Electrolyte disturbances and endocrinal care
Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor in Essentials of Anesthesia for Neurotrauma, 2018
Hyponatremia is classically defined as a sNa of less than 135 mmol/l.2,7,10 Values between 131 and 135 mmol/l are considered of no clinical significance and thresholds for severe hyponatremia of 13021 or 120 mmol/l have been reported.1 It is the most common electrolyte disturbance encountered in clinical medicine and it increases mortality in a variety of clinical settings, both as dependent and independent factors.2 In the ICU, hypernatremia of any severity increases mortality with a relative risk (RR) of 2.6.22 The incidence is particularly high in NCCU patients, especially in those who suffer from ABI10, and it is associated with increased morbidity and mortality.2 Hyponatremia is found in 9% of all patients who have suffered from TBI. Over 56% of patients with SAH of any etiology develop hyponatremia and more than 19% of these have a pNa of less than 130 mmol/l.21 When SAH is caused by a ruptured aneurysm, 30% of patients develop hyponatremia, which constitutes an additional risk factor for stroke in those with high grade hemorrhage (WFNS 4-5).23 Hyponatremia in SAH is associated with worse functional outcomes.24 Fatal brain swelling is a rare complication reported in hyponatremic patients with intracranial disease or in cases of postoperative hyponatremia or water intoxication.1
Renal System
David Sturgeon in Introduction to Anatomy and Physiology for Healthcare Students, 2018
Even drinking excessive quantities of tap water can be extremely harmful. For example, if you consume water faster than it can be excreted by the kidneys, it can decrease the sodium concentration (and osmolality) of the interstitial fluid and plasma (hyponatremia). This results in the osmotic movement of water from the interstitial fluid into the cells causing them to swell. This is known as water intoxication and can result in headaches, confusion, convulsions, coma and even death as cells in the brain swell and increase inter-cranial pressure. In 2007, an American woman died whilst taking part in a radio competition to drink the most water without going to the toilet. The radio station was eventually ordered to pay her family $16 million in compensation since they had been warned that drinking large quantities of water was potentially dangerous. We saw in Chapter 1 that the average human being contains about 40 litres of water which accounts for 55–60% of total body weight. It is extremely important, therefore, that this fluid remains in the correct fluid compartments and that the kidneys continue to maintain normal fluid balance via the mechanisms discussed above.
Basic Urodynamic Tests: Uroflowmetry
Linda Cardozo, Staskin David in Textbook of Female Urology and Urogynecology - Two-Volume Set, 2017
perform quick uroflowmetry cAn Alter the following flow pArAmeters: QmAx And QAve cAn decreAse And time to QmAx As well As durAtion of flow cAn increAse [25–27]. especiAlly, cAtheters with A diAmeter of 7 French Are likely to Alter urine flow [28]. Although the effect of cystoscopy on urine flow pArAmeters hAs only been evAluAted in men, IssA et Al. [29] demonstrAted thAt QmAx significAntly decreAse by 27% After instrumentAtion. Therefore, urethrAl mAnipulAtion should be Avoided prior to uroflowmetry whenever possible. orAl or intrAvenous diuretics As well As increAsed fluid intAke cAn significAntly reduce wAiting time for urine flow meAsurement but do not significAntly Alter uroflow pArAmeters such As QmAx or voided volume [30–32]. Although uroflowmetry is A noninvAsive test suggesting no morbidity, excessive fluid intAke hAs been AssociAted with wAter intoxicAtion resulting in hyponAtremiA And seizure [33]. PAtient behAvior And nervousness during flow testing in the office mAy leAd to incomplete sphincter relAxAtion And decreAsed Urinary flow rAtes or even intermittent flow. Therefore, repeAted uroflowmetry meAsurements should be cArried out in women with Altered flow pArAmeters. CircAdiAn rhythm: It wAs shown in men thAt urine flow vAries during the 24 hour period with higher QmAx
Evaluation of the timing and safety of hysteroscopic myomectomy of large submucosal fibroids pretreated by high intensity focused ultrasound
Published in International Journal of Hyperthermia, 2023
Kaiyin Qu, Min Zou, Zhi Wang, Chunmei Gong, Yu Xiong, Lian Zhang
The hysteroscopic myomectomy was performed at different time points after HIFU according to the symptom relief and patient willingness. A disposable cervical dilation mold was placed to dilate the cervical the night before hysteroscopic myomectomy. The patient was placed in lithotomy position and the procedure was carried out under deep sedation. Respiratory rate, heart rate, blood pressure, and oxygen saturation level were monitored during the procedure. Electrolyte monitoring was also performed with the dynamical blood gas analysis to prevent acute water intoxication and hyponatremia. For non-diabetic patients, 5% dextrose solution was used as uterine distention fluid. For diabetic patients, mannitol solution was used. The hysteroscopic dilatation and perfusion system was used, and the intrauterine pressure was set to 80–100 mmHg (1 mmHg = 0.133 kPa) or less than or equal to mean arterial pressure according to the patient’s monitoring. Myomectomy was performed with a monopolar resection ring under ultrasound guidance. The necrotic fibroids were removed with oval clamp and sucked out with large suction tube under negative pressure. Electrocoagulation was used to stop bleeding. The operation was terminated when no abnormality was detected in the uterine cavity. The resected tissues were sent for pathological evaluation. Blood examination was performed within 24 h after hysteroscopic myomectomy.
Colonoscopy adverse events: are we getting the full picture?
Published in Scandinavian Journal of Gastroenterology, 2020
Lasse Pedersen, Nina Sorensen, Karen Lindorff-Larsen, Charlotte Green Carlsen, Nina Wensel, Christian Torp-Pedersen, Inge Bernstein
Bowel preparation is known to cause dehydration and electrolyte disturbances like hyponatraemia. Dehydration (with or without hyponatraemia) usually occurs due to excess sodium loss caused by bowel preparation combined with insufficient water intake. Normal hydration with hyponatraemia, known as ‘bowel prep hyponatraemia’, can also occur. It results from non-osmotic arginine vasopressin release, high-speed water intake and temporarily restricted diets found in patients undergoing bowel preparation [16]. The result is acute water intoxication similar to the condition seen in marathon runners [17]. Our findings suggest that re-admittance after colonoscopy due to dehydration/hyponatremia is a rare (0.8‰), but potentially fatal AE as some individuals with pre-existing diseases have poor tolerability to electrolyte imbalances and/or dehydration. The bowel preparation regime in the North Denmark Region is a polyethylene glycol electrolyte solution for screening colonoscopies and a sodium picosulfate solution for diagnostic colonoscopies. Sodium picosulfate has been reported to have an increased risk of hyponatraemia compared to polyethylene glycol which corresponds well to our finding that the risk of dehydration/hyponatraemia is higher among diagnostic colonoscopies (Table 6) [18]. However, a definite conclusion cannot be reached as the screening and diagnostic group might not be directly comparable.
The use of hysteroscopy in endometrial cancer: old questions and novel challenges
Published in Climacteric, 2020
P. Török, S. Molnár, R. Lampé, A. Jakab
In our literature review, no age-specific contraindication or restriction was encountered in the use of hysteroscopy. If the procedure is performed under general anesthesia, the general status of the patient should be suitable for surgery8. In patients with serious medical conditions, such as hemodynamic instability, laryngospasm, bronchial asthma, and a previous reaction to general anesthesia, the rate of failure of anesthesia is higher9. Hysteroscopy performed in an outpatient setting also allows this technique for these patients. Fluid overload should be considered a rare but important complication. Volume overload may cause pulmonary edema and congestive heart failure. Water intoxication may lead to hyponatremia, hypo-osmolarity, and cerebral edema10. In older women, these conditions can occur more frequently. Use of inhaled sevoflurane instead of intravenous propofol during operative hysteroscopy results in significantly increased glycine 1.5% absorption, which can decrease the incidence of gynecological transurethral resection of prostate (TURP) syndrome11. In conclusion, accurate fluid balancing and limiting the operation time may prevent such complications, which is more important in older age groups12.
Related Knowledge Centers
- Body Water
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- Vasopressin
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- Electrolyte
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