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Lithium Induced Diabetes Insipidus Wiki

Nephrogenic Diabetes Insipidus

Nephrogenic Diabetes Insipidus

Not to be confused with Neurogenic diabetes insipidus. Nephrogenic diabetes insipidus (also known as renal diabetes insipidus) is a form of diabetes insipidus primarily due to pathology of the kidney. This is in contrast to central/neurogenic diabetes insipidus, which is caused by insufficient levels of antidiuretic hormone (ADH, that is, arginine vasopressin or AVP). Nephrogenic diabetes insipidus is caused by an improper response of the kidney to ADH, leading to a decrease in the ability of the kidney to concentrate the urine by removing free water. Signs and symptoms[edit] The clinical manifestation is similar to neurogenic diabetes insipidus, presenting with excessive thirst and excretion of a large amount of dilute urine. Dehydration is common, and incontinence can occur secondary to chronic bladder distension.[1] On investigation, there will be an increased plasma osmolarity and decreased urine osmolarity. As pituitary function is normal, ADH levels are likely to be abnormal or raised. Polyuria will continue as long as the patient is able to drink. If the patient is unable to drink and is still unable to concentrate the urine, then hypernatremia will ensue with its neurologic symptoms.[citation needed] Causes[edit] Acquired[edit] Nephrogenic DI (NDI) is most common in its acquired forms, meaning that the defect was not present at birth. These acquired forms have numerous potential causes. The most obvious cause is a kidney or systemic disorder, including amyloidosis,[2] polycystic kidney disease,[3] electrolyte imbalance,[4][5] or some other kidney defect.[2] The major causes of acquired NDI that produce clinical symptoms (e.g. polyuria) in the adult are lithium toxicity and high blood calcium. Chronic lithium ingestion – appears to affect the tubules by enterin Continue reading >>

Diabetes Insipidus

Diabetes Insipidus

Overview Diabetes insipidus is a rare condition where you produce a large amount of urine and often feel thirsty. Diabetes insipidus isn't related to diabetes mellitus (usually just known as diabetes), but it does share some of the same signs and symptoms. The two main symptoms of diabetes insipidus are: passing large amounts of urine, even at night (polyuria) In very severe cases of diabetes insipidus, up to 20 litres of urine can be passed in a day. Read more about the symptoms of diabetes insipidus. When to seek medical advice You should always see your GP if you're feeling thirsty all the time. Although it may not be diabetes insipidus, it should be investigated. Also see your GP if you're: passing more urine than normal – most healthy adults pass urine four to seven times in a 24 hour period passing small amounts of urine at frequent intervals – sometimes, this can occur along with the feeling that you need to pass urine immediately Children tend to urinate more frequently because they have smaller bladders. However, seek medical advice if your child urinates more than 10 times a day. Your GP will be able to carry out a number of tests to help determine what's causing the problem. Read more about diagnosing diabetes insipidus. What causes diabetes insipidus? Diabetes insipidus is caused by problems with a hormone called vasopressin (AVP), also called antidiuretic hormone (ADH). AVP plays a key role in regulating the amount of fluid in the body. It's produced by specialist nerve cells in a part of the brain known as the hypothalamus. AVP passes from the hypothalamus to the pituitary gland where it's stored until needed. The pituitary gland releases AVP when the amount of water in the body becomes too low. It helps retain water in the body by reducing the amount Continue reading >>

Diabetes Insipidus

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 be indicated include the following: See Workup for more detail. Management Most patients with DI can drink enough fluid to replace their urine losses. When oral intake is inadequate and hypernatremia is present, provide fluid replacement as follows: Give dextrose and water or an intravenous fluid that is hypo-osmolar with respect to the patient’s serum; do not administer sterile water without dextrose IV Administer fluids at a rate no greater than 500-750 mL/hr; aim at reducing serum sodium by approximately 0.5 mmol/L (0.5 mEq/L) every hour Pharmacologic therapeutic options include the follo Continue reading >>

Diabetes Insipidus

Diabetes Insipidus

During the day, your kidneys filter all your blood many times. Normally, most of the water is reabsorbed, and only a small amount of concentrated urine is excreted. DI occurs when the kidneys cannot concentrate the urine normally, and a large amount of dilute urine is excreted. The amount of water excreted in the urine is controlled by antidiuretic hormone (ADH). ADH is also called vasopressin. ADH is produced in a part of the brain called the hypothalamus. It is then stored and released from the pituitary gland. This is a small gland just below the base of the brain. DI caused by a lack of ADH is called central diabetes insipidus. When DI is caused by a failure of the kidneys to respond to ADH, the condition is called nephrogenic diabetes insipidus. Nephrogenic means related to the kidney. Central DI can be caused by damage to the hypothalamus or pituitary gland as a result of: Head injury Infection Loss of blood supply to the pituitary gland Surgery Nephrogenic DI involves a defect in the kidneys. As a result, the kidneys do not respond to ADH. Like central DI, nephrogenic DI is very rare. Nephrogenic DI may be caused by: Certain drugs, such as lithium Genetic problems Continue reading >>

Treatment Of Nephrogenic Diabetes Insipidus

Treatment Of Nephrogenic Diabetes Insipidus

INTRODUCTION Nephrogenic diabetes insipidus (nephrogenic DI) results from partial or complete resistance of the kidney to the effects of antidiuretic hormone (ADH). As a result, patients with this disorder are not likely to have a good response to hormone administration (as desmopressin [dDAVP]) or to drugs that increase either the renal response to ADH or ADH secretion. Nephrogenic DI can be hereditary or acquired. In adults, a concentrating defect severe enough to produce polyuria due to nephrogenic DI is most often due to chronic lithium use or hypercalcemia and less frequently to other conditions that impair tubular function, such as Sjögren's syndrome [1]. Release of ureteral obstruction is often associated with a diuresis, but this is short lived and does not require specific therapy other than maintenance fluids. (See "Clinical manifestations and causes of nephrogenic diabetes insipidus" and "Clinical manifestations and diagnosis of urinary tract obstruction and hydronephrosis", section on 'Prognosis and recovery of renal function'.) Hereditary nephrogenic DI, which is largely an X-linked disease, may also be seen by internists since early recognition and treatment in infancy has led to survival to adulthood [2,3]. In addition, affected women may be carriers with few or no symptoms until pregnancy or other stress. In infants with hereditary nephrogenic DI, treatment is aimed at minimizing the polyuria and avoiding hypernatremia and volume depletion. In adults, therapy is usually aimed at correcting the underlying disorder or discontinuing an offending drug. In hypercalcemic patients, for example, normalization of the plasma calcium concentration usually leads to amelioration of polyuria. By contrast, lithium-induced nephrogenic DI may be irreversible if the pati Continue reading >>

Hypokalemia & Nephrogenic Diabetes Insipidus: Causes & Diagnoses | Symptoma.com

Hypokalemia & Nephrogenic Diabetes Insipidus: Causes & Diagnoses | Symptoma.com

"Nephrogenic Diabetes Insipidus" . [en.wikipedia.org] , NDI - Nephrogen diab insipidus , nephrogenic diabetes insipidus (diagnosis) , nephrogenic diabetes insipidus , Diabetes insipidus nephrogenic , Nephrogenic diabetes insipidus [fpnotebook.com] [] this condition Nephrogenic Diabetes Insipidus 2: It is very rare and certain other abnormal genes are responsible for this condition Who gets Nephrogenic Diabetes Insipidus [dovemed.com] Nephrogenic diabetes insipidus (also known as renal diabetes insipidus ) is a form of diabetes insipidus primarily due to pathology of the kidney . [en.wikipedia.org] nephrogenic , Nephrogenic diabetes insipidus , NDI - Nephrogenic diabetes insipidus , Nephrogenic diabetes insipidus (disorder) , diabetes; insipidus, nephrogenic , nephrogenic [fpnotebook.com] [] causes nephrogenic diabetes insipidus Hypokalemia and Metabolic alkalosis ------- Bartter, Gitelman & Liddle's syndrome Bartter & Gitelman ----- Normal/dec BP Liddle's -- [usmleforum.com] Nephrogenic diabetes insipidus with dilataion of bilateral renal pelvis, ureter and bladder. [sjkdt.org] Continuing The Conversation Diseases and conditions like diabetic ketoacidosis, alkalosis, abnormally high aldosterone levels, Bartter syndrome, kidney failure, and certain [bblc.tv] [] and aldosterone are high causes chloride resistant metabolic alkalosis treat with potassium supplementation clinically it may present with polyuria and polydipsia because hypokalemia [usmleforum.com] Otherwise, there was no difference regarding the degree of hyponatremia, hypochloremia and hypokalemia among the three patterns. [sjkdt.org] [] symptoms: fatigue muscle weakness and cramping headaches palpitations polyuria and polydipsia (hypokalemia induced nephrogenic diabetes insipidus) signs: metabolic alkalosis Continue reading >>

Lithium-induced Nephrogenic Diabetes Insipidus: Renal Effects Of Amiloride

Lithium-induced Nephrogenic Diabetes Insipidus: Renal Effects Of Amiloride

Lithium-induced Nephrogenic Diabetes Insipidus: Renal Effects of Amiloride Departments of *Medical and Surgical Sciences and Physiology, University of Otago, Dunedin, New Zealand; and Department of Psychological Medicine, University of Otago, Christchurch, New Zealand Prof. Robert J. Walker, Department of Medical & Surgical Sciences, University of Otago, PO Box 913, Dunedin, New Zealand. Phone: (643) 474 0999, 8045; Fax: (643) 474 7641; E-mail: rob.walker{at}stonebow.otago.ac.nz Background and objectives: Polyuria, polydipsia, and nephrogenic diabetes insipidus have been associated with use of psychotropic medications, especially lithium. Design, setting, participants, & measurements: The impact of psychotropic medications on urinary concentrating ability and urinary aquaporin 2 (AQP2) excretion was investigated after overnight fluid deprivation, and over 6 h after 40 g of desmopressin (dDAVP), in patients on lithium (n = 45), compared with those on alternate psychotropic medications (n = 42). Results: Those not on lithium demonstrated normal urinary concentrating ability (958 51 mOsm/kg) and increased urinary excretion of AQP2 (98 21 fmol/mol creatinine) and cAMP (410 15 pmol/mol creatinine). Participants taking lithium were divided into tertiles according to urinary concentrating ability: normal, >750 mOsm/kg; partial nephrogenic diabetes insipidus (NDI), 750 to 300 mOsm/kg; full NDI, <300 mOsm/kg. Urinary AQP2 concentrations were 70.9 13.6 fmol/mol creatinine (normal), 76.5 10.4 fmol/mol creatinine (partial NDI), and 27.3 fmol/mol creatinine (full NDI). Impaired urinary concentrating ability and reduced urinary AQP2, cAMP excretion correlated with duration of lithium therapy. Other psychotropic agents did not impair urinary concentrating ability. Eleven patients on Continue reading >>

Diabetes Insipidus

Diabetes Insipidus

Diabetes Insipidus Definition Diabetes insipidus (DI) is a disorder that causes the patient to produce tremendous quantities of urine. The massively increased urine output is usually accompanied by intense thirst. Description The balance of fluid within the body is maintained through a number of mechanisms. One important chemical involved in fluid balance is called antidiuretic hormone (ADH). ADH is produced by the pituitary, a small gland located at the base of the brain. In a healthy person and under normal conditions, ADH is continuously released. ADH influences the amount of fluid that the kidneys reabsorb into the circulatory system and the amount of fluid that the kidneys pass out of the body in the form of urine. Production of ADH is regulated by the osmolality of the circulating blood. Osmolality refers to the concentration of dissolved chemicals (such as sodium, potassium, and chloride; together called solute) circulating in the fluid base of the blood (plasma). When there is very little fluid compared to the concentration of solute, the pituitary will increase ADH production. This tells the kidneys to retain more water and to decrease the amount of urine produced. As fluid is retained, the concentration of solute will normalize. At other times, when the fluid content of the blood is high in comparison to the concentration of solute, ADH production will decrease. The kidneys are then free to pass an increased amount of fluid out of the body in the urine. Again, this will allow the plasma osmolality to return to normal. Diabetes insipidus occurs when either the amount of ADH produced by the pituitary is below normal (central DI), or the kidneys' ability to respond to ADH is defective (nephrogenic DI). In either case, a person with DI will pass extraordinarily la Continue reading >>

Central Diabetes Insipidus

Central Diabetes Insipidus

Not to be confused with Nephrogenic diabetes insipidus. Central diabetes insipidus, also called neurogenic diabetes insipidus, is a type of diabetes insipidus due to a lack of vasopressin (ADH) production in the brain. Vasopressin acts to increase the volume of blood (intravascularly), and decrease the volume of urine produced. Therefore, a lack of it causes increased urine production and volume depletion. It is also known as neurohypophyseal diabetes insipidus,[1][2] referring to the posterior pituitary (neurohypophysis), which is supplied by the hypothalamus in the brain. This condition has only polyuria in common with diabetes and although not mutually exclusive, with most typical cases, the name diabetes insipidus is a misleading misnomer.[3] A better name might be "hypothalamic-neurohypophyseal ADH deficiency". Causes[edit] Unknown[edit] In at least 25% of cases (the most commonly occurring classification), neurogenic diabetes insipidus is of unknown cause, meaning that the lack of vasopressin production arose from an unknown cause.[4] It is also due to damage of the hypothalamus, pituitary stalk, posterior pituitary, and can arise from head trauma. Acquired[edit] The lack of vasopressin production usually results from some sort of damage to the pituitary gland. It may be caused due to damage to the brain caused by: Benign suprasellar tumors (20% of cases)[4] Infections (encephalitis, tuberculosis etc.) Trauma (17% of cases)[4] or neurosurgery (9% of cases)[4] Non-infectious granuloma (sarcoidosis, Langerhans cell histiocytosis etc.) Leukaemia Autoimmune - associated with thyroiditis Other rare causes which include hemochromatosis and histiocytosis. Vasopressin is released by the posterior pituitary, but unlike most other pituitary hormones, vasopressin is produced Continue reading >>

Diabetes Insipidus Vs. Diabetes Mellitus

Diabetes Insipidus Vs. Diabetes Mellitus

Diabetes mellitus is characterized by high levels of sugar in the blood while diabetes insipidus is a disease where kidneys are unable to conserve water. Diabetes insipidus (DI) is a rare disease while diabetes mellitus is very common; "diabetes" in general usage refers to diabetes mellitus, which is of 3 types — gestational, Type 1 and Type 2 diabetes. The causes, symptoms, treatment and prognosis for diabetes insipidus are different from diabetes mellitus. Comparison chart Excessive thirst, excess volume of severely diluted urine. High blood sugar, excessive urination, increased thirst, increased hunger. 3 in 100,000 people 7.7 per 1000 people Deficiency of ADH. Brain tumor, head injury, medication such as lithium, genetics Type 1 - Autoimmune Disease; Type 2 - Genetics, lifestyle, infection Typically desmopressin (nasal spray) or IM, IV hypertonic saline solution (3% or 5%). Thiazide diuretics. Insulin and lifestyle management Causes and Types of Diabetes Diabetes insipidus Diabetes insipidus, or DI, is characterized by the inability of kidneys to conserve water when they purify blood. This can be either because of: a deficiency of ADH (antidiuretic hormone or vasopressin), or a failure of the kidneys to respond to ADH In the first case, the condition is called central DI, and in the second case it is called nephrogenic DI. Central DI is the more common form of the disease. Central DI can be inherited or caused due to damage to either the hypothalamus (the part of the brain that produces ADH) or the pituitary gland, where ADH is stored. Head injuries, tumors, infections or surgery can inflict such damage. Nephrogenic DI can be inherited (from mother to son) or be caused by kidney disease, hypercalcemia (excess calcium in the body) or by certain drugs such as lithiu Continue reading >>

Diabetes Insipidus

Diabetes Insipidus

What are the types of diabetes insipidus? Central Diabetes Insipidus The most common form of serious diabetes insipidus, central diabetes insipidus, results from damage to the pituitary gland, which disrupts the normal storage and release of ADH. Damage to the pituitary gland can be caused by different diseases as well as by head injuries, neurosurgery, or genetic disorders. To treat the ADH deficiency that results from any kind of damage to the hypothalamus or pituitary, a synthetic hormone called desmopressin can be taken by an injection, a nasal spray, or a pill. While taking desmopressin, a person should drink fluids only when thirsty and not at other times. The drug prevents water excretion, and water can build up now that the kidneys are making less urine and are less responsive to changes in body fluids. Nephrogenic Diabetes Insipidus Nephrogenic diabetes insipidus results when the kidneys are unable to respond to ADH. The kidneys' ability to respond to ADH can be impaired by drugs-like lithium, for example-and by chronic disorders including polycystic kidney disease, sickle cell disease, kidney failure, partial blockage of the ureters, and inherited genetic disorders. Sometimes the cause of nephrogenic diabetes insipidus is never discovered. Desmopressin will not work for this form of diabetes insipidus. Instead, a person with nephrogenic diabetes insipidus may be given hydrochlorothiazide (HCTZ) or indomethacin. HCTZ is sometimes combined with another drug called amiloride. The combination of HCTZ and amiloride is sold under the brand name Moduretic. Again, with this combination of drugs, one should drink fluids only when thirsty and not at other times. Dipsogenic Diabetes insipidus Dipsogenic diabetes insipidus is caused by a defect in or damage to the thirst Continue reading >>

Diabetes Insipidus

Diabetes Insipidus

Diabetes insipidus (DI) is a condition characterized by large amounts of dilute urine and increased thirst.[1] The amount of urine produced can be nearly 20 liters per day.[1] Reduction of fluid has little effect on the concentration of the urine.[1] Complications may include dehydration or seizures.[1] There are four types of DI, each with a different set of causes.[1] Central DI (CDI) is due to a lack of the hormone vasopressin (antidiuretic hormone).[1] This can be due to damage to the hypothalamus or pituitary gland or genetics.[1] Nephrogenic diabetes insipidus (NDI) occurs when the kidneys do not respond properly to vasopressin.[1] Dipsogenic DI is due to abnormal thirst mechanisms in the hypothalamus while gestational DI occurs only during pregnancy.[1] Diagnosis is often based on urine tests, blood tests, and the fluid deprivation test.[1] Diabetes mellitus is a separate condition with an unrelated mechanism, though both can result in the production of large amounts of urine.[1] Treatment involves drinking sufficient fluids to prevent dehydration.[1] Other treatments depend on the type.[1] In central and gestational disease treated is with desmopressin.[1] Nephrogenic disease may be treated by addressing the underlying cause or the use of a thiazide, aspirin, or ibuprofen.[1] The number of new cases of diabetes insipidus each year is 3 in 100,000.[4] Central DI usually starts between the ages of 10 and 20 and occurs in males and females equally.[2] Nephrogenic DI can begin at any age.[3] The term "diabetes" is derived from the Greek word meaning siphon.[5] Signs and symptoms[edit] Excessive urination and extreme thirst and increased fluid intake (especially for cold water and sometimes ice or ice water) are typical for DI.[6] The symptoms of excessive urination Continue reading >>

Central Diabetes Insipidus

Central Diabetes Insipidus

is completely unrelated to diabetes, even though they share the symptoms of peeing more and feeling thirsty. It's also called "central DI," "pituitary DI," "hypothalamic DI," "neurohypophyseal DI," or "neurogenic DI." Central DI is much less common than diabetes, and treatments for the two diseases are different. The key sign of central diabetes insipidus is extreme thirst and excessive urination. The disease happens when the body doesn't make enough of the hormone vasopressin, which controls how much urine the kidneys put out. Without vasopressin, the kidneys can't work properly. As a result, the body loses a lot of water, quickly, in diluted urine. This makes people very thirsty, so they drink lots of water. Anyone can get central DI, but it's not common. Only about 1 in every 25,000 people gets it. In about half the cases, doctors don't know what causes central DI. Other times, it happens because of damage or injury to the hypothalamus or pituitary gland. This damage can be due to surgery, head trauma, tumor, inflammation, or infection. In very rare cases, genetic defects are the cause. Prompt treatment of injuries, infections, and tumors can lower the odds of getting the disease. People with central DI usually have the following symptoms: Frequent urination -- more than 3 liters of urine a day Frequent nighttime awakening to pee Involuntary urination during sleep (bed-wetting) Pale, colorless urine Low measured concentration of urine Extreme thirst -- often drinking more than 1 gallon of liquid per day In severe cases, or if a person can't get enough liquid to drink, central diabetes insipidus can cause: Confusion Loss of consciousness Symptoms of central DI in children may be: Low energy Irritability Slow growth Fever A checkup may not show any signs of central DI, Continue reading >>

Medical Definition Of Diabetes Insipidus

Medical Definition Of Diabetes Insipidus

Diabetes insipidus: Excessive urination and extreme thirst as a result of inadequate output of the pituitary hormone ADH (antidiuretic hormone, also called vasopressin) or the lack of the normal response by the kidney to ADH. There are two types of diabetes insipidus -- central and nephrogenic. Central diabetes insipidus is a lack of ADH production and is due to damage to the pituitary gland or hypothalamus where ADH is produced. Nephrogenic diabetes insipidus is lack of response of the kidney to the fluid-conserving action of ADH. Nephrogenic diabetes insipidus can be due to diseases of the kidney (such as polycystic kidney disease), certain drugs (such as lithium), and can also occur an inherited disorder. In both central and nephrogenic diabetes insipidus, patients excrete extraordinarily large volumes of very dilute urine. They feel thirsty and drink very large amounts of water to compensate for the water they lose in the urine. The main danger with diabetes insipidus comes when fluid intake does not keep pace with urine output, resulting in dehydration and high blood sodium. The treatment of central diabetes insipidus is with vasopressin used as a nasal spray or as tablets. Nephrogenic diabetes insipidus does not respond to vasopressin treatment. In cases of nephrogenic diabetes insipidus caused by a drug (such as lithium), stopping the drug usually leads to recovery. In cases of hereditary nephrogenic diabetes insipidus, treatment is with fluid intake to match urine output and drugs that lower urine output. Effective treatment is important because the dehydration and high blood sodium can cause brain damage and death. Last Editorial Review: 5/13/2016 Continue reading >>

Diabetes Insipidus

Diabetes Insipidus

Anti-Diuretic Hormone (ADH) from the posterior pituitary stimulates water uptake from the distal convoluted tubule and collecting ducts of the kidney and so conserves water. Release is regulated by osmoreceptors in the hypothalamus and volume receptors in the hypothalamus. A deficiency of ADH is known as Diabetes insipidus. Causes of deficiency may be: Central: Central DI is characterized by decreased secretion of antidiuretic hormone (ADH)—also known as arginine vasopressin (AVP)—which gives rise to polyuria and polydipsia by diminishing the patient’s ability to concentrate urine. Diminished or absent ADH can be the result of a defect in 1 or more sites involving the hypothalamic osmoreceptors, the supraoptic or paraventricular nuclei, or the supraopticohypophyseal tract. Nephrogenic: failure of the nephrons to respond to ADH present in the kidney.Is characterized by a decrease in the ability to concentrate urine due to a resistance to ADH action in the kidney. Nephrogenic DI can be observed in chronic renal insufficiency, lithium toxicity, hypercalcemia, hypokalemia, and tubulointerstitial disease, rarely, diabetes insipidus may be hereditary. Psychogenic diabetes insipidus (psychogenic polydipsia) : It results from a neurological disorder of thirst control or as a result of some behavioral problem that triggers excessive water intake. In either case, the abnormally large volume of excreted urine in animals with psychogenic polydipsia is caused by excessive water intake (polydipsia), rather than by some primary problem with kidney, pituitary or hypothalamic function. Clinical Signs There will be a marked polyuria, 5-20X normal output, often resulting in nocturia and incontinence. There will also be a desperate polydipsia, animal will search for water. Other clin Continue reading >>

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