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General Physical
Published in Keith Hopcroft, Vincent Forte, Symptom Sorter, 2020
SMALL PRINT: serum and urine osmolality, sickle-cell screen. Urinalysis: glycosuria in diabetes, specific gravity raised in dehydration and reduced in diabetes insipidus and compulsive water drinking, may be proteinuria and/or microscopic haematuria in CKD.Fasting blood glucose or HbA1c: to definitively diagnose diabetes.FBC/ESR: Hb may be reduced and ESR elevated in Sjögren’s linked to connective tissue disorder; Hb may also be reduced in CKD.U&E: may suggest dehydration or CKD.Calcium: elevated in hypercalcaemia.Rheumatoid factor and other autoantibodies: Sjögren’s may be linked to rheumatoid arthritis, SLE or other connective tissue disease.Serum and urine osmolality: serum osmolality raised and urine osmolality low in diabetes insipidus; in compulsive water drinking, serum osmolality low.Sickle-cell screen: to detect sickle-cell anaemia.
The Pituitary Gland Eva Nagy
Published in Istvan Berczi, Pituitary Function and Immunity, 2019
Both oxytocin and vasopressin are octapeptides, synthesized by nerve cells located in the supraoptic and in the paraventricular nuclei of the hypothalamus and transported to the posterior pituitary where they are stored and released. Vasopressin plays an important regulatory role in water conservation and maintenance of body fluid osmolality, blood volume, and blood pressure. In healthy adults, plasma vasopressin concentration correlates with plasma osmolality. The average serum osmolality is 288 mOsm/kg. In this case the plasma vasopressin is around 1 pg/mℓ. Oxytocin is a regulator of lactation (milk ejection) and of uterine smooth muscle contraction. Oxytocin level of plasma in men and preovulatory women: 0.5 to 2 μ U/mℓ, ovulating women: 2 to 4 μ U/mℓ, lactating women: 5 to 10 μ U/mℓ. Increased plasma osmolality is a powerful stimulus for release of vasopressin. The hypertonic environment of the collecting ducts results in water reabsorption, tending to reduce plasma osmolality. Pathological deficiency of vasopressin results in an increased plasma osmolality and excretion of large volumes of pale, dilute urine with secondary polydipsia. This condition is called diabetes insipidus.
Investigation of Pituitary Disease
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Thozhukat Sathyapalan, Stephen L. Atkin
SIADH needs to be confirmed by results of paired serum and urine samples: serum hyposmolality must be <275 mOsm/kg (normal range: 275–295 mOsm/kg), and urine osmolality >100 mOsm/kg and sodium ≥30 mmol/L, in the absence of hypovolaemia, hypervolaemia, adrenal or thyroid dysfunction and use of diuretics.21, 22 Paired serum and spot urine samples need to be sent for osmolality and sodium to confirm both hyponatraemia and SIADH. Serum osmolality measurement is not necessary when there is an obvious contributory cause. It can confirm true hyponatraemia (<275 mOsmol/kg) and rules out the rarer hyperosmolar hyponatraemia and pseudohyponatraemia (serum osmolality ≥275 mmol/L).23
Hematological, Biochemical and Hemodynamic Changes during Operative Hysteroscopy using Consecutive Distension Media
Published in Egyptian Journal of Anaesthesia, 2023
Ahmed Mohamed Mandour, Abdelraheem Elawamy, Abdelraouf M.S Abdelraouf, Ahmed Mohamed Elsonbaty, Mostafa Elsonbaty, Atef M Darwish, Esam Abdalla, Zein . Z Hassan, Mohamed Anwar
Comparison of the amount of fluid absorption (glycine 1.5%) between study and control showed it was significantly lower in the study than control group. (P < 0.05). Serum osmolality showed it was lower in the control group than study group. Sodium level was significantly lower in the control group than the study group at times (15 minutes, 30 minutes and 45 minutes after induction) (P < 0.05). Regarding arterial blood gases data (ABG) (HCO3) we found no significant differences between the study and control groups except that HCO3 at 45 minutes after induction among the study group was significantly lower and these changes are still within the normal range and of no clinical importance. Comparison of (hemoglobin, hematocrit and platelet count) at different times showed that they were significantly lower in the control group than the study group at 6 hours postoperatively (P< 0.05) (Table 3).
The role of serum osmolality in Meniere’s disease with acute sensorineural hearing loss
Published in International Journal of Audiology, 2023
Clinically, the Isosorbide has been utilised to treat EH for decades (Kitahara et al., 1982). By way of elevating the serum osmolality, Isosorbide thus increases the osmotic pressure in the perilymph (Kakigi and Takeda 2009). Since the endolymph volume depends upon the osmotic pressure gradient between the endolymph and perilymph, fluid is transferred from endolymphatic space to perilymphatic space if osmotic pressure in the perilymph is greater than that in the endolymph, and resolution of EH is thus achieved (Figure 1). Conversely, a decrease in serum osmolality may precipitate hydrops formation as shown by acute SNHL in patients with end-stage renal disease during haemodialysis. The pathogenesis of the latter was referred to a rapid decrease in the serum osmolality as evidenced by a recent report (Li, Cheng, and Young, 2020).
In-patient outcomes of patients with diabetic ketoacidosis and concurrent protein energy malnutrition: A national database study from 2016 to 2017
Published in Postgraduate Medicine, 2021
Asim Kichloo, Hafeez Shaka, Zain El-Amir, Farah Wani, Jagmeet Singh, Genaro Romario Velazquez, Ehizogie Edigin, Dushyant Dahiya
DKA is aknown metabolic derangement of DM. Its morality rate is estimated to be 6–10% [8]. It can be a consequence of type 1 or type 2 DM [9,10]. In type 1 DM, DKA occurs as a result of decreased serum insulin secondary to β-cell destruction and decreased functional β-cells [9]. Decreased serum insulin leads to increases in counterregulatory hormones like cortisol, glucagon, growth hormone, and epinephrine [9]. This leads to increased hepatic gluconeogenesis and glycogenolysis increasing serum glucose concentrations [9]. Additionally, there is also decreased peripheral glucose uptake secondary to decreased insulin in the circulation, resulting in hyperglycemia and increased serum osmolality. Muscle proteolysis also contributes to hyperglycemia, and these processes ultimately result in osmotic diuresis [9]. Fatty acid production also occurs and is promoted by the presence of catecholamines, which results in increased redox reactions including the β-oxidation of free fatty acids. This results in ketone production [9]. Pyruvate depletion secondary to gluconeogenesis shifts fatty acids toward ketone production and away from the citric acid cycle, also resulting in excessive ketone production and ultimately ketoacidosis [9].