1/16. coma and seizures due to severe hyponatremia and water intoxication in an adult with intranasal desmopressin therapy for nocturnal enuresis.Desmopressin, a synthetic analogue of the antidiuretic hormone, is an effective medication for primary nocturnal enuresis for both children and adults. Its safety is well established. Although it has a favorable side effect profile, because of its pharmacological effect, intranasal desmopressin can rarely induce water intoxication with profound hyponatremia if given without adequate restriction of water intake. The authors describe an adult patient with water intoxication and severe hyponatremia accompanied by loss of consciousness and seizures after 2-day intranasal administration of desmopressin. The present and the previously reported cases emphasize the need for greater awareness of the development of this serious and potentiallyfatal complication. In addition, to adjust the drug to the lowest required dosage, adequate restriction of water intake is recommended, and serum levels of sodium should be measured periodically to allow for early detection of water intoxication and hyponatremia.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
2/16. Hyponatraemic coma induced by desmopressin and ibuprofen in a woman with von Willebrand's disease.A middle-aged woman was admitted to the hospital after being found unconscious at home. A brain CT scan excluded an intracranial bleed or other focal abnormality. Laboratory analysis showed hyponatraemia (sodium: 121 mmol L(-1)) and a low plasma osmolality, with normal sodium excretion and urine osmolality. A diagnosis of hyponatraemic coma was made. The patient was treated with water restriction; 24 h later the sodium was 135 mmol L(-1) and the patient was neurologically fully recovered. The patient, who suffered from von Willebrand's disease, had received desmopressin and ibuprofen for analgesia 2 days before after a dental intervention. She had received desmopressin several times in the past without any complications. A few patients treated with desmopressin for coagulation abnormalities have been reported to develop water intoxication and severe hyponatraemia resulting in seizures and coma. By inhibiting prostaglandin synthesis, non-steroid anti-inflammatory agents (NSAIDs) potentiate the effect of water reabsorption in the renal tubules of vasopressin, therefore enhancing water retention. Desmopressin and NSAIDs should not be used in combination in patients with bleeding disorders, but it is often followed in clinical practice. In addition, this is probably not an unusual situation in patients treated with desmopressin for other 'non-haemorrhagic' indications. This report emphasizes the need for practitioners to be aware of this rare but severe complication.- - - - - - - - - - ranking = 0.44444444444444keywords = water (Clic here for more details about this article) |
3/16. child abuse: acute water intoxication in a hyperactive child.A 4-year-8-month-old boy was brought to our emergency department with coma and seizure. Initial physical examination showed evidence of physical child abuse and sudden body weight gain of 3.4 kg in one day. The laboratory results showed normal renal function with severe hyponatremia and the MRI study showed diffuse brain swelling. All of these findings were compatible with the diagnosis of acute water intoxication. Careful history taking from the boy and his parents separately confirmed the course of chronic polydipsia with acute compulsive water drinking. After clinical assessment and follow-up by psychiatrist, the patient was diagnosed with hyperactivity disorder. We present this case and show the possibility of correlation between compulsive water drinking, child abuse and hyperactivity disorder on acute water intoxication.- - - - - - - - - - ranking = 0.88888888888889keywords = water (Clic here for more details about this article) |
4/16. acupuncture treatment of syncope based on differentiation of signs and symptoms.1. The three typical cases reported above were syncopic patients of different types. Case 1 belonged to yin-depletion syndrome, case 2 pertained to yang-depletion syndrome, and case 3 Jue syndrome due to disturbance between qi and the blood induced by deficiency of qi and accumulation of phlegm. All of the three cases were satisfactorily cured with acupuncture and moxibustion though they did not respond to western medicines. 2. The rationale of acupuncture treatment for syncope includes: 1) Regulating yin and yang: For yin-depletion syndrome, reinforcing method is mainly adopted for nourishing water to promote reproduction of the body fluids and replenishing yin to restore yang; in case of yang-depletion syndrome, moxibustion and needle-warming methods are mainly used for recuperating the depleted yang to rescue the patient from collapse and for invigorating yang to restore yin. 2) Resuscitating the patient by regulating qi and the blood and dredging the channels to activate the circulation. After a successful resuscitation, the patient should be radically treated with appropriate herbal medicines so as to consolidate the therapeutic efficacy. 3. An emergency treatment for syncopal patients with acupuncture and moxibustion must be based on a conscientious differentiation of the signs and symptoms. The treatment should strictly follow the therapeutic principles: reinforce for the deficiency, reduce for the excess, cool the heat and warm the cold.- - - - - - - - - - ranking = 0.11111111111111keywords = water (Clic here for more details about this article) |
5/16. living wills and the right to die.Two recent court decisions clarified whether and under what circumstances a patient may refuse life-sustaining medical treatment, including food and water. The Nancy Cruzan case, decided by the U.S. Supreme Court on June 25, 1990, and the case of Shirley Crabtree, decided by family Court Senior Judge Daniel G. Heely in hawaii on April 26, 1990, had differing outcomes. Moreover, hawaii has a living will statute which purports to place limits on when and whether a person may choose to die rather than live in a severely disabled condition. This article will summarize the current law, and will offer practical advice to physicians on how to deal with these sensitive issues that affect their patients.- - - - - - - - - - ranking = 0.11111111111111keywords = water (Clic here for more details about this article) |
6/16. A case of myxoedema coma successfully treated by low dose oral triiodothyronine.Myxoedema coma is fortunately rare and is probably rarer in a warm climate such as australia. It carries a high mortality rate. Its correct management is still a controversial issue. A case of severe myxoedema coma who was successfully treated is described. Thyroid hormone was replaced in the form of triiodothyronine given orally in doses of 20-40 microng/day. There was an improvement in body temperature within six hours of the first dose; this was accompanied by a brisk fall in serum CPK and cholesterol with a rapid rise of plasma T3 into the euthyroid range. There was a defect in water excretion which was rapidly reversed as renal function returned to normal. review of the literature suggests that low dose oral therapy with T3 is a satisfactory form of initial management.- - - - - - - - - - ranking = 0.11111111111111keywords = water (Clic here for more details about this article) |
7/16. water intoxication and Syntocinon infusion.A case of severe water intoxication with convulsion and prolonged coma, following the use of a high dose Syntocinon infusion is described. The pathogenesis and treatment of the condition are discussed.- - - - - - - - - - ranking = 0.11111111111111keywords = water (Clic here for more details about this article) |
8/16. A case of water hemlock poisoning.Water hemlock is a ubiquitous plant that can be mistaken for a turnip as in the case reported. Oral ingestion causes an explosive illness consisting of nausea, vomiting, abdominal cramps, and grand mal seizures that can progress to cyanosis and death. In the reported case a 30-year old man was found semi-comatose some 75 minutes after ingesting a "turnip". The history revealed profuse emesis shortly after eating lunch that changed from bile to frank blood. There was a mean orthostatic blood pressure change of 30 torr, with an increase in the heart rate of 10%. neurologic examination revealed a lethargic patient. Following administration of 4 liters of Ringer's lactate the patient's blood pressure stabilized and with continued isotonic fluid maintenance he improved rapidly. This case indicates that appropriate management should be directed toward protecting the patient's airway from gastric aspiration, restoring the intravascular and extracellular volume deficit, and controlling cerebral edema.- - - - - - - - - - ranking = 0.44444444444444keywords = water (Clic here for more details about this article) |
9/16. water intoxication in a psychotic patient with normal renal water excretion.A psychotic patient with hyponatremia and obtundation following short-term ingestion of large amounts of water was found to have maximally dilute urine, and underwent brisk diuresis until the serum osmolality returned to normal. This is the first report of normal renal diluting capacity as documented by measurement of urine osmolality in a water-intoxicated, schizophrenic patient, and demonstrates that normal renal diluting mechanisms may on occasion be overwhelmed by massive water ingestion.- - - - - - - - - - ranking = 0.77777777777778keywords = water (Clic here for more details about this article) |
10/16. hypophosphatemia associated with coma.In three cases of severe hypophosphatemia profound coma was associated. Although the occurrence of hypophosphatemia appeared to coincide with a high rate of intravenous administration of glucose and water, two of the three patients had liver disease and the other had hypothermia. In two instances the neurologic status improved with intravenous phosphate therapy. These case reports emphasize the importance of early recognition and treatment of profound hypophosphatemia in critically ill patients.- - - - - - - - - - ranking = 0.11111111111111keywords = water (Clic here for more details about this article) |
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