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Questions for part C
Published in Henry J. Woodford, Essential Geriatrics, 2022
Which of the following options is most likely to help manage problematic nocturia?Commencing a calcium channel blocker in the morningDrinking no alcohol in the hour before bedtimeElevating head of bedMelatonin at nightReducing dietary salt content
Diabetic Nephropathy
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
When the kidney reserve is slightly diminished, the patient is asymptomatic. Mild to moderate renal insufficiency usually only causes elevated blood creatinine and BUN. However, since the kidneys cannot sufficiently concentrate the urine, nocturia is common. The earliest manifestations of uremia include anorexia, decreased mental acuity, fatigue, and lassitude. Once kidney disease worsens, neuromuscular symptoms may develop. These can include coarse muscular twitching, muscle cramps, peripheral motor and sensory neuropathies, hyperreflexia, restless legs syndrome, and seizures. The seizures are usually due to hypertensive or metabolic encephalopathy. Patients usually develop anorexia, an unpleasant taste in the mouth, nausea, vomiting, stomatitis, and weight loss. The skin can become yellowish brown in color. In some individuals, uremic frost forms on the skin due to the crystallization of sweat. Itching may be extreme. Chronic uremia results in prominent undernutrition and generalized tissue wasting. When CKD is advanced, gastrointestinal ulceration with bleeding and pericarditis may occur. Over 80% of patients are hypertensive with advanced CKD – usually because of hypervolemia. Coronary artery disease or hypertension may cause heart failure. Renal retention of sodium and water may cause edema, dyspnea, or both.
Inflammatory Disorders of the Nervous System
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Nocturia: Desmopressin spray (DDAVP) reduces the volume of urine produced.
Pharmacotherapeutic options in the treatment of nocturia: an update on the current oral drug therapies
Published in Expert Opinion on Pharmacotherapy, 2022
The management of patients with nocturia often requires a multimodal approach since many patients are likely to have more than one causative factor and often there is a complex array of underlying medical conditions contributing to a global symptom of nocturia. Clinical assessment should identify the most bothersome aspect of nocturia, and treatment is aimed at optimizing a patient’s symptoms to improve quality of life given that a complete cure of nocturia is often not possible. Treatment strategies should start with lifestyle changes and behavioral modifications and follow by two or more drugs to target different underlying causes of nocturia. It is important to have a frank discussion with patients to set realistic goals and expectations and to work together to decrease nocturia episodes, increase total sleep time and quality and improve the overall quality of life.
Comparison of sleep and chronotype between senior and undergraduate university students
Published in Chronobiology International, 2019
P Núñez, C Perillan, J Arguelles, E Diaz
In older people, sleep is characterized by an increased number of awakenings (Duffy et al. 2015). Sleep homeostasis regulates wakefulness and sleep and generates sleep pressure as a function of time of being awake. Sleep pressure increases during waking and sleep deprivation, and decreases during sleep (Dijk et al. 2000). The age-related sleep efficiency may be partially due to the reduced homeostatic sleep pressure with aging. This contributes to an increased number of nocturnal awakenings and reduced daytime sleepiness (Mander et al. 2017), as observed in the present study. For another part, nocturia, defined as the complaint of waking from sleep at night to void, occurs with increasing frequency as adults age. A recent review reports nocturia incidence at a rate of 11.5% per year in people aged >60 years (Pesonen et al. 2016), agreeing with our results. Among older adults, nocturia typically occurs due to multiple potential causes, which include lower urinary tract dysfunction, increased urine production, sleep dysfunction or a combination of these conditions (Inouye et al. 2007). Disturbed sleep and persistent pain are also common in old people (Onen and Onen 2018). The relationship between pain and sleep disturbance appears straightforward. Pain provokes disturbed sleep, and sleep disturbances interfere with the ability to initiate and maintain sleep (Frohnhofen 2018).
Nocturia in female patients: Current clinical features, treatment patterns and outcomes at a tertiary referral centre
Published in Arab Journal of Urology, 2019
Siri Drangsholt, Benoit Peyronnet, Maria Arcila-Ruiz, Rachael D. Sussman, Ricardo Palmerola, Dominique R. Pape, Nirit Rosenblum, Victor W. Nitti, Benjamin M. Brucker
A retrospective chart review of all new female patients seen in a single-centre functional urology practice with the diagnosis of nocturia was performed. Billing records were mined from 2010 to 2016, (a period after the initiation of electronic medical records) for patients with a primary diagnosis of nocturia, with an International Classifications of Disease ninth revision (ICD-9) code 788.43 and ICD-10 code R35.1. All patients were evaluated and treated by one of three Female Pelvic Medicine and Reconstructive Surgery (FPMRS)-certified urologists. The inclusion criterion was a primary diagnosis of nocturia. Patients were excluded if they were male, if they had undergone a treatment for bladder cancer, had a history of recurrent UTIs or had OAB predominant daytime symptoms. Up to three visits within a 12-month period from the time of presenting were reviewed.