After a single vaccination, VLA1553 induced seroprotective chikungunya virus neutralising antibody levels in 263 (98·9%) of 266 participants in the VLA1553 group (95% CI 96·7-99·8; p<0·0001) 28 days post-vaccination, independent of age. VLA1553 was generally safe with an adverse event profile similar to other licensed vaccines and equally well tolerated in younger and older adults. Serious adverse events were reported in 46 (1·5%) of 3082 participants exposed to VLA1553 and eight (0·8%) of 1033 participants in the placebo arm. Only two serious adverse events were considered related to VLA1553 treatment (one mild myalgia and one syndrome of inappropriate antidiuretic hormone secretion). Both participants recovered fully. The strong immune response and the generation of seroprotective titres in almost all vaccinated participants suggests that VLA1553 is an excellent candidate for the prevention of disease caused by chikungunya virus. Valneva, Coalition for Epidemic Preparedness Innovation, and EU Horizon 2020.

Postoperative Dysnatremia in Pediatric Patients Undergoing Palatoplasty.

Identifying predisposing factors to dysnatremia to improve perioperative care after cleft surgery. Retrospective case series. Patient data were obtained through the electronic medical records of the hospital. Tertiary care university hospital. The inclusion criterion was the measurement of an abnormal natremia value, defined as Na >150 or <130mmol/l after a cleft lip or cleft palate repair procedure. The exclusion criterion was natremia between 131 and 149mmol/l. Natremia measurements were available for 215 patients born between 1995 and 2018. Five patients presented with postoperative dysnatremia. Several predisposing factors to dysnatremia have been identified: drugs, infection, administration of intravenous fluids, and postoperative syndrome of inappropriate antidiuretic hormone secretion. Although the hospital environment contributes to dysnatremia development, the fact that only patients undergoing cleft palate repair develop natremia anomalies suggests that this surgery may be itself a risk factor. Children undergoing palatoplasty may be at higher risk to develop postoperative dysnatremia. Early recognition of symptoms and risk factors, postoperative monitoring, and prompt treatment of dysnatremia diminish the risk of neurological complications.

Emergencies in Oncological Practice

Oncological emergencies are defined as an acute lifethreatening event in a patient with a tumor occurring as part of their complex treatment regimen or secondarily to their underlying malignancy. These events can occur at any time from the initial diagnosis of their cancer to endstage disease; and can be encountered in any clinical setting, ranging from primary care physician and emergency department visits to a variety of subspecialty environments. Oncologic emergencies are clinical situations that can lead to death in a short time (24-48 hours) if not quickly faced. In the clinical practice of the medical oncologist, such situations do not infrequently occur. The onset of oncologic emergencies may depend on the presence of cancer itself, the therapies carried out to counteract cancer, or the patient’s predisposition to develop such events. It is essential to recognize the aforementioned situations early in order to treat them promptly, thus avoiding serious consequences. BJM Vol. 34 No. 2(1) Suppliment 2023 Scientific Presentation 186 Therefore, it is critically important that all physicians have a working knowledge of the potential oncological emergencies that may present in their practice and how to provide the most effective care without delay. Nervous system emergencies include spinal cord compression, raised ICP, leptomeningeal disease, seizures and altered mental status whereas superior venacaval syndrome, hyperviscocity syndrome, hyperleukocytosis, venous thromboembolism, Hemorrhage and DIC are the vascular and haematologic emergencies. Several classic metabolic oncologic emergencies include syndrome of inappropriate antidiuretic hormone secretion, tumor lysis syndrome and hypercalcemia of malignancy. Among the pulmonary problems airway obstruction, massive haemoptysis, toxic lung injuries, pneumonitis and pulmonary fibrosis can be caused by cancer and cancer treatment. Urologic emergencies such as hemorrhagic cystitis and obstructive uropathy are also seen. Gastrointestinal bleeding in patients with cancer and typlitis in patients with neutropenic fever are potentially serius complications also. Immune check point inhibitors may cause irAEs in practically any organ system ranging from SJS, TEN, thyroiditis, hypophysitis, adrenilitis, diabetic ketoacidosis to life threatening pneumonitis and myocarditis which may be associated with poor overall survival. Oncologic emergencies can threaten the well-being of almost any patient with a malignancy. Although some of these conditions are related to cancer therapy, they are by no means confined to the period of initial diagnosis and active treatment. In the setting of recurrent malignancy, these events can occur years after the surveillance of a cancer patient has been appropriately transferred from a medical oncologist to a primary care provider. As such, awareness of a patient’s cancer history and its possible complications forms an important part of any clinician’s knowledge base. Prompt identification of and intervention in these emergencies can prolong survival and improve quality of life, even in the setting of terminal illness. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 186-187

A case of syndrome of inappropriate secretion of antidiuretic hormone (SIADH) caused by traumatic hemopneumothorax

症例は73歳女性．自動車乗車中に単独事故で受傷し救急搬送された．胸部単純CTで両側多発骨折，軽度左血気胸，外傷性肝損傷を認め入院となった．入院2日目に呼吸状態が悪化，左胸腔ドレナージを行い呼吸状態は改善したが，入院3日目に痙攣及び遷延する意識障害を認めた．血液検査で著明な血清ナトリウム値低下を認め，中枢神経系疾患や副腎機能異常を認めなかったことから抗利尿ホルモン分泌異常症候群（syndrome of inappropriate secretion of antidiuretic hormone：SIADH）と診断した．補液による電解質補正にて血清ナトリウム値は速やかに正常化し，意識も改善した．

Status Epilepticus in Meningoencephalitis Patients with Hyponatremia Associated with Use of Hypotonic Maintenance Solutions in Children: Is It the Time Switching to Isotonic Maintenance Solutions?

Hyponatremia is one of the complication of inpatient care which is quite common in the pediatric population. This condition often occurs due to the administration of intravenous fluids that are hypotonic and is exacerbated by the condition of SIADH (Syndrome of Inappropriate Anti Diuretic Hormone) which occurs in patients with pain, anxiety, stress, administration of anesthetic agents, narcotics, operative procedures and administration of positive pressure ventilation and infections, especially pneumonia and meningitis. In addition, this condition is also exacerbated by the addition of glucose into the administration of pediatric maintenance fluids. when glucose is metabolized it will leave free water which will affect plasma osmolality. In 2018, the AAP released strong recommendations in administering isotonic fluids as maintenance fluids in pediatric patients in addition to the addition of glucose and potassium. but in clinical practice in hospitals, the use of hypotonic fluids that have been used for a long time is still difficult to abandon because practitioners feel they have not found enough cases of complications. This case report describes a meningoencephalitis patient with status epilepticus who experienced hyponatremia after being given hypotonic fluids according to local guidelines and improved after sodium correction

Post operative copeptin does not predict occurrence of the syndrome of inappropriate antidiuresis (SIAD) after pituitary transsphenoidal surgery

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Syndrome of inappropriate antidiuretic hormone secretion associated with olfactory neuroblastoma

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)