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Diabetes Insipidus Hypernatremia

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Diabetes Insipidus

Practice Essentials Diabetes insipidus (DI) is defined as the passage of large volumes (>3 L/24 hr) of dilute urine (< 300 mOsm/kg). It has the following 2 major forms: Two other forms are gestational DI and primary polydipsia (dipsogenic DI); both are caused by deficiencies in AVP, but the deficiencies do not result from a defect in the neurohypophysis or kidneys. Signs and symptoms The predominant manifestations of DI are as follows: The most common form is central DI after trauma or surgery to the region of the pituitary and hypothalamus, which may exhibit 1 of the following 3 patterns: In infants with DI, the most apparent signs may be the following: In children, the following manifestations typically predominate: If the condition that caused DI also damaged the anterior pituitary or hypothalamic centers that produce releasing factors, patients may present with the following: Physical findings vary with the severity and chronicity of DI; they may be entirely normal or may include the following: See Clinical Presentation for more detail. If the clinical presentation suggests DI, laboratory tests must be performed to confirm the diagnosis, as follows: Additional studies that may Continue reading >>

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  1. Jules08

    why does taking metformin 500mg (1 tab 3 times a day) make me feel so sick?

  2. dkNP

    it's a great drug, but it can have some nasty side effects. there are a couple of things to try:
    1) titrating the dose, e.g., take half a tablet once a day for a week, then one tablet once a day for a week and keep increasing by half a tablet until you're on the recommended dose for you - it's a pain but can help your body adjust
    2) take the tablet with meals - some people can get away with taking it just before they eat, but some people have to literally have half their food, take the tablet then finish their meal
    3) take the metformin with a calcium tablet at the same time (over the counter calcium supplement) this seems to counteract the calcium leaching that causes the gut upsets which are so troublesome.
    4) there is a slow release version available that some people say has fewer side effects
    hope this helps.

  3. Jules08

    Thank you for the advice
    I have been trying to conceive for nearly a year and still no joy. I was diagnosed with PCOS in May last year and I have cysts over both my ovaries. I was then reviewed again in November last year and this is what the doc has started me on and I have to stay on these for 6 months until I am seen again.
    Thanks again

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What is HYPERNATREMIA? What does HYPERNATREMIA mean? HYPERNATREMIA meaning - HYPERNATREMIA pronunciation - HYPERNATREMIA definition - HYPERNATREMIA explanation - How to pronounce HYPERNATREMIA? Source: Wikipedia.org article, adapted under https://creativecommons.org/licenses/... license. Hypernatremia is a high sodium ion level in the blood. Early symptoms may include a strong feeling of thirst, weakness, nausea, and loss of appetite. Severe symptoms include confusion, muscle twitching, and bleeding in or around the brain. Normal serum sodium levels are 135 - 145 mmol/L (135 - 145 mEq/L). Hypernatremia is generally defined as a serum sodium level of more than 145 mmol/L. Severe symptoms typically only occur when levels are above 160 mmol/L. Hypernatremia is typically classified by a person's fluid status into low volume, normal volume, and high volume. Low volume hypernatremia can occur from sweating, vomiting, diarrhea, diuretic medication, or kidney disease. Normal volume hypernatremia can be due to fever, inappropriately decreased thirst, prolonged increased breath rate, diabetes insipidus, and from lithium among other causes. High volume hypernatremia can be due to hyperaldosteronism, be health care caused such as when too much intravenous 3% normal saline or sodium bicarbonate is given, or rarely be from eating too much salt. Low blood protein levels can result in a falsely high sodium measurement. The cause can usually be determined by the history of events. Testing the urine can help if the cause is unclear. If the onset of hypernatremia was over a few hours, then it can be corrected relatively quickly using intravenous normal saline and 5% dextrose. Otherwise correction should occur slowly with, for those unable to drink water, half-normal saline. Hypernatremia due to diabetes insipidus as a result of a brain disorder, may be treated with the medication desmopressin. If the diabetes insipidus is due to kidney problems the medication which is causing it may need to be stopped. Hypernatremia affects 0.3-1% of people in hospital. It most often occurs in babies, those with impaired mental status, and the elderly. Hypernatremia is associated with an increased risk of death but it is unclear if it is the cause. The major symptom is thirst. The most important signs result from brain cell shrinkage and include confusion, muscle twitching or spasms. With severe elevations, seizures and comas may occur. Severe symptoms are usually due to acute elevation of the plasma sodium concentration to above 157 mmol/L (normal blood levels are generally about 135145 mmol/L for adults and elderly). Values above 180 mmol/L are associated with a high mortality rate, particularly in adults. However, such high levels of sodium rarely occur without severe coexisting medical conditions. Serum sodium concentrations have ranged from 150228 mmol/L in survivors of acute salt overdosage, while levels of 153255 mmol/L have been observed in fatalities. Vitreous humor is considered to be a better postmortem specimen than postmortem serum for assessing sodium involvement in a death. The cornerstone of treatment is administration of free water to correct the relative water deficit. Water can be replaced orally or intravenously. Water alone cannot be administered intravenously (because of osmolarity issue), but rather can be given with addition to dextrose or saline infusion solutions. However, overly rapid correction of hypernatremia is potentially very dangerous. The body (in particular the brain) adapts to the higher sodium concentration. Rapidly lowering the sodium concentration with free water, once this adaptation has occurred, causes water to flow into brain cells and causes them to swell. This can lead to cerebral edema, potentially resulting in seizures, permanent brain damage, or death. Therefore, significant hypernatremia should be treated carefully by a physician or other medical professional with experience in treatment of electrolyte imbalance, specific treatment like ACE inhibitors in heart failure and corticosteroids in nephropathy also can be used.

Transient Central Diabetes Insipidus And Marked Hypernatremia Following Cardiorespiratory Arrest

Copyright © 2017 Sahar H. Koubar and Eliane Younes. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Central Diabetes Insipidus is often an overlooked complication of cardiopulmonary arrest and anoxic brain injury. We report a case of transient Central Diabetes Insipidus (CDI) following cardiopulmonary arrest. It developed 4 days after the arrest resulting in polyuria and marked hypernatremia of 199 mM. The latter was exacerbated by replacing the hypotonic urine by isotonic saline. 1. Introduction Central Diabetes Insipidus (CDI) is characterized by the lack of antidiuretic hormone (ADH) causing loss of urinary concentrating ability, polyuria, thirst, and hypernatremia. ADH is an octapeptide synthesized in the supraoptic nuclei of the hypothalamus and then stored and released from the posterior pituitary gland. It maintains normal serum osmolality by promoting free water reabsorption in the collecting ducts of the nephron. The known causes of CDI include germinoma/craniopharyngioma; Langerhans cell histiocyto Continue reading >>

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Popular Questions

  1. lthaus

    Good Fruit / Bad Fruit.

    What are your observations...
    I think I have no problem eating Green Granny Smith Apples.
    I'm not so sure about oranges at this time. I had some mandern
    oranges on my salad for lunch today.. I'll see in an hour or so.
    v.

  2. Lois

    I have never had a problem with the granny smith apples. Oranges are another thing. Eating an orange will throw my numbers to high. Because of that, I don't eat them or drink orange juice. There are plenty of fruits I love and apples are among them.
    How did it go with the mandarine oranges?

  3. cheryl

    I love granny smith apples too, I have had no problems with them, most fruit does not bother me and I do stay away from oranges for the most part, I will eat an orange if I am having a under 100 bg day. But I will not drink oj either makes me too high

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====================== DISCLAIMER: THE AUTHOR DISCLAIMS ANY LIABILITY, LOSS, INJURY, OR DAMAGE INCURRED AS A CONSEQUENCE DIRECTLY OR INDIRECTLY OF THE USE AND APPLICATION OF ANY OF THE CONTENT AND MATERIAL CONTAINED IN THIS VIDEO. ALTHOUGH THE INFORMATION IN THIS VIDEO HAS BEEN CAREFULLY REVIEWED FOR CORRECTNESS, THE AUTHOR CANNOT ACCEPT ANY RESPONSIBILITY FOR ANY ERRORS OR OMISSIONS THAT MAY BE MADE. THE AUTHOR MAKES NO WARRANTY. EXPRESS OR IMPLIED. AS TO THE COMPLETENESS, CURRENCY OR ACCURACY OF THE CONTENTS OF THIS VIDEO. THE INFORMATION CONTAINED IN THIS VIDEO SHOULD NOT BE CONSTRUED AS SPECIFIC INSTRUCTIONS FOR INDIVIDUAL PATIENTS, MANUFACTURER'S PRODUCT INFORMATION AND PACKAGE INSERTS SHOULD BE REVIEWED FOR CURRENT INFORMATION. INCLUDING CONTRAINDICATIONS. DOSAGES. AND PRECAUTIONS.

Central Diabetes Insipidus

OVERVIEW diabetes insipidus is a condition caused by loss of the effect of antidiuretic hormone on the collecting ducts of the kidneys, resulting in loss of free water. diabetes insipidus can be central or nephrogenic This article will focus on CDI PATHOPHYSIOLOGY Normal physiology ADH is produced in the hypothalamus and travels along nerve fibers to the posterior pituitary, where it is stored and released Increased plasma osmolality stimulates release of ADH ADH promotes reabsorption of water in the collecting duct of nephrons via translocation of aquaporins (water channels) to the plasma membrane from internal sites within the cells Diabetes insipidus central DI (CDI) results from causes that impair the synthesis, transport, or release of ADH nephrogenic DI (NDI) results from receptor, or downstream, unrepsonsiveness to circulating ADH loss of ADH effect results in polyuria, dehydration, hypernatremia and a hyperosmolar state CAUSES OF CENTRAL DIABETES INSIPIDUS Acquired Surgery (transsphenoidal) – common TBI – common Idiopathic Autoimmune Tumours (suprasellar, lung, breast, lymphoma, leukaemia) Hypoxic brain injury Brain stem death Profound hyponatraemia -> cerebral oedema R Continue reading >>

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Popular Questions

  1. rowan

    I'm shocked! I usually make my own soup but last lot ran out last night and I was too hungry to wait after coming in from walking the dog, so had a tin of Heinz Chicken and Sweetcorn soup.
    I was 11.7 before the walk, and 17.7 aound 2 hours after the soup! It was 25 carbs a tin, and I've about a dozen tins of various flavours that I bought before joining here. I think I'd best look for the local food bank to donate them, can't see me risking those numbers again!

  2. Robinredbreast

    rowan said: ↑
    I'm shocked! I usually make my own soup but last lot ran out last night and I was too hungry to wait after coming in from walking the dog, so had a tin of Heinz Chicken and Sweetcorn soup.
    I was 11.7 before the walk, and 17.7 aound 2 hours after the soup! It was 25 carbs a tin, and I've about a dozen tins of various flavours that I bought before joining here. I think I'd best look for the local food bank to donate them, can't see me risking those numbers again! There's normally wheat/gluten,potato starch, sugars in these soups. We have to be so careful

  3. Bluetit1802

    Yes, tinned soup isn't wise without first checking the label. Far too much flour and very often potatoes. Sweetcorn isn't a wise choice either! Shame because as you say, it is always a handy quick meal.

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