检索结果-南通市图书馆

Severe hypernatremia in hyperglycemic conditions;managing it effectively:A case report

World Journal of Critical Care Medicine 2023年第1期12卷 29-34页

作者： Maulik K Lathiya Praveen Errabelli Susan M Cullinan Emeka J Amadi Department of Emergency Mayo Clinic Health SystemEau ClaireWI 54703United States Department of Nephrology Mayo Clinic Health SystemEau ClaireWI 54703United States Hospital Internal Medicine Mayo Clinic Health SystemEau ClaireWI 54703United States

BACKGROUND Diabetic ketoacidosis(DKA)and hyperglycemic hyperosmolar state(HHS)are common acute complications of diabetes mellitus with a high risk of mortality.When combined with hypernatremia,the complications can be even worse.hypernatremia is a rarely associated with DKA and HHS as both are usually accompanied by normal sodium or hyponatremia.As a result,a structured and systematic treatment approach is critical.We discuss the therapeutic approach and implications of this uncommon presentation.CASE SUMMARY A 62-year-old man with no known past medical history presented to emergency department with altered mental status.Initial work up in emergency room showed severe hyperglycemia with a glucose level of 1093 mg/dL and severe hypernatremia with a serum sodium level of 169 mEq/L.He was admitted to the intensive care unit(ICU)and was started on insulin drip as per DKA protocol.Within 12 h of ICU admission,blood sugar was 300 mg/dL.But his mental status didn’t show much improvement.He was dehydrated and had a corrected serum sodium level of>190 mEq/L.As a result,dextrose 5%in water and ringer's lactate were started.He was also given free water via an nasogastric(NG)tube and IV Desmopressin to improve his free water deficit,which improved his serum sodium to 140 mEq/L.CONCLUSION The combination of DKA,HHS and hypernatremia is rare and extremely challenging to manage,but the most challenging part of this condition is selecting the correct type of fluids to treat these conditions.Our case illustrates that desmopressin and free water administration via the NG route can be helpful in this situation.

关键词： Diabetic ketoacidosis Hyperglycemic hyperosmolar state hypernatremia Hyperglycemia Desmopressin Case repot

来源：

维普期刊数据库评论

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Overlap of diabetic ketoacidosis and hyperosmolar hyperglycemic state

引用

World Journal of Clinical Cases 2022年第32期10卷 11702-11711页

作者： Esraa Mamdouh Hassan Hisham Mushtaq Esraa Elaraby Mahmoud Sherley Chhibber Shoaib Saleem Ahmed Issa Jain Nitesh Abbas B Jama Anwar Khedr Sydney Boike Mikael Mir Noura Attallah Salim Surani Syed A Khan Critical Care Medicine Mayo Clinic Health SystemMankatoMN 56001United States Medicine St.Vincent's Medical CenterBridgeportCT 06606United States Medicine College of MedicineUniversity of SharjahSharjah 27272United Arab Emirates Medicine Mercy Catholic Medical CenterDarbyPA 19025United States Medicine Mayo HospitalLahore 54000PunjabPakistan Medicine Medical University of the AmericasNevisWest Indies Medicine BronxCare Health SystemBronxNY 10457United States Medicine University of Minnesota Medical SchoolMinneapolisMN 55455United States Medicine&Pharmacology Texas A&M University Health Science CenterCollege StationTX 77843United States Anesthesiolgy Mayo ClinicRochesterMN 55905United States

Diabetic ketoacidosis(DKA)and hyperosmolar hyperglycemia state(HHS)are two life-threatening metabolic complications of diabetes that significantly increase mortality and morbidity.Despite major advances,reaching a uniform consensus regarding the diagnostic criteria and treatment of both conditions has been challenging.A significant overlap between these two extremes of the hyperglycemic crisis spectrum poses an additional hurdle.It has well been noted that a complete biochemical and clinical patient evaluation with timely diagnosis and treatment is vital for symptom resolution.Worldwide,there is a lack of large-scale studies that help define how hyperglycemic crises should be managed.This article will provide a comprehensive review of the pathophysiology,diagnosis,and management of DKA-HHS overlap.

关键词： Diabetic ketoacidosis Hyperosmolar Coma Diabetes Metabolic acidosis hypernatremia Hyperosmolar hyperglycemia state

来源：

维普期刊数据库评论

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Serum Sodium Fluctuation Prediction among ICU Patients Using Neural Network Algorithm:Analysis of the MIMIC-IV Database

引用

Journal of Beijing Institute of Technology 2023年第2期32卷 188-197页

作者： Haotian Yu Tongpeng Guan Jiang Zhu Xiao Lu Xiaolu Fei Lan Wei Yan Zhang Yi Xin School of Life Science Beijing Institute of TechnologyBeijing 100081China Xuanwu Hospital Capital Medical UniversityBeijing 100053China

Sodium homeostasis disorder is one of the most common abnormal symptoms of elderly patients in intensive care unit(ICU),which may lead to physiological disorders of many organs.The current prediction of serum sodium in ICU is mainly based on the subjective judgment of doctors’experience.This study aims at this problem by studying the clinical retrospective electronic medical record data of ICU to establish a machine learning model to predict the short-term serum sodium value of ICU patients.The data set used in this study is the open-source intensive care medical information set Medical Information Mart for Intensive Care(MIMIC)-IV.The time point of serum sodium detection was selected from the ICU clinical records,and the ICU records of 25risk factors related to serum sodium were extracted from the patients within the first 12 h for statistical analysis.A prediction model of serum sodium value within 48 h was established using a feedforward neural network,and compared with previous methods.Our research results show that the neural network learning model can predict the development of serum sodium in patients using physiological indicators recorded in clinical electronic medical records within 12 h,and has better prediction effect than the serum sodium formula and other machine learning models.

关键词： serum sodium structured electronic medical record hypernatremia hyponatremia neural network machine learning

来源：

维普期刊数据库

同方期刊数据库评论

在线全文

学校读者我要写书评

暂无评论

Sodium variability is associated with increased mortality in severe burn injury

引用

Burns & Trauma 2017年第4期5卷 243-248页

作者： Soman Sen Nam Tran Brian Chan Tina L. Palmieri David G. Greenhalgh Kiho Cho Department of Surgery Division of Burn Surgery University of California Davis 2425 Stockton Blvd. Suite 718 Sacramento CA 95817 USA

Background:Dysnatremias are associated with increased mortality in critically ill patients. hypernatremia in burn patients is also associated with poor survival. Based on these findings, we hypothesized that high plasma sodium variability is a marker for increased mortality in severely burn-injured patients. Methods:We performed a retrospective review of adult burn patients with a burn injury of 15%total body surface area (TBSA) or greater from 2010 to 2014. All patients included in the study had at least three serum sodium levels checked during admission. We used multivariate logistic regression analysis to determine if hypernatremia, hyponatremia, or sodium variability independently increased the odds ratio (OR) for death. Results:Two hundred twelve patients met entry criteria. Mean age and%TBSA for the study was 45 ± 18 years and 32 ± 19%. Twenty-nine patients died for a mortality rate of 14%. Serum sodium was measured 10,310 times overall. The median number of serum sodium measurements per patient was 22. Non-survivors were older (59 ± 19 vs. 42 ± 16 years) and suffered from a more severe burn injury (50 ± 25%vs. 29 ± 16%TBSA). While mean sodium was significantly higher for non-survivors (138 ± 3 milliequivalents/liter (meq/l)) than for survivors (135 ± 2 meq/l), mean sodium levels remained within the laboratory reference range (135 to 145 meq/l) for both groups. Non-survivors had a significantly higher median number of hypernatremic (>145 meq/l) measurements (2 vs. 0). Coefficient of variation (CV) was significantly higher in non-survivors (2.85 ± 1.1) than survivors (2.0 ± 0.7). Adjusting for TBSA, age, ventilator days, and intensive care unit (ICU) stay, a higher CV of sodium measurements was associated with mortality (OR 5.8 (95%confidence interval (CI) 1.5 to 22)). Additionally, large variation in sodium ranges in the first 10 days of admission may be associated with increased mortality (OR 1.35 (95%CI 1.06 to1.7)). Conclusions:Increased variability in plasma sodium may be associated with death in severe

关键词： Sodium Burns Critical illness Ions hypernatremia Hyponatremia

来源：

维普期刊数据库评论

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Prognostic factors influencing outcome in adult liver transplantation using hypernatremic organ donation after brain death

引用

Hepatobiliary & Pancreatic Diseases International 2020年第4期19卷 371-377页

作者： Zheng-Jun Zhou Guang-Shun Chen Zhong-Zhou Si Qiang Li Yang-Yang Bin Hai-Zhi Qi Jie-Qun Li Center of Organ Transplantation The Second Xiangya Hospital of Central South UniversityChangsha 410011China

Background:Hypernatremic donors was regarded as the expanded criteria donors in liver transplantation.The study was to investigate the effects of donor hypernatremia on the outcomes of liver transplantation and identify the prognostic factors possibly contributing to the poor outcomes.Methods:Donor serum sodium levels before procurement were categorized as normal sodium(hypernatremia to reperfusion washypernatremia liver donors,minimization of the exposure time from hypernatremia to reperfusion is critical to prevent graft loss.

关键词： Liver transplantation hypernatremia Expanded criteria donors

来源：

维普期刊数据库

同方期刊数据库评论

在线全文

学校读者我要写书评

暂无评论

Metabolic Emergencies in Newborns in a Subsaharian Neonatology Department: Evaluation of Glucose, Sodium and Potassium Disorders

引用

Open Journal of Pediatrics 2022年第1期12卷 263-273页

作者： Ndèye Fatou Sow Amadou Sow Mame Aita Seck Yaay Joor Dieng Djeneba Fafa Cissé Papa Moctar Faye Ndèye Ramatoulaye Diagne Ousmane Ndiaye Department of Pediatrics National Children’s Center Albert Royer Dakar Sénégal

Introduction: Metabolic neonatal adaptation is a complex phenomenon and metabolic disorders can be frequent in immature newborns or in life-threatening situations. In Low and Middle income countries (LMIC) the difficult access to some diagnostic tests makes the management of the metabolic emergencies challenging. The main objectives of this study were to assess the frequency and circumstances of occurrence and to describe the clinical picture associated with glucose, sodium and potassium disorders in neonates. Patients and Methods: Our study was a retrospective and descriptive study conducted in the neonatology unit of National Children Hospital Albert Royer in Dakar (Senegal) from January 1 to December 31, 2014. Results: The prevalence of the studied metabolic disorders was 46.7%. The most common metabolic disorder noted was Hyperglycemia followed by Hyponatremia. Thermoregulation disturbances were found particularly in newborns with serum sodium disorders (hyponatremia 33.5% and hypernatremia 59.7%). Neurological signs were noted in case of blood sugar abnormalities (hypoglycemia 26.1% and hyperglycemia 29.8%). Half of the newborns with hyperglycemia (82 cases/50%) had blood sugar levels greater than or equal to 2 g/l. hypernatremia was severe (Serum sodium> 180 mmol/l) in 12 neonates (16.7%). The main diagnoses retained were sepsis (159 cases/45.4%), prematurity (96 cases/27.4%), intrauterine growth retardation (66 cases/18.9%), malformations (63 cases/18%), perinatal asphyxia (44 cases/12.6%) and malnutrition (36 cases/10.3%). For most metabolic disorders, the correction was late and was done beyond 48 hours. On average, the correction time varied between 3 hours and 6 days. The most frequent complications were cerebral edema (12 cases), brain death (8 cases) and increased intracranial pressure (3 cases). The most lethal disorders were Hyperkalemia followed by Hyperglycemia. Conclusion: Metabolic disorders especially glucose, sodium and potassium disorders are common in newborns. They are medical emergencies

关键词： Metabolic Disorders Newborn Hypoglycemia Hyperkalaemia Hyperglyce-mia hypernatremia

来源：

维普期刊数据库评论

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Caudal and Lentiform nuclei Myelinolysis following Endoscopical surgery for pediatric Craniopharyngioma: two cases report and literature review

引用

Chinese Neurosurgical Journal 2018年第3期4卷 166-172页

作者： Zhi Gang Wang Lian Ying Jiang Wen Hao Zhang Tao Hong Department of Neurosurgery The First Affiliated Hospital of NanChang UniversityNo.17 YongWai StreetNanChangJiangXi 330006People’s Republic of China Department of Neurology Affiliated Hospital of Guangdong Medical UniversityZhanjiangGuangdongChina Medical Image Center Yongxin County People’s HospitalJiAnJiangxiChina

Background: The extrapontine myelinolysis (EPM) of osmotic demyelination syndrome (ODS) is a rare and dangerous disorder of the central nervous system. The mechanism is not fully understood and the treatment is controversial. There are few reports of EPM occurred after endonasal endoscopic resection of pediatric craniopharyngioma. Case presentation: We report two unusual cases of such a rare condition. Both are procedured uneventful endonasal endoscopical craniopharyngioma resection, after operation, the patients suffered serious diabetic insipidus with remarkable fluctuation of serum sodium though we applied pitutrin continual management to maintain everyday normal urine and correct serum sodium disorder. MR images occured caudal and lentiform nuclei myelinolysis following these serious conditions. Conclusions: In this study relevant literatures are reviewed in order to further understand this complication and contribute to the prevention and treatment of EPM caused by inappropriate correction of serum sodium disorder.

关键词： Extrapontine myelinolysis(EPM) Craniopharyngioma Endonasal endoscopic surgery SIADH hypernatremia

来源：

维普期刊数据库

同方期刊数据库评论

在线全文

学校读者我要写书评

暂无评论

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

引用

Open Journal of Nephrology 2017年第1期7卷 19-23页

作者： Alpha Oumar Bah Mamadou Cellou Balde Amadou Bah Alpha Oumar Barry Departement of Nephrology Donka National Hospital Conakry Guinea Departement of Nephrology-Hemodialysis Chiva Hospital Foix Cedex France Departement of Diabetology Donka National Hospital Conakry Guinea Departement of Reanimation Donka National Hospital Conakry Guinea

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.

关键词： hypernatremia Hyperosmolar Coma Multiple Organ Failure Acute Renal Failure Diabetes

来源：

维普期刊数据库评论

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Early Hepatic Encephalopathy after a Transjugular Intrahepatic Portosystemic Shunt Procedure: Case Report

引用

Open Journal of Gastroenterology 2021年第6期11卷 81-88页

作者： Miriam Viviane Baron Gabriela Di Lorenzo Garcia Scherer Michele Paula dos Santos Andres Felipe Mantilla Santamaria Cristine Brandenburg Isabel Cristina Reinheimer Marcus Vinicius de Mello Pinto Aline Ronis Sampaio Alexandre Gomes Sancho Alexandre Gomes Sancho Esteban Fortuny Pacheco Felice Picariello Danielle de Mello Florentino Joice Nedel Ott Carolina Gonçalves Pinheiro Nathália Ken Pereira Iketani Sonia Carvalho Patrícia Froes Meyer Bartira Ercília Pinheiro da Costa Postgraduate Program in Medicine and Health Sciences of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS) Porto Alegre Rio Grande do Sul Brazil School of Medicine of the Pontifical Catholic University of Rio Grande do Sul (PUC/RS) Porto Alegre Rio Grande do Sul Brazil Industrial University of Santander (UIS) Bucaramanga Colombia University of Vale do Acaraú (IDJ/UVA) Ceará Brazil Celulare Institute Rio de Janeiro Brazil Unigranrio Rio de Janeiro Brazil Universidad Finis Terrae Santiago Chile Università degli Studi di Napoli Federico II Napoli Italy Uniredentor University Rio de Janeiro Brazil Postgraduate Program in Health Sciences of the Faculty of Medicine of ABC (FABC) S&#227o Paulo Brazil Hospital Beneficiente Portuguesa of Belém Pará Brazil Rigshospital Copenhagen East K&#248benhavn Denmark Centro Universitário do Rio Grande do Norte Natal Brazil

Patients with decompensated hepatic cirrhosis may present systemic alterations and dysfunction of multiple organs. Ascites, portal hypertension, esophageal varices, and hepatic encephalopathy are common complications arising from cirrhosis. The aim of this paper is to report a case of a patient with liver cirrhosis and the complications of a transjugular intrahepatic portosystemic shunt. Male, elderly, and ex-alcoholic, diagnosed with liver cirrhosis, ascites, and esophageal varices. He underwent transjugular intrahepatic portosystemic shunt due to portal hypertension and returned to the hospital after 24 hours with agitation and mental confusion. He had a bowel movement stop, neurological worsening, loss of renal function, hepatic hydrothorax, hepatic encephalopathy, hypernatremia, hypocalcemia, and hypophosphatemia. He underwent a new procedure to occlude the transjugular intrahepatic portosystemic shunt, showing improvement of the mental status and ascites. However, continued with decompensation and hydro-electrolytic disorders. He evolved with worsening of the ventilatory pattern, and neurological and renal function, with a fatal outcome. Esophageal varices due to portal hypertension can be corrected with the transjugular intrahepatic portosystemic shunt. However, complications such as hypernatremia, hepatic hydrothorax, and hepatic encephalopathy may occur. Therefore, there is a need for reintervention to shunt or reduce its caliber. Thus, for patients with advanced age and decompensated cirrhosis, the potential risks and benefits of this procedure should be carefully evaluated due to the risk of complications and death.

关键词： Ascites hypernatremia Portasystemic Shunt Transjugular Intrahepatic Hepatic Encephalopathy

来源：

维普期刊数据库评论

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

欢迎您,

建议与咨询留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

时间限定

文献类型

馆藏选择

核心期刊

语言

文献类型

帮助

文字说明：

检索规则说明：

检索范例：

分类表

所选分类

限定检索结果

文献类型

馆藏范围

日期分布

学科分类号

主题

机构

作者

语言

在线全文

在线全文

在线全文

在线全文

在线全文

在线全文

在线全文

在线全文

在线全文

请选择保存的检索档案：

请选择收藏分类：

通借通还

欢迎您,

建议与咨询 留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

时间限定

文献类型

馆藏选择

核心期刊

语言

文献类型

帮助

文字说明：

检索规则说明：

检索范例：

分类表

所选分类

限定检索结果

文献类型

馆藏范围

日期分布

学科分类号

主题

机构

作者

语言

在线全文

在线全文

在线全文

在线全文

在线全文

在线全文

在线全文

在线全文

在线全文

请选择保存的检索档案： 新增检索档案 确定 取消

请选择收藏分类： 新增自定义分类 确定 取消

通借通还

建议与咨询留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

请选择保存的检索档案：

请选择收藏分类：