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Diabetes Insipidus And Siadh

Inappropriate Secretion Of Adh And Central Diabetes Insipidus Are Related To Antiphospholipid Antibodies In Slecase Report And Review Of The Literature

Inappropriate Secretion Of Adh And Central Diabetes Insipidus Are Related To Antiphospholipid Antibodies In Slecase Report And Review Of The Literature

antiphospholipid , central diabetes insipidus , hyponatraemia , SLE A syndrome of inappropriate secretion of antidiuretic hormone (ADH) (SIADH) and central diabetes insipidus (CDI) has been described as occurring in various central nervous system conditions. Antiphospholipid antibodies (APL) have been implicated in many neurological symptoms in patients with systemic lupus erythematosus (SLE). The presence of APL and their eventual role in the development of SIADH or CDI in SLE has never been studied. We describe two cases of SIADH occurring in the setting of SLE with APL. We retrospectively reviewed the literature on SLE associated with SIADH or CDI using a computer-assisted search from 1967 to 2005 in French, Spanish and English in the Medline Database using the keywords SIADH, CDI, APL and hyponatraemia. We found 11 cases of SIADH and five cases of CDI associated with SLE and one case of pure antiphospholipid syndrome associated with SIADH. The clinical and radiological data on all those reported patients were analysed. Laboratory data were also extracted from all the reports, and a positive status of APL was recorded if a patient had one of the following diagnostic criteria at the time SIADH (or CDI) appeared: false positive Veneral Disease Research Laboratory (VDRL), lupus anticoagulant (LA) or presence of anticardiolipin antibodies (ACA). We compared the prevalence of APL in the classic SLE population and in our collection of reported SLE patients with ADH disorders. We found that ADH disorders (SIADH and CDI) in SLE patients were significantly associated with the presence of APL. We also found that most patients had no radiological evidence of thrombotic brain disease (evaluated by CT scan or MRI), and only one patient had focal neurological impairment. We sugge Continue reading >>

Clinical Aspects Of Diabetes Insipidus And Hyponatremia

Clinical Aspects Of Diabetes Insipidus And Hyponatremia

Endocrine Abstracts (2013) 32 S10.2 | DOI: 10.1530/endoabs.32.S10.2 Clinical aspects of diabetes insipidus and hyponatremia Northwestern University, Chicago, Illionois, USA. Diabetes insipidus (DI) is a syndrome caused by various defects in the secretion or action of the antidiuretic hormone, arginine vasopressin (AVP). They include impaired AVP production (pituitary DI), increased AVP degradation (gestational DI), suppression of AVP secretion by excessive water intake (primary polydipsia) or decreased antidiuretic effect due to various abnormalities in the kidney (nephrogenic DI). In all four types, the severity of the defect varies between patients. This complicates differential diagnosis by traditional methods based on the urinary response to fluid restriction and injection of AVP or its analogue, desmopressin. An alternative approach is now available. It begins with measurement of basal plasma AVP. If it is normal or elevated (>2 pg/ml), the patient has nephrogenic DI and further testing can focus on the pathogenesis. If basal plasma vasopressin is low (<2 pg/ml), nephrogenic DI is excluded and a brain MRI to determine the absence or presence of the normal posterior pituitary bright spot distinguishes pituitary DI from primary polydipsia. This method is more than 90% accurate as judged by the response to standard therapeutic doses of AVP or desmopressin. Hyponatremia is also due to several different defects in the osmoregulation of antidiuresis. They include impaired suppression of AVP secretion due to non-osmotic stimuli (effective hypovolemia, true hypovolemia, nausea or cortisol deficiency) as well as inappropriate secretion of AVP (SIADH) due to ectopic production or primary defects in osmoregulation. The latter take various forms including downward resetting o Continue reading >>

Diabetes Insipidus Vs Siadh

Diabetes Insipidus Vs Siadh

Diabetes insipidus and Syndrome of Inappropriate Anti-diuretic Hormone [SIADH] have some similarities, but are two very different conditions. They both involve how the body create vasopressin [ADH] and one of the primary symptoms of both conditions is excessive thirst, but the results are completely the opposite. In diabetes insipidus, the body is excreting too many fluids as urine, which can often leave people feeling dehydrated. In SIADH, a person is retaining too much water instead. Because the signs and symptoms can be somewhat similar, even if the body is either retaining too much water or too little, then here are some of the differences in these two opposite conditions that involve ADH. Vasopressin is an anti-diuretic hormone. It is used by the body to regulate how much water is in the body at any given time. The kidneys are told to hang onto water or told to get rid of it. It can also create increased blood pressure levels because of vasoconstriction. But, to make matters even more confusing, people who are suffering from liver cirrhosis may have inappropriate ADH levels that is similar to diabetes insipidus, but not actually the condition itself. Meningitis and encephalitis can also be the cause of diabetes insipidus or cause SIADH. All of this is regulated by the posterior pituitary, though nephrogenic diabetes insipidus is caused by the kidneys. Treatment involves finding the cause of the condition and resolving it or reducing bothersome symptoms. Different Causes for Different Conditions SIADH is typically an issue which occurs when there is another disease going on. For patients with lung cancer, SIADH can actually be one of the first symptoms that are experienced. Remember there is too much fluid being retained by the body. Damage to the pituitary gland o Continue reading >>

Pathophysiology And Etiology Of The Syndrome Of Inappropriate Antidiuretic Hormone Secretion (siadh)

Pathophysiology And Etiology Of The Syndrome Of Inappropriate Antidiuretic Hormone Secretion (siadh)

INTRODUCTION The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a disorder of impaired water excretion caused by the inability to suppress the secretion of antidiuretic hormone (ADH) [1]. If water intake exceeds the reduced urine output, the ensuing water retention leads to the development of hyponatremia. The SIADH should be suspected in any patient with hyponatremia, hypoosmolality, and a urine osmolality above 100 mosmol/kg. In SIADH, the urine sodium concentration is usually above 40 mEq/L, the serum potassium concentration is normal, there is no acid-base disturbance, and the serum uric acid concentration is frequently low [1]. (See "Diagnostic evaluation of adults with hyponatremia".) The pathophysiology and etiology of SIADH will be reviewed here. The treatment of this disorder is discussed separately. (See "Treatment of hyponatremia: Syndrome of inappropriate antidiuretic hormone secretion (SIADH) and reset osmostat".) PATHOPHYSIOLOGY Pathogenesis of hyponatremia — The plasma sodium concentration (PNa) is a function of the ratio of the body's content of exchangeable sodium and potassium (NaE and KE) and total body water (TBW) as described by Edelman's classic equation: PNa ≈ (NaE + KE)/Total body water Continue reading >>

Transient Lymphocytic Panhypophysitis Associated With Siadh Leading To Diabetes Insipidus After Glucocorticoid Replacement

Transient Lymphocytic Panhypophysitis Associated With Siadh Leading To Diabetes Insipidus After Glucocorticoid Replacement

Transient Lymphocytic Panhypophysitis Associated with SIADH Leading to Diabetes Insipidus after Glucocorticoid Replacement The Social Insurance Chuo General Hospital The Social Insurance Chuo General Hospital The Social Insurance Chuo General Hospital The Social Insurance Chuo General Hospital A 52-year-old man presented with vomiting, general fatigue and hyponatremia. His symptoms and signs were consistent with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Endocrine studies revealed hypopituitarism and administration of hydrocortisone resulted in a marked polyuria. The patient was diagnosed as masked diabetes insipidus. The lymphocytic hypophysitis was also diagnosed on the basis of MRI findings and anti-pituitary antibody. Six months later, these abnormalities disappeared. Diabetes insipidus may exist in a case of hyponatremia due to contrastive SIADH. Such patients may recover spontaneously and careful follow-up is required, avoiding a long-term treatment by monotonous continuation of hormonal replacement. Continue reading >>

Diabetes Insipidus And Siadh | Harrison's Manual Of Medicine, 18e | Accessmedicine | Mcgraw-hill Medical

Diabetes Insipidus And Siadh | Harrison's Manual Of Medicine, 18e | Accessmedicine | Mcgraw-hill Medical

Diabetes insipidus (DI) results from insufficient AVP production by the hypothalamus or from impaired AVP action in the kidney. AVP deficiency is characterized by production of large amounts of dilute urine. In central DI, insufficient AVP is released in response to physiologic stimuli. Causes include acquired (head trauma; neoplastic or inflammatory conditions affecting the hypothalamus/posterior pituitary), congenital, and genetic disorders, but almost half of cases are idiopathic. In gestational DI, increased metabolism of plasma AVP by an aminopeptidase (vasopressinase) produced by the placenta leads to a relative deficiency of AVP during pregnancy. Primary polydipsia results in secondary insufficiency of AVP due to physiologic inhibition of AVP secretion by excessive fluid intake. Nephrogenic DI is caused by AVP resistance in the kidney; it can be genetic or acquired from drug exposure (lithium, demeclocycline, amphotericin B), metabolic conditions (hypercalcemia, hypokalemia), or renal damage. Symptoms include polyuria, excessive thirst, and polydipsia, with a 24-h urine output of >50 mL/kg/day and a urine osmolality that is less than that of serum (<300 mosmol/kg; specific gravity <1.010). DI can be partial or complete; in the latter case the urine is maximally diluted (<100 mosmol/kg) and the daily urine output can reach 1020 L. Clinical or laboratory signs of dehydration, including hypernatremia, occur only if the pt simultaneously has a thirst defect (not uncommon in pts with CNS disease) or does not have access to water. Other etiologies of hypernatremia are described in Chap. 2 . DI must be differentiated from other etiologies of polyuria ( Chap. 52 ). Unless an inappropriately dilute urine is present in the setting of serum hyperosmolality, a fluid depriva Continue reading >>

Diabetes Insipidus And Siadh

Diabetes Insipidus And Siadh

Sort Signs of dehydration hypotension tachycardia weight loss headache dizziness decreased skin turgor dry mucous membranes constipation Late manifestations of SIADH Personality changes hostility decreased DTRs Nausea/vomiting diarrhea confusion lethargy Cheyne-Stokes respirations seizures coma/death Lab findings for Diabetes Insipidus Urine dilute----> Specific gravity < 1.005 Low osmolality (50 - 200) Decreased pH Decreased urine sodium Decreased urine potassium Increased serum osmolality Increased serum sodium and potassium (because of increased serum osmolality) SIADH Urine concentrated - specific gravity >1.025 - High osmolality - Increased urine sodium and potassium Serum (blood) concentrated - Decreased serum osmolality - Decreased serum sodium and potassium Interventions for DI (remember: DI results in too little ANTI- Diuretic Hormone ---> more is excreted) IV fluids needed to match output and correct electrolytes Monitor I & O; specific gravity Weight daily Encourage fluids as tolerated Avoid bulk foods, juices for constipation Avoid caffeine products that promote further diuresis Monitor for dehydration (mental status, skin turgor, etc.) Interventions for SIADH (Remember: too much ADH ---> retaining fluid) Restrict oral fluids (500 - 1,000 mL/day) Monitor I & O; specific gravity Weigh daily Seizure precautions Mouth care for limited oral intake Quiet environment monitor for fluid volume excess (HTN; tachycardia; hypothermia) Continue reading >>

Problems With Adh: Siadh And Diabetes Insipidus

Problems With Adh: Siadh And Diabetes Insipidus

Introduction and Background Water. It's a vital component of our bodies, making up about 70% of each cell's volume. Water homeostasis is key to survival - and our body has evolved complex biochemical systems to keep the right amount of water in our cells. One of these includes a hormone called antidiuretic hormone, or ADH. ADH's job is to act on the kidneys to promote water reabsorption. In this lesson, we'll compare and contrast diabetes insipidus, or DI, in which there is too little ADH, and syndrome of inappropriate antidiuretic hormone secretion , or SIADH, in which there is too much ADH. Let's start by reviewing a little about ADH. ADH is also called arginine vasopressin, AVP, or just vasopressin. Made in the pituitary gland, ADH has a many functions, but for this lesson, we'll focus on its main place of action: the kidneys. ADH binds to receptors on the kidneys' nephrons, stimulating them to reabsorb water. The volume of urine made drops, and the amount of solute (salts and other solids) in it increases. This measure of amount of solute per kilogram of solvent is called osmolality. We'll see how DI and SIADH affect osmolality of both blood and urine later in the lesson. Diabetes Insipidus In diabetes insipidus, or DI, the body produces too little anti-diuretic hormone. Since diuresis means the production of urine, a shortage of ADH, which works against diuresis, results in polyuria, the production of a lot of urine. And indeed, polyuria is the primary symptom of diabetes insipidus. It's also because of polyuria that diabetes insipidus shares part of its name with diabetes mellitus, since both have polyuria as a symptom. However, these conditions are not related, because the etiologies behind them are very different. In diabetes mellitus, polyuria is caused by hype Continue reading >>

Cerebral Salt Wasting

Cerebral Salt Wasting

SIADH - causes Intracranial – infection, stroke, hemorrhage, tumor, very common in SAH population (69%) Intrathoracic – malignancy, abscess, PNA, effusion, PTX, chest wall deformity Drugs – vasopressin, DDAVP, oxytocin, analgesics, antidepressants, amiodarone, antipsychotics, sulfonylureas, carbamazepine, cyclophosphamide Extracranial tumors – small-cell lung CA, pancreatic CA HIV/AIDS Hereditary – “gain-of-function†V2 receptor mutation Miscellaneous – Guillan-Barre, nausea, stress, pain, acute psychosis Major surgery **** Idiopathic SIADH - pathophysiology ADH-induced water retention Dilutional hyponatremia Volume expansion -> secondary natriuresis Sodium and water loss Potassium loss Result: Euvolemic hyponatremia Reduced serum osmolality Increased urine osmolality Increased urine sodium Laboratory Findings Na < 135 mEq/L Posm < 270 mOsm/kg Uosm > 300 mOsm/kg UNa > 25 mEq/L Low BUN Normal Cr Low uric acid Low albumin SIADH - treatment Treat the underlying cause, if known Fluid Restriction – commonly 800-1000mL/d Correct Na+ deficit – no more than 10mEq/L in 24 hours, 18mEq/L in 48 hours 0.9% NaCl 3% NaCl NaCl enteral tablets – 2-3g TID Add a loop diuretic SIADH – treatment Vasopressin receptor antagonists Promote aquaresis Tolvaptan, conivaptan Vaprisol (Conivaptan) Indicated in euvolemic or hypervolemic hyponatremia Contraindicated in hypovolemic hyponatremia V1a and V2 receptors Causes aquaresis or excretion of free water Demeclocycline or Lithium (diminished collecting tubule response to ADH) Cerebral Salt Wasting Hyponatremia caused by impaired renal tubular function -> inability of kidneys to conserve salt Salt wasting leads to volume depletion Two theories: Impaired sympathetic neur Continue reading >>

Diabetes Insipidus (di) Vs Siadh Syndrome Of Inappropriate Antidiuretic Hormone Nclex Review

Diabetes Insipidus (di) Vs Siadh Syndrome Of Inappropriate Antidiuretic Hormone Nclex Review

SIADH vs Diabetes Insipdius! Are you studying diabetes insipidus and SIADH and find it very confusing discerning between the two disease processes? You are not alone! 1 Weight Management Goals - Frequently Asked Questions Review Common Questions & Answers About a Prescription Obesity Treatment. Prescription treatment website 2 Start Download - View PDF Convert From Doc to PDF, PDF to Doc Simply With The Free Online App! download.fromdoctopdf.com In this article, I am going to easily break down the differences between diabetes insipidus (DI) and SIADH (Syndrome of Inappropriate Anti-diuretic Hormone). I addition, I provide a lecture on how to remember the differences between the two! Don’t forget to take the SIADH vs Diabetes Insipidus Quiz. What is Diabetes Insipidus and SIADH? This is where the body has a problem producing ADH (either too much or not enough). What is ADH? It is anti-diuretic hormone. This hormone is produced in the hypothalamus, and stored and eventually released in the posterior pituitary gland. In order to understand diabetes insipidus and SIADH, you MUST understand how ADH works because ADH plays an important role in both DI an SIADH. Lecture on SIADH and DI Key Points to Remember about SIADH and DI Each condition is related the secretion of ADH (anti-diuretic hormone also called vasopressin) which plays a major role in how the body RETAINS water. Each condition presents oppositely of each other (ex: in SIADH the patient retains water vs. DI where the patient loses water)—-Remember they are opposite of each other! Diabetes Insipidus and Diabetes Mellitus are two separate conditions and are not related although they share the name “Diabetes”. How does the Anti-diuretic Hormone work? ADH is produced in the hypothalamus and secreted/stored by t Continue reading >>

Central Neurogenic Diabetes Insipidus, Syndrome Of Inappropriate Secretion Of Antidiuretic Hormone, And Cerebral Salt-wasting Syndrome In Traumatic Brain Injury

Central Neurogenic Diabetes Insipidus, Syndrome Of Inappropriate Secretion Of Antidiuretic Hormone, And Cerebral Salt-wasting Syndrome In Traumatic Brain Injury

Comparison of central neurogenic diabetes insipidus, syndrome of inappropriate secretion of antidiuretic hormone, and cerebral salt-wasting syndrome The goal in CNDI is to correct the ADH deficiency and restore fluid balance by promoting sodium and water reabsorption. In the acute phase of CNDI, exogenous ADH is provided, and fluid equivalent to the amount of urine output is given either orally, if the patient can tolerate adequate oral intake, or intravenously. 8 Patients with intact thirst centers who are able to take fluids orally are encouraged to drink as much as possible when thirsty to keep up with fluid losses. However, in patients with TBI, complications from impaired level of consciousness, sensory and motor deficits, and dysphagia often preclude oral intake, and intravenous solutions are required to meet the fluid demands. Intravenous hypotonic solutions most often used to replace lost body fluids include 0.45% saline titrated hourly to replace urine output. 3 Exogenous ADH, either desmopressin (DDAVP), vasopressin, or lypressin, may be administered. Desmopressin can be administered nasally 5 to 2 g/d in divided doses or parenterally 5 to 40 g/d in daily divided doses. 3 Vasopressin (aqueous Pitressin) can be administered intravenously 0.5 to 2 U every 3 hours for patients who have urine output of more than 300 mL/h for 2 consecutive hours. 3 A vasopressin infusion may become necessary, which can be started at 0.2 U/min and titrated to a maximum dose of 0.9 U/min. 5 Lypressin dosage is 5 to 20 U 3 to 7 times per day nasally. 5 The following formula can be used to calculate the body water deficit (amount of fluid lost). For example, a patient with a serum sodium level of 150 mEq/L who weighs 70 kg would have a 3-L deficit: The resulting body water deficit can Continue reading >>

Diabetes Insipidus (di) Vs Syndrome Of Inappropriate Antidiuretic Hormone (siadh)

Diabetes Insipidus (di) Vs Syndrome Of Inappropriate Antidiuretic Hormone (siadh)

Syndrome of inappropriate antidiuretic hormone (SIADH) and diabetes insipidus (DI) can confuse anyone because they are both endocrine disorders that involve the antidiuretic hormone (ADH). It is easy to assume that diabetes insipidus is part of the diabetes mellitus family, but it is not. However, this endocrine disorder is caused by the hyposecretion of ADH. On the other hand, SIADH is caused by the body releasing excess amount of ADH. Would you be able to look at a lab value of serum sodium and see if it is consistent with SIADH? Do you know the treatment priority for diabetes insipidus? To lose the confusion, Join David W. Woodruff, MSN, RN-BC, CNS, CEN who gave a clear insight on the comparison of diabetes insipidus and SIADH and a little pop quiz at the end of his presentation. If this video has helped you gain a better understanding of the two endocrine disorders, please share below! HT: www.ed4nurses.com Source: Silvestri, Linda Anne. “The Adult Client With an Endocrine Disorder.”Saunders Comprehensive Review for the NCLEX-RN Examination. 5th ed. St. Louis, MO: Saunders Elsevier, 2011. 652. Print. Continue reading >>

Paradoxical Hyponatremia And Polyurodipsia In A Patient With Lithium-induced Nephrogenic Diabetes Insipidus

Paradoxical Hyponatremia And Polyurodipsia In A Patient With Lithium-induced Nephrogenic Diabetes Insipidus

Diabetes insipidus is a condition marked by polyuria that is caused by the inability of the kidneys to reabsorb free water. There are various causes of diabetes insipidus, which can be further classified into the central and nephrogenic subgroups. Central diabetes insipidus is characterized by injury to the neurohypophysial system and is often the result of hypoxic encephalopathy, iatrogenic injury to the pituitary gland during surgical procedures, and autoimmune attack to vasopressin-producing cells in the hypothalamus. Nephrogenic diabetes insipidus is characterized by the inability of the kidneys to respond to adequate levels of vasopressin, often the result of chronic lithium use, which injures the collecting ducts of the kidneys.1 However, inheritable forms of nephrogenic diabetes insipidus exist as well.2 A 43-year-old man with a history of schizoaffective disorder was hospitalized and treated numerous times during the course of several months for hyponatremia; sodium levels as low as 117 mmol/L were recorded. The hyponatremia was believed to be a result of psychogenic polydipsia at the time of treatment. The patient presented to a small community hospital in North Carolina with watery vomiting and severe headache of 2 days duration. Review of symptoms revealed polydipsia and polyuria. The patient admitted to drinking excessive amounts of water, attributing it to his constant and over-whelming thirst and dry mouth. In his group home, he had been observed drinking water from the toilet and sink. The patient stated that he received lithium therapy for his schizoaffective disorder from 1986 to 1997. The therapy was reinitiated in 2011 and continued until the time of presentation. The patient reported that the constant thirst was present when he was receiving lithium; Continue reading >>

Diabetes Insipidus And Siadh - Textbook Of Nephro-endocrinology - Chapter 19

Diabetes Insipidus And Siadh - Textbook Of Nephro-endocrinology - Chapter 19

1 Division of Nephrology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, The University of Pittsburgh School of Medicine, Pittsburgh, PA, USA 2 Director of Clinical Research, Renal Consultants of Houston, Houston, TX, USA Diabetes insipidus (DI) is a polyuric condition due to either inadequate vasopressin production, termed central diabetes insipidus, or the renal resistance to vasopressin, termed nephrogenic diabetes insipidus. An unusual form of DI, gestational diabetes insipidus, occurs during pregnancy from the degradation of plasma arginine vasopressin (AVP) by excessive vasopressinase produced in the placenta. This condition responds to the administration of desmopressin, as it is not degraded by vasopressinase and remits following delivery. Polyuria, unrelated to a disorder in AVP production or response, can be due to excess fluid intake. This condition is referred to as primary polydypsia and can be seen in compulsive water drinking or psychogenic polydypsia. Primary polydypsia can be difficult to distinguish from DI at times. Congenital nephrogenic diabetes insipidus is a rare hereditary disorder, with an estimated prevalence of 1 in 250,000 males. There are two forms of inheritance, an X-linked recessive form, which affects the majority of individuals, and autosomal recessive and dominant forms, which affect the minority of individuals. Copyright 2009 Elsevier Inc. All rights reserved. Continue reading >>

Diabetes Insipidus: Causes, Symptoms And Treatment

Diabetes Insipidus: Causes, Symptoms And Treatment

Diabetes insipidus is a condition where the body loses too much fluid through urination, causing a significant risk of dangerous dehydration as well as a range of illnesses and conditions. There are two forms of the disease: nephrogenic diabetes insipidus and central diabetes insipidus (also known as neurogenic diabetes insipidus). A number of factors have been linked to the development of diabetes insipidus, which may also occur in pregnancy or with the use of certain medications. Establishing the cause of the problem can help determine the most appropriate treatment to support the regulation of water balance in the body. Diabetes insipidus is a condition that can be managed successfully. Contents of this article: What is diabetes insipidus? An uncommon condition, diabetes insipidus is a disorder affecting the regulation of body fluid levels. Two key symptoms resemble those of the more common forms of diabetes that affect blood sugar levels (diabetes mellitus types 1 and 2).1-5 People with diabetes insipidus produce excessive amounts of urine (polyuria), resulting in frequent urination and, in turn, thirst (polydipsia). However, the underlying cause of these two symptoms is quite different from the causes in types 1 and 2 diabetes. In diabetes mellitus, elevated blood sugar prompts the production of large volumes of urine to help remove the excess sugar from the body. In diabetes insipidus, it is the body's water balance system itself that is not working properly. Here are some key points about diabetes insipidus. More detail and supporting information is in the body of this article. Diabetes insipidus is a condition where the body fails to properly control water balance, resulting in excessive urination. Diabetes insipidus can be caused by low or absent secretion of t Continue reading >>

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