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Gastroenterology Report 2014年第1期2卷 21-26页

作者： Robert J.Gianotti Andres Cardenas Department of Gastroenterology Beth Israel Deaconess Medical CenterBoston MA GI Unit Institut Clinic de Malalties Digestives i MetaboliquesHospital ClinicUniversity of Barcelona

hyponatraemia is a common complication of advanced cirrhosis related to an impairment in the renal capacity for eliminating solute-free water,causing a retention of water that is disproportionate to the retention of sodium,thus leading to a reduction in serum sodium concentration and *** main pathogenic factor responsible for hyponatraemia is a non-osmotic hypersecretion of arginine vasopressin(AVP)or antidiuretic hormone from the neurohypophysis,related to circulatory *** in cirrhosis is associated with increased morbidity and *** is also associated with increased morbidity and impaired short-term survival after *** current standard of care based on restricting fluids to 1-1.5 L/day is rarely *** approaches,such as albumin infusion and the use of vaptans—which act by specifically antagonizing the effects of AVP on the V2 receptors located in the kidney tubules—have been evaluated for their role in the management of *** short-term treatment with vaptans is associated with a marked increase in renal solute-free water excretion and improvement of hyponatraemia;however their use in patients with end-stage liver disease is limited by hepatotoxic effects of some of these *** administration of vaptans seems to be effective in maintaining the improvement of serum sodium concentration,but the available information is still limited.

关键词： hyponatraemia cirrhosis end-stage liver disease vaptans

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Acute symptomatic hyponatraemia following sodium picosulfate/magnesium citrate as bowel preparation for colonoscopy—A case series

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Case Reports in Clinical Medicine 2014年第2期3卷 101-104页

作者： Hannah Forde Triona O’Shea Colin Davenport Diarmuid Smith Academic Department of Endocrinology and RCSI Medical School Beaumont Hospital Dublin Ireland

Oral purgatives such as sodium phosphate and sodium picosulfate/magnesium citrate (Picolax) combinations are commonly used as a preparation step for colonoscopies in Ireland. These substances can occasionally cause significant electrolyte disturbances including hyponatraemia. Although this is a rare complication of undergoing a colonoscopy, if not treated promptly and appropriately, these electrolyte abnormalities can be associated with life threatening complications. We report cases of symptomatic hyponatraemia in three women aged 65-75 years, following ingestion of Picolax in preparation for a colonoscopy. All three patients had documented previously normal electrolytes and all three required hospital admission for management of their electrolyte disturbance. However, the clinical presentations were variable and depended upon the severity of the hyponatraemia. Patient 1 presented with nausea and vomiting 7 hours post Picolax ingestion. Plasma sodium was 124 mmol/l. She was diagnosed with mild symptomatic hyponatraemia, and treated with anti-emetics and slow intravenous infusion of 0.9% Saline. Patient 2 developed acute confusion 8 hours following ingestion of Picolax. Plasma sodium was 120 mmol/l and she was clinically dehydrated. She was also treated with intravenous 0.9% Saline. Patient 3 presented with seizures and reduced GCS, 48 hours post Picolax ingestion. Plasma sodium was 111 mmol/l. As she had severe life threatening hyponatraemia with seizures, she was treated with boluses of 3% hypertonic saline. It is recommended that cleansing agents should be used with caution in the elderly, patients with a low seizure threshold, patients with renal impairment, liver cirrhosis, heart failure, and patients on diuretics. These patients should have plasma sodium monitored pre- and post-colonoscopy to ensure early detection of hyponatraemia if present, and to initiate prompt and appropriate management to prevent the serious complications associated with hyponatraemia.

关键词： hyponatraemia Colonoscopy Sodium Picosulfate/Magnesium Citrate Picolax

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Volumetric Overload Shocks: Why Is Starling’s Law for Capillary Interstitial Fluid Transfer Wrong? The Hydrodynamics of a Porous Orifice Tube as Alternative

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Surgical Science 2016年第6期7卷 245-249页

作者： Ahmed N. Ghanem Salma A. Ghanem Retired Consultant Urologist Mansoura Egypt Guys & St. Thomas NHS Trust London UK

Based on clinical and experimental work two new types of volumetric overload shocks are reported: volumetric overload shock type one and type two depending on the type of fluid causing their induction. Volumetric overload shock type one is induced by sodium-free fluids such as glycine, glucose, mannitol and sorbitol and is characterized with acute dilutional hyponatraemia. Volumetric overload shock type 2 is induced with sodium-based fluids normal saline and plasma substitutes used for resuscitation of the critically ill and has no serological marker. It presents with the multiple vital organs dysfunction or failure syndrome or the adult respiratory distress syndrome. Hypertonic sodium is an effective treatment when given early adequately. The underlying pathophysiology is discussed. An alternative to Starling’s law for the capillary interstitial fluid transfer is given. Hydrodynamic of a porous orifice tube akin to capillary with a surrounding Chamber akin to the interstitial fluid space demonstrated a rapid dynamic magnetic field-like fluid circulation between the surrounding chamber and the lumen of the G tube that represent an adequate replacement for Starling’s law.

关键词： Shock The Multiple Vital Organs Dysfunction or Failure Syndrome The Adult Respiratory Distress Syndrome The Transurethral Resection of the Prostate Syndrome hyponatraemia

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