1/12. syndrome of inappropriate antidiuretic hormone secretion associated with lisinopril.OBJECTIVE: To describe a case of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) associated with lisinopril therapy. CASE SUMMARY: A 76-year-old white woman who was being treated with lisinopril and metoprolol for hypertension presented with headaches accompanied by nausea and a tingling sensation in her arms. Her serum sodium was 109 mEq/L, with a serum osmolality of 225 mOsm/kg, urine osmolality of 414 mOsm/kg, and spot urine sodium of 122 mEq/L. diclofenac 75 mg qd for osteoarthritic pain and lisinopril 10 mg qd for hypertension was begun in 1990. lisinopril was increased to 20 mg qd in August 1994 and to 20 mg bid pm in August 1996 for increasing blood pressure; metoprolol 50 mg qd was added in July 1996. A diagnosis of SIADH was postulated and further evaluation was undertaken to exclude thyroid and adrenal causes. After lisinopril was discontinued and the patient restricted to 1000 mL/d of fluid, serum sodium gradually corrected to 143 mEq/L. The patient was discharged taking metoprolol alone for her hypertension; serum sodium has remained > or =138 mEq/L through April 1999, 32 months after discharge, despite daily use of diclofenac. DISCUSSION: Angiotensin-converting enzyme (ACE) inhibitors in antihypertensive doses may block conversion of angiotensin I to angiotensin ii in the peripheral circulation, but not in the brain. Increased circulating angiotensin I enters the brain and is converted to angiotensin ii, which may stimulate thirst and release of antidiuretic hormone from the hypothalamus, eventually leading to hyponatremia. CONCLUSIONS: SIADH should be considered a rare, but possible, complication of therapy with lisinopril and other ACE inhibitors.- - - - - - - - - - ranking = 1keywords = thirst (Clic here for more details about this article) |
2/12. Transient reduction in the posterior pituitary bright signal preceding water intoxication in a malnourished child.We describe a 4 year-old boy with hypothalamic dysfunction and weight loss, attributed to psychosocial deprivation. Reduced intensity of the posterior pituitary bright signal (PPBS) on MRI, associated with a normal urinary concentrating ability, was documented in the 24 hours prior to the development of the syndrome of inappropriate secretion of antidiuretic hormone (ADH) and severe hyponatraemia. The PPBS was normal on MRI 2 months later, following weight gain and resolution of the other hypothalamic abnormalities. This report shows that the abnormalities of ADH associated with decreased intensity of the PPBS include increased secretion and abnormal regulation as well as ADH deficiency. The association of osmotically unregulated ADH secretion with undernutrition and stress suggests that particuar caution should be used when fluid intake in such children is not driven by thirst.- - - - - - - - - - ranking = 1keywords = thirst (Clic here for more details about this article) |
3/12. Tolterodine-induced hyponatraemia.Management of electrolyte abnormalities is challenging in older people as the sensation of thirst, renal function and hormonal modulators of the milieu interior are often impaired. Furthermore, the complex effects of ageing upon these homeostatic mechanisms are often superimposed upon a background of chronic disease, malnutrition and co-existent medications. Hyponatraemia is one of the commonest electrolyte abnormalities, occurring in approximately 7% of healthy elderly persons. Hyponatraemia may only come to light when some other ailment prompts investigations or hospital admission. Drug-induced hyponatraemia is common in older people and is most commonly associated with diuretics and SSRI/SNRI antidepressants, but has also been reported with a wide range of other drugs. We believe this is the first case report of hyponatraemia due to tolterodine.- - - - - - - - - - ranking = 1keywords = thirst (Clic here for more details about this article) |
4/12. Hyponatraemic encephalopathy despite a modest rate of fluid intake during a 109 km cycle race.OBJECTIVE: To report a case of exertional hyponatraemic encephalopathy that occurred despite a modest rate of fluid intake during a 109 km cycling race. methods: Men and women cyclists were weighed before and after the race. All subjects were interviewed and their water bottles measured to quantify fluid ingestion. A blood sample was drawn after the race for the measurement of serum Na( ) concentration. RESULTS: From the full set of data (n = 196), one athlete was found to have hyponatraemic encephalopathy (serum [Na( )] 129 mmol/l). She was studied subsequently in the laboratory for measurement of sweat [Na( )] and sweat rate. CONCLUSIONS: Despite a modest rate of fluid intake (735 ml/h) and minimal predicted sweat Na( ) losses, this female athlete developed hyponatraemic encephalopathy. The rate of fluid intake is well below the rate currently prescribed as optimum. drinking to thirst and not to a set hourly rate would appear to be the more appropriate behaviour.- - - - - - - - - - ranking = 1keywords = thirst (Clic here for more details about this article) |
5/12. Severe hyponatremia: an association with lisinopril?A 63-year-old white woman with a history of hypertension and chronic obstructive pulmonary disease presented to the emergency room with worsening shortness of breath, anorexia, coughing, increased thirst, and leg edema of two weeks' duration. Medications included lisinopril 10 mg/d, which had been started six weeks earlier, sustained-release theophylline 300 mg q12h, and an albuterol inhaler. The lisinopril was discontinued on admission. serum sodium concentration was 109 mmol/L; the osmolality of the blood and of the urine were 253 mOsmol and 438 mOsmol, respectively, with a specific gravity of 1.025 and a urine sodium of 17 mmol/L. The hyponatremia initially was considered to be the syndrome of inappropriate antidiuretic hormone secretion in response to the patient's suspected pneumonia. Due to worsening blood pressure, lisinopril was restarted and the serum sodium concentration dropped from 134 to 126 mmol/L. Evaluation of the patient's hyponatremia included assessment of thyroid, adrenal, hepatic, and cardiac function that were within normal limits. The patient was discharged on the following medications: sustained-release theophylline 300 mg tid, prednisone 10 mg/d, albuterol inhaler 2 puffs q6h, and sustained-release verapamil 240 mg/d for blood pressure control. Her serum sodium concentration has remained between 135 and 140 mmol/L during hospitalizations for exacerbations of chronic obstructive pulmonary disease and for pneumonias 10 and 12 months after discharge.- - - - - - - - - - ranking = 1keywords = thirst (Clic here for more details about this article) |
6/12. polydipsia, polyuria, and hypertension associated with renin-secreting wilms tumor.A 16-month-old black male infant had unusual thirst, polyuria, hyponatremia, and hypertension. His polyuria was unresponsive to vasopressin therapy, and his high blood pressure was not effectively controlled by antihypertensive drugs. Radiographic examinations revealed an occult wilms tumor in the right kidney. After removal of the tumor, the signs and symptoms were relieved. The tumor had a renin activity about 280 times that of the adjacent renal cortex, and many intracytoplasmic secretory granules were found on electron microscopy. The pathogenesis of these clinical manifestations appears to be mediated through the physiologic pathways of renin-angiotensin ii and renin-aldosterone.- - - - - - - - - - ranking = 1keywords = thirst (Clic here for more details about this article) |
7/12. water intoxication and rhabdomyolysis.A 44-year-old woman was admitted because of stupor. She had consumed 3 liters of water due to thirst after drinking alcohol. Laboratory findings on admission revealed marked hyponatremia (sodium: 115 mEq/l). She was diagnosed as having water intoxication. She recovered from her hyponatremia upon excretion of a large amount of hypotonic urine. Subsequently, however, her serum creatine phosphokinase was markedly elevated at 28,650 IU/l, and her serum myoglobin reached 2,760 ng/ml. The relationship between the occurrence of hyponatremia secondary to water intoxication and rhabdomyolysis was suggested.- - - - - - - - - - ranking = 1keywords = thirst (Clic here for more details about this article) |
8/12. Hyponatraemic-hypertensive syndrome due to unilateral renal ischaemia in women who smoke heavily.The hyponatraemic-hypertensive syndrome due to renal ischaemia is presumed to be uncommon. We describe four patients who presented with this syndrome over a period of 21 months. All were women who smoked heavily and had unilateral atherosclerotic renal ischaemia. Hypokalaemia was present in each patient, and in one case resulted in recurrent ventricular tachycardia. All had noted thirst, polyuria, and weight loss. Initiation of treatment with a converting-enzyme inhibitor reduced arterial pressure precipitously in two patients. Removal of the ischaemic kidney, or chronic therapy with a converting-enzyme inhibitor reversed the biochemical abnormalities and the presenting symptoms, and lowered arterial pressure. Detailed studies in two patients before and after treatment confirmed the central role of the renin-angiotensin system in the development of the hyponatraemic-hypertensive syndrome.- - - - - - - - - - ranking = 1keywords = thirst (Clic here for more details about this article) |
9/12. captopril-induced hyponatremia with irreversible neurologic damage.A 61-year-old Chinese-American man with a history of congestive heart failure and hypertension was admitted to the san francisco veterans Administration Hospital with confusion, cortical blindness, and generalized flaccidity. serum sodium level on admission was 114 meq/liter. Administration of captopril had been begun for afterload reduction two weeks before admission with a concomitant fall in serum sodium level from 137 meq/liter to 126 meq/liter in one week. A history of marked thirst with consumption of large volumes of water was reported for over one week prior to hospitalization. Despite correction of the hyponatremia within 24 hours at a rate of 0.9 meq/liter per hour, the patient remained semi-comatose and died four days later with a gastrointestinal bleed. It is suggested that the thirst phenomenon and hyponatremia were caused by the introduction of captopril. This lead to irreversible neurologic damage and death, despite the correction of the serum sodium level.- - - - - - - - - - ranking = 2keywords = thirst (Clic here for more details about this article) |
10/12. Persistent hyponatremia and inappropriate antidiuretic hormone secretion in children with extensive burns.Three children aged 2 1/2 to 5 1/2 yr, with burns covering 30%--45% of body surface area, developed hyponatremia and serum hypotonicity on the 5th--6th day following the burn injury. The hyponatremia persisted for 10--15 days. During this period, all three passed inappropriately concentrated urines. One child also demonstrated marked and inappropriate thirst. All three children demonstrated persistent respiratory alkalosis, which appeared and disappeared concomitantly with the hyponatremia. There were no signs of dehydration, and plasma volumes, measured in two children, were normal to high. These children are believed to show evidence of inappropriate antidiuretic hormone (ADH) secretion. In the absence of those conditions known to produce this syndrome, it is postulated that in these children it may have resulted from prolonged pain, anxiety, and/or pyrexia.- - - - - - - - - - ranking = 1keywords = thirst (Clic here for more details about this article) |
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