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Desmopression is an effective adjunct treatment for reversing excessive hyponatremia overcorrection

World Journal of Clinical Cases 2013年第5期1卷 155-158页

作者： Kamel A Gharaibeh Matthew J Craig Christian A Koch Anna A Lerant Tibor Fülp va Csongrádi Department of Internal Medicine University of Mississippi Medical CenterJacksonMS 39216-4505United States Department of Anesthesiology University of Mississippi Medical CenterJacksonMS 39216-4505United States Department of Medicine University of Debrecen Medical and Health Science CentreUniversity of Debrecen4032 DebrecenHungary

We report a case of a 50-year-old malnourished African American male with hiccups, nausea and vomiting who was brought to the Emergency Department after repeated seizures at home. Laboratory evaluations revealed sodium(Na+) 107 mmol/L, unmeasurably low potassium, chloride < 60 mmol/L, bicarbonate of 38 mmol/L and serum osmolality 217 m Osm/kg. Seizures were controlled with 3% saline Ⅳ. Once nausea was controlled with iv antiemetics, he developed large volume free water diuresis with 6 L of dilute urine in 8 h(urine osmolality 40-60 m Osm/kg) and serum sodium rapidly rose to 126 mmol/L in 12 h. Both intravenous desmopressin and 5% dextrose in water was given to achieve a concentrated urine and to temporarily reverse theacute rise of sodium, respectively. Serum Na+ was gradually re-corrected in 2-3 mmol/L daily increments from 118 mmol/L until 130 mmol/L. Hypokalemia was slowly corrected with resultant auto-correction of metabolic alkalosis. The patient discharged home with no neurologic sequaele on the 11 th hospital day. In euvolemic hyponatremic patient, controlling nausea may contribute to unpredictable free water diuresis. The addition of an antidiuretic hormone analog, such as desmopressin can limit urine output and prevent an unpredictable rise of the serum sodium.

关键词： Hyponatremia Hypokalemia overcorrection Polyuria Antidiuretic hormone Vasopressin Desmopressin Osmotic demyelination syndrome Central pontine myelinolysis

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Comparison of contrast sensitivity based on the surgical results for intermittent exotropia

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International Journal of Ophthalmology(English edition) 2019年第11期12卷 1725-1730页

作者： Hae Rang Kim Soo Jung Lee Department of Ophthalmology Haeundae Paik Hospital Inje University College of Medicine

AIM: To compare contrast sensitivity(CS) based on the surgical results for intermittent exotropia(IXT) and to examine the relationship between CS and photophobia.METHODS: Medical records of the patients who underwent bilateral lateral rectus muscle recession for IXT between 4 and 12 years old were reviewed retrospectively. They were categorized based on the surgical results;successful correction group(n=36) and overcorrection group(esotropia ≥10 PD at 3 mo postoperatively, n=18). Using CGT-2000 test for CS was performed binocularly, and subjective reports of photophobia was investigated preoperatively and at 3 mo postoperatively. Objective photophobia was defined as a significant decrease in CS in the presence of glare.RESULTS: Preoperatively, there was no difference in CS between the groups. Postoperatively, under mesopic conditions, significant improvement of CS was observed at 6.3°, 4°, and 2.5° in the successful correction group and at 6.3° and 4° in the overcorrection group, regardless of glare. Under photopic conditions, at all visual angles except 0.64°, improvement in CS was noted in both groups while CS worsened significantly at 0.64° in the overcorrection group postoperatively. At all visual angles under photopic conditions postoperatively, regardless of glare, CS in the overcorrected group was significantly worse than that in the successful correction group, and CS was significantly decreased by addition of glare in both groups. All patients except one(96.4%) in the successful correction group and 8 patients(61.5%) in overcorrection group showed improvement of photophobia postoperatively, which correlated with CS under photopic conditions(P=0.001, 0.03).CONCLUSION: After surgery for IXT, CS under photopic conditions improve at all visual angles except 0.64°, while CS is significantly worse in the overcorrection group postoperatively at 0.64°. Subjective photophobia havesignificant correlation with CS under photopic conditions, and may be used as an objective indicator of photophobia.

关键词： contrast sensitivity intermittent exotropia overcorrection photophobia success

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Transepithelial photorefractive keratectomy for myopia:effect of age and keratometric values

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International Journal of Ophthalmology(English edition) 2021年第5期14卷 744-749页

作者： Amanda Nur Shinta Pertiwi Indra Tri Mahayana Agus Supartoto Wasisdi Goenawan Suhardjo Department of Ophthalmology Faculty of MedicinePublic Health and NursingUniversitas Gadjah Mada-Sardjito Eye CenterDr.Sardjito General HospitalYogyakarta 55284Indonesia Dr.Yap Eye Hospital Yogyakarta 55232Indonesia

AIM:To investigate demographic and preoperative factors increasing the risk of ametropia following transepithelial photorefractive keratectomy(trans PRK)in myopia and myopic astigmatism.METHODS:This retrospective cohort study included myopic eyes(-0.50 to-8.75 D)with or without astigmatism(up to 3.50 D)enrolled at Dr.Yap Eye Hospital Yogyakarta.Trans PRK was performed using Technolaz 217 z100 excimer laser.Subjects were clustered into ametropia and emmetropia group based on uncorrected distance visual acuities(UDVA)3 mo post-operatively.Multiple preoperative and intraoperative parameters were analyzed using Logistic regression to obtain their effect on ametropia risk following trans PRK.RESULTS:A total of 140 eyes of 87 consecutive subjects were studied.Prevalence of ametropia following trans PRK was 20(14.29%)eyes.Subjects in ametropia group were significantly older than the emmetropia group(31.80±14.23 vs 18.88±2.41,respectively;P-6 D;OR=12.78),steeper anterior keratometric readings(Kmax>45 D and mean K>44 D;OR=4.28 and 4.35,respectively)increased the risk of ametropia following trans PRK.Adjusted multivariate Logistic regression analysis showed that age was the strongest predictor for the incidence of ametropia following trans PRK.Complications of trans PRK were overcorrection,suspected posterior keratoectasia and accommodation insuffiency.CONCLUSION:Older age can be the strongest factor for increasing ametropia risk following trans PRK.Cut-off points of Kmax and mean K at 45 and 44 D respectively are proposed as the predictors for ametropia following trans PRK.

关键词： transepithelial photorefractive keratectomy refractive surgery emmetropization overcorrection

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