Serum Electrolyte Abnormalities Research Articles

Diabetic ketoacidosis complicated by supraventricular tachycardia in a young adult: a case report

Diabetic ketoacidosis (DKA) is one of the most common serious metabolic complications of diabetes in adolescents and young adults. Compli- cations are due to metabolic acidosis, electrolyte abnormalities, acute renal failure and respiratory distress. Serum electrolyte abnormalities are common in DKA. Such serum electrolyte alterations, including acidosis, have been as- sociated with the development of cardiac arrhythmias. We report the case of a 29-year-old man whose parents have diabetes mellitus. His illness began six months earlier with a weight loss of 15 kg. He did not seek for medical atten- tion. The patient presented in a family medical unit with drowsiness and dehy- dration. On examination, his blood pressure was 90/60 mmHg, pulse rate 216 beats/minute, respiratory rate 32 cycles/minute, and temperature 36.5°C. His random blood glucose was 458 mg/dL with ketonuria. His electrocardiogram showed supraventricular tachycardia. He was referred to a second level hospital where he was admitted into the Intensive Care Unit (ICU) after three hours of stabilization. The patient was discharged in good condition 11 days after his admission to the hospital and was to continue treatment with glargine insulin (1 UI/kg) at home. He was also advised on healthy nutrition, blood glucose target of 150 mg/dL and follow-up in the Outpatient Department of Cardiology and Internal Medicine.

SERUM ELECTROLYTES AND OUTCOME IN PATIENTS UNDERGOING ENDOSCOPIC GASTROSTOMY.

Percutaneous endoscopic gastrostomy (PEG) is a gold standard for long term enteral feeding. Neurologic dysphagia and head/neck cancer are the most common indications for PEG as they can lead to protein-energy malnutrition and serum electrolyte abnormalities, with potential negative impact on metabolic balance. Refeeding syndrome may also be related with severe electrolyte changes in PEG-fed patients and contribute to poor prognosis. This study aims to evaluate the changes in serum concentrations of the main electrolytes and its possible association with the outcome. Retrospective study of patients followed in our Artificial Nutrition Clinic, submitted to PEG from 2010 to 2016, having head/neck cancer or neurologic dysphagia, who died under PEG feeding. Serum electrolytes (sodium, potassium, chlorine, magnesium, calcium and phosphorus) were evaluated immediately before the gastrostomy procedure. Survival after PEG until death was recorded in months. We evaluated 101 patients, 59 with electrolyte alterations at the moment of the gastrostomy. Sodium was altered in 32 (31.7%), magnesium in 21 (20.8%), chlorine in 21 (20.8%), potassium in 14 (13.8%), calcium in 11 (10.9 %) and phosphorus in 11 (10.9%). The survival of patients with low sodium (<135 mmol/L) was significantly lower when compared to patients with normal/high values, 2.76 months vs 7.80 months, respectively (P=0.007). Changes in serum electrolytes of patients undergoing PEG were very common. More than half showed at least one abnormality, at the time of the procedure. The most frequent was hyponatremia, which was associated with significantly shorter survival, probably reflecting severe systemic metabolic distress.

The impact of early enteral nutrition on pediatric patients undergoing gastrointestinal anastomosis a propensity score matching analysis.

This study was conducted to assess the clinical advantages of early enteral nutrition (EEN) in pediatric patients who underwent surgery with gastrointestinal (GI) anastomosis.EEN has been associated with clinical benefits in various aspect of surgical intervention, including GI function recovery and postoperative complications reduction. Evaluable data documenting clinical advantages with EEN for pediatric patients after surgery with GI anastomosis are limited.We retrospectively reviewed the medical records of 575 pediatric patients undergoing surgical intervention with GI anastomosis. Among them, 278 cases were managed with EEN and the remaining cases were set as late enteral nutrition (LEN) group. Propensity score (PS) matching was conducted to adjust biases in patient selection. Enteral feeding related complications were evaluated with symptoms, including serum electrolyte abnormalities, abdominal distention, abdominal cramps, and diarrhea. Clinical outcomes, including GI function recovery, postoperative complications, length of hospital stay, and postoperative follow-up, were assessed according to EEN or LEN.Following PS matching, the baseline variables of the 2 groups were more comparable. There were no differences in the incidence of enteral feeding-related complications. EEN was associated with postoperative GI function recovery, including time to first defecation (3.1 ± 1.4 days for EEN vs 3.8 ± 1.0 days for LEN, risk ratio [RR], 0.62; 95% confidence interval [CI] 0.43–1.08, P = .042). A lower total episodes of complication, including infectious complications and major complications were noted in patients with EEN than in patients with LEN (117 [45.9%] vs 137 [53.7%]; OR, 0.73, 95% CI 0.52–1.03, P = .046). Mean postoperative length of stay in the EEN group was 7.4 ± 1.8 days versus 9.2 ± 1.4 days in the LEN group (P = .007). Furthermore, the incidence of adhesive small bowel obstruction was lower for patients with laxative administration compared with control, but no significant difference was attained (P = .092)EEN was safe and associated with clinical benefits, including shorten hospital stay, and reduced overall postoperative complications on pediatric patients undergoing GI anastomosis.

Incident adverse drug reactions in geriatric inpatients: a multicentred observational study.

Adverse drug reactions (ADRs) are common in older adults and frequently have serious clinical and economic consequences. This study was conducted as a feasibility study for a randomized control trial (RCT) that will investigate the efficacy of a software engine to optimize medications and reduce incident (in-hospital) ADRs. This study's objectives were to (i) establish current incident ADR rates across the six sites participating in the forthcoming RCT and (ii) assess whether incident ADRs are predictable. This was a multicentre, prospective observational study involving six European hospitals. Adults aged ⩾ 65 years, hospitalized with an acute illness and on pharmacological treatment for three or more conditions were eligible for inclusion. Adverse events (AEs) were captured using a trigger list of 12 common ADRs. An AE was deemed an ADR when its association with an administered drug was adjudicated as being probable/certain, according to the World Health Organization Uppsala Monitoring Centre causality assessment. The proportion of patients experiencing at least one, probable/certain, incident ADR within 14 days of enrolment/discharge was recorded. A total of 644 patients were recruited, evenly split by sex and overwhelmingly of White ethnicity. Over 80% of admissions were medical. The median number of chronic conditions was five (interquartile range 4-6), with eight or more conditions present in approximately 10%. The mean number of prescribed medications was 9.9 (standard deviation 3.8), which correlated strongly with the number of conditions (r = 0.54, p < 0.0001). A total of 732 AEs were recorded in 382 patients, of which 363 were incident. The majority of events were classified as probably or possibly drug related, with heterogeneity across sites (χ2 = 88.567, df = 20, p value < 0.001). Out of 644 patients, 139 (21.6%; 95% confidence interval 18.5-25.0%) experienced an ADR. Serum electrolyte abnormalities were the most common ADR. The ADRROP (ADR Risk in Older People) and GerontoNet ADR risk scales correctly predicted ADR occurrence in 61% and 60% of patients, respectively. This feasibility study established the rates of incident ADRs across the six study sites. The ADR predictive power of ADRROP and GerontoNet ADR risk scales were limited in this population.

Association of Serum Creatinine and Electrolyte Abnormalities in Preterm Low Birth Weight Neonates

Introduction: Being born prematurely is a threat to survival and the subsequent quality of life ICDDR,B Health and Science Bulletin published in March 2006 reported that prematurity and low birth weight contributes to 27.8% of neonatal deaths in rural areas of Bangladesh Premature infant are at increased risk of developing dehydration or over hydration. Therefore, high index of suspicion, prompt recognition and thorough understanding of common electrolyte abnormalities are necessary to improve neonatal outcome. The investigation of renal function in pretenn neonate is complicated because of continuing renal development, rise in creatinine is transient and may not be clinically significcmt. Serum creatinine is most widely used marker of renal function in adults and children but its validity as a marker of GFR/ renal function is doubtful a few studies have been conducted on assessment of renal function and electrolytes in the context of prematurity in Bangladesh. But it seems to be essential for immediate management for planning appropriate fluid and electrolyte therapy and thereby for improved outcome. Information was collected who gave consent and participated in the study willingly. The sample size was 50. Duration of data collection was approximately 6 (Six) months.Patients admitted to the Holy Family Red Crescent Medical College and hospital and after meeting the inclusion and exclusion criteria a simple random sampling technique was applied for selecting the sample patients. Total 50 pretenn LBW neonates fulfilling the inclusion criteria were studied during this study period. Mean creatinine level was .82 mmoKrange was 0.40-1.90 mg/d1. Abnormal electrolytes were documented in 20(40%) pretenn LBW neonates of which hyperkalemia was the predominant electrolyte abnormality found in 8(16.0%) neonates, hyponatremia was found in 7 (14.0%), hypokalemia in 3 (6.0%) and hypernatremia 2 (4.0%). In the present study 20 of preterm LBW babies have electrolyte abnormalities. Hyperkalemia was found in 8(16.0%) babies in this study from above findings it is evident that prematurity causes transient renal impairment, in preterm neonates which is inversely related to gestational age. Renal impairment should be suspected if the serum creatinine rises or fails to show normal post-natal fall. It was observed that electrolyte abnormalities are common in preterm LBW neonates and transient renal failure also occurs in a large number of preterm LBW babies. So, identification of renal failure and associated electrolyte abnormalities and proper management of fluid and electrolytes and close monitoring are important.

AB016. Which laser works best for benign prostatic hyperplasia

For decades, transurethral resection of the prostate (TUR-P) has been considered the “gold standard” surgical procedure for men with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). The GreenLight (GL) laser has a wavelength of 532 nm the range of visible green light. The emitted energy is mostly absorbed by hemoglobin, thus heating the intracellular fluid in the well vascularized prostatic tissue which leads to vaporization. Since about half of men over the age of 60 often have lower LUTS due to BPH with prolonged life expectancy worldwide, more symptomatic BPH patients will require surgical interventions. The incidence of cardiovascular, stroke, and lung diseases also increases with age, the number of BPH patients at high risk for these diseases will increase accordingly. Gu et al. concluded that age has little effect on the efficacy and safety of GL HPS™ laser. Series of a total of 188 BPH patients at high cardiovascular risk and on long-term anticoagulation underwent 120-W GL laser vaporization of the BPH showed that no patient required blood transfusion, and none revealed any evidence of intraoperative fluid absorption leading to serum electrolyte abnormalities. Severe intraoperative and postoperative complications were not occurred. Disadvantage of previous KTP laser is limited volume reduction in large size prostate and may be insufficient to maintain long-lasting good functional results. Brunken et al. reported that GL laser enucleation of the prostate volume ≥50 cc. The results showed that all patients were able to void properly and during follow-up, none of the patients needed further interventions or hospital treatment. A multicenter randomized controlled trial at Europe compared GL laser with monopolar TUR-P with a total of randomized 139 patients. The results for IPSS variation were not different between two group in prostate volume ≥70 cc. The authors concluded that GL laser seems an acceptable alternative to TUR-P with close results on LUTS improvement in the short term and GL laser is associated with a reduced hospital stay with less postoperative irrigation and hematuria. Based on recently reported series, GL laser were not influenced by the size of prostate, the use of anticoagulant, the intake of 5-ARI for BPH management, a history of AUR. GL laser can be applied to the patients of large size of prostate, or difficult to stop the use of anticoagulant.

Mexiletine Prevents Recurrent Torsades de Pointes in Acquired Long QT Syndrome Refractory to Conventional Measures

ObjectivesThe purpose of this study was to examine the role of mexiletine, a late sodium current (INa-L) blocker, in acute termination of torsades de pointes (TdP) refractory to conventional therapy in acquired long QT syndromes (LQTS). BackgroundLong QT interval can predispose to TdP and is therefore associated with significant mortality. Currently, there is no available pharmacotherapy to target directly the ionic basis of most LQTS for the acute termination of TdP. Earlier evidence highlighted the role of INa-L in the pathophysiology of long QT and TdP, particularly in patients with congenital LQTS. MethodsTwelve patients with TdP caused by acquired LQTS were treated with mexiletine after failure of conventional treatment including discontinuation of QT-prolonging drugs, intravenous administration of magnesium, and correction of serum electrolyte abnormalities. ResultsNo recurrence of TdP occurred within 2 h after initiation of treatment with mexiletine in all 12 patients. Macro T-wave alternans accompanied by QT prolongation, an electrocardiographic precursor of TdP that was seen in 3 patients, was also abolished by mexiletine. Treatment with mexiletine shortened the QTc interval from 599 ± 27 ms to 514 ± 16 ms (p = 0.001). The interval from the peak to the end of the T-wave (Tp-e interval) decreased from 145 ± 18 ms to 106 ± 9 ms (p = 0.005). The Tp-e/QT ratio decreased from 0.27 ± 0.02 to 0.23 ± 0.018 (p = 0.01). Mexiletine had no significant effect on QRS complex duration. ConclusionsINa-L blockade with mexiletine may be an effective treatment approach to terminate refractory TdP from several acquired causes of LQTS.

Avoidance and management of perioperative complications of endoscopic third ventriculostomy: the Dhaka experience.

Although endoscopic third ventriculostomy (ETV) is a minimally invasive procedure, serious perioperative complications may occur due to the unique surgical maneuvers involved. In this paper the authors report the complications of elective and emergency ETV and their surgical management in 412 patients from July 2006 to October 2012 at Dhaka Medical College Hospital (a government hospital) and other private hospitals in Dhaka, Bangladesh. The authors attempted some previously undescribed simple maneuvers that may help to overcome the difficulties of managing complications. The complication rate was determined by recording intraoperative changes in pulse and blood pressure, bleeding episodes, serum electrolyte abnormalities, CSF leakage, and neurological deterioration in the immediate postoperative period. Intraoperative complications included hemodynamic alterations in the form of tachycardia, bradycardia, and hypertension. Bleeding was categorized as major in 2 cases and minor in 68 cases. Delayed recovery from anesthesia occurred in 14 cases, CSF leakage from the wound in 11 cases, and electrolyte imbalance in 5 cases. Postoperatively, 2 patients suffered convulsions and 1 had evidence of third cranial nerve injury. Three patients died as a result of complications. Complications during endoscopy can lead to serious consequences that may sometimes be very difficult to manage. The authors have identified and managed a large number of complications in this series, although the rate of complications is consistent with that in other reported series. These complications should be kept in mind perioperatively by both surgeons and anesthesiologists, as prompt detection and action can help minimize the risks associated with neuroendoscopic procedures.

Congenital diarrhoeal disorders: advances in this evolving web of inherited enteropathies.

Congenital diarrhoeal disorders (CDDs) represent an evolving web of rare chronic enteropathies, with a typical onset early in life. In many of these conditions, severe chronic diarrhoea represents the primary clinical manifestation, whereas in others diarrhoea is only a component of a more complex multi-organ or systemic disorder. Typically, within the first days of life, diarrhoea leads to a life-threatening condition highlighted by severe dehydration and serum electrolyte abnormalities. Thus, in the vast majority of cases appropriate therapy must be started immediately to prevent dehydration and long-term, sometimes severe, complications. The number of well-characterized disorders attributed to CDDs has gradually increased over the past several years, and many new genes have been identified and functionally related to CDDs, opening new diagnostic and therapeutic perspectives. Molecular analysis has changed the diagnostic scenario in CDDs, and led to a reduction in invasive and expensive procedures. Major advances have been made in terms of pathogenesis, enabling a better understanding not only of these rare conditions but also of more common diseases mechanisms.

Coronary Fistulas in a Patient with a Novel Long QT Syndrome Mutation

The congenital long QT syndrome (LQTS) is a genetic cardiac channelophathy with variable penetrance characterized by corrected QT (QTc) interval prolongation and predisposition to polymorphic ventricular tachycardia (PVT), which normally presents with syncope or sudden death. It can be caused by mutations in different ion channels, resulting in prolongation of the myocardial repolarization1. The clinical course of LQTS throughout a patient’s lifetime is significantly influenced by the genotype and acquired factors that additionally compromise myocardial repolarization, including drug use, serum electrolyte abnormalities, autoimmune diseases, severe bradycardia, acute heart failure decompensation and myocardial ischemia2. This report presents the first description of PVT precipitated by myocardial ischemia secondary to multiple coronary fistulas in a patient with a novel LQTS-causing mutation.

Acquired Fanconi syndrome in patients with Legionella pneumonia

BackgroundHyponatremia is often observed in patients with Legionella pneumonia. However, other electrolyte abnormalities are uncommon and the mechanism remains to be clarified.Case presentationWe experienced two male cases of acquired Fanconi syndrome associated with Legionella pneumonia. The laboratory findings at admission showed hypophosphatemia, hypokalemia, hypouricemia and/or hyponatremia. In addition, they had the generalized dysfunction of the renal proximal tubules presenting decreased tubular reabsorption of phosphate (%TRP), increased fractional excretion of potassium (FEK) and uric acid (FEUA), low-molecular-weight proteinuria, panaminoaciduria and glycosuria. Therefore, they were diagnosed as Fanconi syndrome. Treatment for Legionella pneumonia with antibiotics resulted in the improvement of all serum electrolyte abnormalities and normalization of the %TRP, FEK, FEUA, low-molecular-weight proteinuria, panaminoaciduria and glycosuria, suggesting that Legionella pneumophila infection contributed to the pathophysiology of Fanconi syndrome.ConclusionTo the best of our knowledge, this is the first report demonstrating Fanconi syndrome associated with Legionella pneumonia.

Brain White Matter Abnormality in a Newborn Infant with Congenital Adrenal Hyperplasia

Several studies have described brain white matter abnormalities on magnetic resonance imaging (MRI) in children and adults with congenital adrenal hyperplasia (CAH), while the brain MRI findings of newborn infants with CAH have not been clarified. We report a newborn boy with CAH who presented brain white matter abnormality on MRI. He was diagnosed as having salt-wasting CAH with a high 17-OHP level at neonatal screening and was initially treated with hydrocortisone at 8 days of age. On day 11 after birth, he had a generalized tonic seizure. No evidence of serum electrolyte abnormalities was observed. Brain MRI revealed white matter abnormalities that consisted of bilateral small diffuse hyperintensities on T1-weighted images with slightly low intensity on T2-weighted images in the watershed area. Several factors associated with brain white matter abnormalities in adults with CAH, such as increasing age, hypertension, diabetes and corticosteroid replacement, were not applicable. Although the cause of the phenomenon in this case is unclear, brain white matter abnormality could be observed in newborn infants with CAH as well as in adult patients.

Pancytopenia Associated with Hypopituitarism in an Acromegaly Patient: A Case Report and a Review of the Literature

We present the case of a patient with acromegaly who had pancytopenia with hypopituitarism secondary to the excision of a pituitary macroadenoma and radiation therapy. A 28-year-old man presented with pancytopenia and serum electrolyte abnormalities. He was diagnosed with acromegaly and underwent surgery and gamma-knife radiotherapy for a pituitary macroadenoma at the age of 22 years. A recent brain magnetic reso nance imaging showed an empty sella, and the basal hormonal profile demonstrated deficiencies of pituitary hormones except thyrotropin. As presenting pancytopenia, his bone marrow biopsy showed hypocellular marrow. The total number of hemocytes increased after hydrocortisone replacement. Hypopituitarism was a possible cause of pan cytopenia, and glucocorticoids had crucial effects on converting pancytopenia to normal in this case. ( Endocrinol Metab 27:308313, 2012)

Role of Routine Preoperative Biochemistry in Anaesthesia

Objectives: To assess the value of routine preopera-tive biochemical tests and their effects on anaesthetic management. Design: A cross sectional study. Place and Duration of Study: Shalamar Hospital, Lahore. From August 1 st 2009 to November 30 th 2009. Methodology: We studied consecutive 500 ASA I and ASA II patients, 40 years of age and above, sche-duled for elective surgery. Patients with any disease or factor that can lead to metabolic disturbance were ex-cluded from the study. Results: Patients were divided into 4 age groups, (Group A (40 - 49 years), Group B (50 - 59 years), Group C (60 - 69 years) and Group D (more than 70 years). Total abnormalities detected were 8 (1.6%). Abnormal blood sugar was found in 5 cases, 1.1% of all the tested patients, which belonged to age group A (1.7% of the group population). Abnormal blood urea was found in 2 cases which is 0.4% of the tested popu-lation and all of these belonged to age group D (2.8% of the age group population). Abnormal creatinine was found in one of the two cases of abnormal blood urea in the age group D, which is 0.2% of the tested popula-tion (1.4% of the group population). Serum electrolyte abnormalities were not found in any patient. The anae-sthetic management was changed in 5 cases with abno-rmal blood sugar and was not influenced in patients with abnormal blood urea and serum creatinine. Conclusion and Recommendation: Routine pre-operative serum electrolytes in patients, aged 40 - 70 years with no history of cardiac disease, renal disease and diabetes are not recommended. We recommend routine preoperative estimation of blood sugar in the all patients above the age of 40 years and renal func-tion tests in patients above the age of' 70 years. Key Words: Routine preoperative blood sugar, Urea, Creatinine, peri and postoperative, anaesthetic mana-gement.

101: QTc Prolongation and Serum Electrolyte Abnormalities In Emergency Department Patients

101: QTc Prolongation and Serum Electrolyte Abnormalities In Emergency Department Patients

Dyshomeostasis of Serum Sodium Concentration in Congestive Heart Failure

Congestive heart failure (CHF) is the most common discharge diagnosis in the United States and accounts for greater than 1 million hospital discharges annually. CHF is associated with many serum electrolyte abnormalities, the most common and perhaps most significant of which is hyponatremia. CHF with hyponatremia makes the already high morbidity and mortality of CHF even more unfavorable. Further, the usual treatment for CHF with diuretics usually aggravates hyponatremia. Hyponatremia may result in impaired cognition and neurologic performance in a large number of patients, which is usually reversible with correction. The high morbidity and mortality with CHF and hyponatremia are not improved with the usual treatment with diuretics or ultrafiltration. This article provides an overview of the pathophysiology of hyponatremia in CHF. In addition, the authors will explore the various treatment options that are available and the evidence to support their utility.

Traumatic Bladder Rupture Following Vaginal Hysterectomy

Although complications associated with vaginal hysterectomy are rare, the most common complications involve bladder injury. These injuries are sustained most commonly during mobilization of the posterior bladder wall off of the lower uterine segment, particularly in the setting of adhesions from prior cesarean sections. Bladder injuries may present with urinary retention, gross hematuria, serum electrolyte, and creatinine abnormalities, a bowel ileus or abdominal pain. This report describes a patient who underwent a total vaginal hysterectomy complicated by an unrecognized bladder injury, rupture, and subsequent abdominopelvic urinoma, requiring surgical drainage and repair.

Hypokalaemia in children hospitalised for diarrhoea and malnutrition in Calabar, Nigeria

To describe the acid base and electrolyte pattern of morbidity and mortality in children with diarrhoea and protein energy malnutrition. The diarrhoea treatment and training unit of the university of Calabar teaching hospital was used for the study. It was a prospective study in which consecutive children below the age of 15 years with protein energy malnutrition and diarrhoeal diseases admitted into the DTU were screened for acid base and serum electrolyte abnormalities. The study was carried out over a two year period from January 1997 to December 1998. Hypokalaemia was seen in 45 (23.4%) patients. This was second to acidosis. Metabolic acidosis was the commonest abnormality in this study and was seen in 108(56.3%) of the patients included in the study. There was hyponatraemia in 25(13%). Hypochloraemia in 8(4.2%) and hypernatraemia in 6(3.1%) of the patients respectively. This study has shown that hypokalaemia is a common electrolyte abnormality in children with severe protein energy malnutrition and diarrhoeal diseases. There is need to encourage the use of readily available interventions such as the UNICEF and WHO oral rehydration solution in patients with diarrhoea and/or severe protein energy malnutrition to reduce morbidity and mortality from acid base and electrolyte disturbances.

Clinical features and heritability of hypoadrenocorticism in Nova Scotia Duck Tolling Retrievers: 25 cases (1994–2006)

To evaluate the clinical features and heritability of naturally occurring hypoadrenocorticism in Nova Scotia Duck Tolling Retrievers (NSDTRs). Retrospective case series. 25 NSDTRs with hypoadrenocorticism. Questionnaires completed by owners of NSDTRs with hypoadrenocorticism and medical records from veterinarians were reviewed for information regarding diagnosis, age at diagnosis, concurrent diseases, age at death, and cause of death. Pedigrees were analyzed for heritability and mode of inheritance of hypoadrenocorticism (including complex segregation analysis of pedigrees of 1,515 dogs). On the basis of results of ACTH stimulation testing, hypoadrenocorticism was diagnosed in 16 female and 9 male NSDTRs (including 6 full siblings). Median age at diagnosis was 2.6 years; the diagnosis was made prior to 2 years of age in 11 dogs. Seventeen dogs had hyponatremia, hyperkalemia, or both, and serum electrolyte concentrations were within reference ranges for 8 dogs at the time of diagnosis. Median survival time after diagnosis for 4 dogs that died or were euthanized as a result of medical causes was 1.6 years. Heritability was calculated at 0.98 with no sex effect, and complex segregation analysis fit a major gene model with an autosomal recessive mode of inheritance. In NSDTRs, hypoadrenocorticism was diagnosed at an earlier age, compared with published reports of age at diagnosis among the general dog population. Among the study dogs, 32% had no serum electrolyte abnormalities at the time of diagnosis, and the disease appeared to have an autosomal recessive mode of inheritance in the breed.

Maximal bladder capacity is a positive predictor of response to desmopressin treatment in patients with MS and nocturia

The aim of the study is to evaluate the efficacy of desmopressin therapy in the symptomatic treatment of nocturia in patients with multiple sclerosis (MS) and neurogenic detrusor overactivity, and to investigate the validity of maximal bladder capacity as a predictor of response to intranasal desmopressin inhalation. A set of 20 women with MS and neurogenic detrusor overactivity enrolled in a prospective pilot study and were divided into two groups: Group A, the large bladder capacity group (maximal bladder capacity >250 ml, compliance >20 ml/cm H(2)O, n=10) and Group B, the small bladder capacity group (maximal bladder capacity <250 ml, compliance <20 ml/cm H(2)O, n=10). Maximal bladder capacities were measured by urodynamic evaluation. The dosage selected for the study was based on the established dose of commercially available desmopressin nasal spray (20 mug before bedtime) and on clinical trial experience. All patients were monitored for arterial blood pressure before and after treatment and for weight increase for the first 5 days of treatment. Night time voiding diaries were maintained for the 6 weeks of the trial; similarly, serum electrolyte levels and urine osmolality were measured twice weekly during the trial. The mean volume of nocturnal incontinence decreased significantly in both groups (P<0.005). The average number of episodes of nocturia per night in Group A decreased from 2.35 to 0.89 and in Group B from 2.31 to 1.65. The maximum hours of sleep uninterrupted by nocturia increased from 2.54 to 4.62 in Group A and from 2.45 to 3.23 in Group B. Side effects were infrequent; only 2 patients complained of transient headaches. Neither hyponatremia nor serum electrolyte abnormalities occurred. Our results suggest that desmopressin is effective in the symptomatic management of nocturia in patients with MS and neurogenic detrusor overactivity. Maximal bladder capacity is a valuable predictor of response to desmopressin.