Volume 6, Number 1;  July 5, 2006

Patient: 60 year old African American male presenting with 3 days intractable nausea/vomiting.  There was a history of an 20 month span of hiccups, and GERD, but no psychiatric or altered mental status symptoms.  Labs revealed sodium = 107, potassium = 3.0, chloride = 62, bicard = 29.  Further questioning revealed patient had been imbibing extensive amounts of water and beer in an effort to stem hiccups.

Session Handout:

Readings:

Link Directly to Fulltext Article at Publisher

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Unique Identifier [PMID]: 14992265

Authors: Massieu L. Montiel T. Robles G. Quesada O.

Institution: Departamento de Neurociencias, Instituto de Fisiologia Celular, Universidud Nacional Autonoma de Mexico, Mexico, DF.

Title: Brain amino acids during hyponatremia in vivo: clinical observations and experimental studies. [Review] [61 refs]

Source: Neurochemical Research. 29(1):73-81, 2004 Jan.

Abstract: Hyponatremia is a highly morbid condition, present in a wide range of human pathologies, that exposes patients to encephalopathic complication and the risk of permanent brain damage and death. Treating hyponatremia has proved to be difficult and still awaits safe management, avoiding the morbid sequelae of demyelinizing and necrotic lesions associated with the use of hypertonic solutions. During acute and chronic hyponatremia in vivo, the brain extrudes the excessive water by decreasing its content of electrolytes and organic osmolytes. At the cellular level, a similar response occurs upon cell swelling. Among the organic osmolytes involved in both responses, free amino acids play a prominent role because of the large intracellular pools often found in nerve cells. An overview of the changes in brain amino acid content during hyponatremia in vivo is presented and the contribution of these changes to the adaptive cell responses involved in volume regulation discussed. Additionally, new data are provided concerning changes in amino acid levels in different regions of the central nervous system after chronic hyponatremia. Results favor the role of taurine, glutamine, glutamate, and aspartate as the main amino acid osmolytes involved in the brain adaptive response to hyponatremia in vivo. Deeper knowledge of the adaptive overall and cellular brain mechanisms activated during hyponatremia would lead to the design of safer therapies for the hyponatremic patient. [References: 61]

Publication Type: Journal Article. Review.

Link Directly to Fulltext article in Ovid

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Unique Identifier [PMID]: 12861122

Authors: Decaux G. Soupart A.

Institution: Hopital Universitaire Erasme, Bruxelles, Belgium. guy.decaux@skynet.be

Title: Treatment of symptomatic hyponatremia. [Review] [41 refs]

Source: American Journal of the Medical Sciences. 326(1):25-30, 2003 Jul.

Abstract: Inadequate treatment of severe hyponatremia (<120 mEq/L) can be associated with severe neurological damage. In acute (<48 hours) hyponatremia, usually observed in the postoperative period, prompt treatment with hypertonic saline (3%) can prevent seizures and respiratory arrest. For patients with chronic (>48-72 hours) symptomatic hyponatremia, correction must be rapid during the first few hours (to decrease brain edema) followed by a slow correction limited to 10 mmol/L over 24 hours to avoid the development of osmotic demyelinating syndrome. In patients with asymptomatic hyponatremia, slow correction is the appropriate approach. When patients are overtreated, neurologic damage can be prevented by relowering the serum sodium (SNa) so that the daily increase in SNa remains below 10 mmol/L/24 hours. Frequent measurements of SNa during the correction phase of SNa are mandatory to avoid overcorrection. The use of urea to treat hyponatremia represents an advantageous alternative to hypertonic saline. [References: 41]

Publication Type: Journal Article. Review.

Link Directly to Fulltext Article at Publisher

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Unique Identifier [PMID]: 10824078

Authors: Adrogue HJ. Madias NE.

Institution: Department of Medicine, Baylor College of Medicine and Methodist Hospital, Houston, USA.

Title: Hyponatremia.[see comment]. [Review] [60 refs]

Source: New England Journal of Medicine. 342(21):1581-9, 2000 May 25.

Publication Type: Journal Article. Review.

Resident Report / Department of Medicine & Grady Branch Library

Emory University School of Medicine

2006 Edition

Participating Faculty:  Carlos Del Rio MD  / Joyce Doyle MD / Lorenzo Difrancesco MD / Joel Mermis MD / Maunank Shah MD

Contact: Karl Woodworth