Hyponatremia is relatively common in patients with neurologic disorders, while its diagnosis and treatment remain controversial. Osmotic demyelination syndrome (ODS) has shown to be closely associated with hyponatremia. ODS patients often present as central pontine myelinolysis, extrapontine myelinolysis, or both. This article reviews the clinical manifestations, pathogenesis, and risk factors of ODS in patients with hyponatremia caused by neurologic disorders.
Demyelinating Diseases ; etiology ; therapy ; Humans ; Hyponatremia ; complications ; etiology ; Nervous System Diseases ; complications

Diagnosis, Differential ; Humans ; Hyponatremia ; diagnosis ; etiology ; therapy ; Inappropriate ADH Syndrome ; diagnosis ; etiology ; therapy

Hysteroscopic surgery is a minimally invasive procedure for the treatment of intrauterine pathologies. However, it can result in fatal complications. We herein report a case of symptomatic hyponatremia and hyperglycemia during hysteroscopic resection of severe intrauterine adhesion with 5% dextrose in water as the distension medium. Because of the difficulty of the incision, the infusion pressure was 100 to 150 mmHg, and surgery was continued for 70 minutes. A total of 19 L of 5% dextrose in water was used as an irrigating fluid. Large-scale absorption of irrigating fluid (3 L) induced dilutional hyponatremia (120 mmol/L) and hyperglycemia (30 mmol/L). Initial signs were abnormal flatulence and postoperative coma. Hypertonic saline, diuretics, insulin, and liquid restriction were the prevailing treatment strategies for hyponatremia and hyperglycemia. Ionized calcium and potassium levels decreased during treatment. We emphasize the importance of prevention, recognition, and a meticulous perioperative treatment standard. Surgical teams must be vigilant in fluid deficit monitoring and serum electrolyte analysis.
Adult ; Female ; Humans ; Hyperglycemia ; etiology ; Hyponatremia ; etiology ; Hysteroscopy ; adverse effects ; Intraoperative Complications ; etiology ; Tissue Adhesions ; Uterine Diseases ; surgery

Acute Kidney Injury ; etiology ; prevention & control ; Ascites ; etiology ; prevention & control ; Humans ; Hyponatremia ; etiology ; prevention & control ; Liver Cirrhosis ; complications ; prevention & control

OBJECTIVEAtrial natriuretic peptide (ANP) is a cardiac hormone with many biological effects. Hypersecretion may lead to hyponatremia. This study examined the umbilical ANP levels in high risk neonates.

METHODSA total of 117 high risk neonates born between June, 2004 and June, 2005 were divided into Simple asphyxia and Normal score groups according to their Apgar's scores. The Simple asphyxia group was subdivided into Mild (n=20) and Severe asphyxia groups (n=17), and the Normal score group was subdivided into Infection (n=25) and Non-infection groups (n=55). Forty normal neonates were used as the Control group. The samples of umbilical cord blood were collected at delivery and the umbilical ANP levels were measured by radioimmunoassay. Meanwhile the sodium levels in the peripheral vein were measured.

RESULTSThe mean umbilical ANP levels in high risk neonates were significantly higher than those in the normal neonates. A more significant increase of the umbilical ANP level was observed in premature infants (1.46 +/- 0.39 ng/mL), and neonates with serious infection (1.16 +/- 0.35 ng/mL) and with severe asphyxia (2.12 +/- 0.46 ng/mL) compared with the normal neonates (0.62 +/- 0.33 ng/mL; P < 0.01). The serum sodium level was negatively correlated with the umbilical ANP level (r=-0.99, P < 0.01).

CONCLUSIONSThe umbilical ANP levels increased significantly in the high risk neonates, suggesting high risk neonates are susceptible to hyponatremia.

Atrial Natriuretic Factor ; blood ; Fetal Blood ; chemistry ; Humans ; Hyponatremia ; etiology ; Infant, Newborn ; Risk ; Sodium ; blood

Aged ; Alcoholic Beverages ; Humans ; Hyponatremia ; etiology ; Male ; Substance Withdrawal Syndrome ; complications

Clinical records of a patient with olfactory neuroblastoma presented with hyponatremia as initial symptoms were analyzed and the literatures were reviewed. At initial onset, the patient presented with hyponatremia. After pathological examination, the diagnosis was olfactory neuroblastoma. The blood sodium has been normal after operation and radiotherapy. The incidence rate of olfactory neuroblastoma is low, and it is easily misdiagnosed. Its diagnosis relies on pathological examination. We should pay more attention to the unspecific symptoms of patients with hyponatremia, which can help to improve early diagnosis and the prognosis.
Esthesioneuroblastoma, Olfactory ; complications ; pathology ; Humans ; Hyponatremia ; etiology ; Nasal Cavity ; pathology ; Nose Neoplasms ; complications ; pathology ; Prognosis

An 18-day-old male infant was admitted to the hospital due to recurrent hyperkalemia for more than 10 days. The neonate had milk refusal and dyspnea. The blood gas analysis revealed recurrent hyperkalemia, hyponatremia and metabolic acidosis. Adrenocortical hormone replacement therapy was ineffective. Additional tests showed a significant increase in aldosterone levels. Family whole exome sequencing revealed that the infant had compound heterozygous in the SCNNIA gene, inherited from both parents. The infant was diagnosed with neonatal systemic pseudohypoaldosteronism type I. The infant's electrolyte levels were stabilized through treatment with sodium polystyrene sulfonate and sodium supplement. The infant was discharged upon clinical recovery. This study provides a focused description of differential diagnosis of salt-losing syndrome in infants and introduces the multidisciplinary management of neonatal systemic pseudohypoaldosteronism type I.
Infant ; Infant, Newborn ; Humans ; Male ; Pseudohypoaldosteronism/genetics* ; Hyperkalemia/etiology* ; Hyponatremia/diagnosis* ; Diagnosis, Differential

BACKGROUNDHemolytic anemia, elevated liver enzymes and low platelet count (HELLP) syndrome is a severe obstetric complication which usually resolves in most patients after delivery.

METHODSWe report a rare case of aggravation of HELLP syndrome after delivery.

RESULTSThe patient underwent the treatment for HELLP syndrome, including glucocorticoid therapy. The symptoms of HELLP syndrome reappeared and became more severe than before the termination of pregnancy. The patient also had severe and persistent hypoproteinemia, hyponatremia and hypocalcemia.

CONCLUSIONSHELLP syndrome is an acute and critical obstetric syndrome which can have heterogeneous presentations and variable prognosis. We should be fully aware of the diverse clinical characteristics of this condition.

Adult ; Anemia, Hemolytic ; diagnosis ; etiology ; Delivery, Obstetric ; adverse effects ; Female ; HELLP Syndrome ; diagnosis ; etiology ; Humans ; Hypocalcemia ; diagnosis ; etiology ; Hyponatremia ; diagnosis ; etiology ; Hypoproteinemia ; diagnosis ; etiology ; Pregnancy ; Young Adult

Late-onset hyponatremia (LOH), hyponatremia occurring after two weeks of age with the achievement of full feeding, is the result of a negative sodium balance caused by inadequate salt intake or excessive salt loss due to immature renal or intestinal function in preterm infants. The aims of our study were to identify the risk factors for LOH and its influence on neonatal outcomes. This was a retrospective cohort analysis of 161 preterm infants born before 34 weeks of gestation between June 2009 and December 2010 at Seoul National University Hospital. LOH was defined as a sodium level < or = 132 mEq/L or 133-135 mEq/L with oral sodium supplementation. LOH occurred in 49 (30.4%) of the studied infants. A lower gestational age, a shorter duration of parenteral nutrition, the presence of respiratory distress syndrome, the use of furosemide, and feeding with breast milk were significant risk factors for LOH. In terms of neonatal outcomes, the infants with LOH had longer hospital stays and higher risks of bronchopulmonary dysplasia and retinopathy of prematurity requiring surgery. LOH lasting at least 7 days significantly increased moderate to severe bronchopulmonary dysplasia, periventricular leukomalacia, and extra-uterine growth retardation. LOH is commonly observed in preterm infants; it may be a risk factor for bronchopulmonary dysplasia and retinopathy of prematurity or a marker of illness severity.
Bronchopulmonary Dysplasia/etiology ; Cohort Studies ; Female ; Humans ; Hyponatremia/*etiology ; Infant, Newborn ; Infant, Premature ; Logistic Models ; Male ; Retrospective Studies ; Risk Factors