Diabetic Nephropathy
Jahangir Moini, Matthew Adams, Anthony LoGalbo in Complications of Diabetes Mellitus, 2022
The balance of sodium and water is maintained by increased fractional sodium excretion in the urine, plus a normal thirst response. Plasma sodium is usually normal. Hypervolemia usually occurs when dietary intake of sodium or water is restricted or excessive. Heart failure may be caused by an overload of sodium and water. This is more common if the patient has decreased cardiac reserve. Potassium is a substance with secretion mostly controlled via distal nephron secretion. Therefore, renal adaptation usually regulates normal plasma levels of potassium. This cannot occur when renal failure is advanced or the patient consumes too much potassium in the diet. Plasma potassium can be increased when renal failure is not as advanced by the use of ACE inhibitors, potassium-sparing diuretics, beta-blockers, cyclosporine, NSAIDs, tacrolimus, pentamidine, trimethoprim/sulfamethoxazole, or ARBs.
Rheology of Paraproteinemias and Leukemias
Gordon D. O. Lowe in Clinical Blood Rheology, 2019
The plasma (or serum) hyperviscosity syndrome (HVS) is a variable complex of clinical symptoms and signs, associated with markedly elevated levels of plasma (or serum) viscosity.2,3 While usually associated with the paraproteinemias (WM or MM), it is occasionally due to rheumatoid arthritis or Sjogren’s syndrome (Chapter 12, this volume). Isolated reports of hyperviscosity in MM were published in the 1930s.4 In the 1940s, Waldenström5,6 described hyperviscosity in the macroglobulinemia which was subsequently named after him (WM) and classified as IgM in type. In the early 1960s, Fahey and colleagues2,3 defined the clinical syndrome, showed its presence in many patients with WM, described its relationship to increased serum viscosity, and demonstrated the clinical efficacy of viscosity reduction by plasmapheresis. The correlation of viscosity data with plasma protein changes and with clinical symptoms was then pursued by several workers, notably Somer.7,8 In the 1970s, increasing attention was paid to hyperviscosity in MM;8-15 the importance of hypervolemia, as well as hyperviscosity, in the production of clinical symptoms was also realized.8,16
Cardiomyopathies in the elderly
Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich in Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
β-adrenergic blocking agents and nondihydropyridine calcium channel blockers, particularly verapamil, have been shown to reduce symptoms in patients with HOCM; however, no clear effect on mortality has been documented (153,163). As in patients with coronary disease, hypersensitivity to β-adrenergic stimulation accompanied by precipitous clinical deterioration may occur in patients who are abruptly withdrawn from β-blockers (164). Patients who do not respond to β-blockade can have a salutary response to relatively large doses of verapamil, although care must be taken to avoid paradoxical worsening of obstruction due to marked afterload-reducing effects at high doses in some patients (165). Controlled release disopyramide in doses of 150–600 mg daily has also been demonstrated to decrease symptoms in as many as 66% of patients, with a reduction in subaortic gradient of approximately 50% over 3 years (166). All of these agents are relatively contraindicated in patients with conduction system disease in the absence of cardiac pacing, and disopyramide must be given concomitantly with other AV nodal blocking agents to prevent rapid conduction of atrial fibrillation. Positive inotropic agents such as digoxin and load-reducing agents such as nitrates, diuretics, and dihydropyridine calcium channel blockers are relatively contraindicated because of their ability to increase the gradient across the LV outflow tract (140,157,162). However, as previously mentioned, patients with hypervolemia may require diuretic therapy.
The Prognostic Impact of the Geriatric Nutritional Risk Index in Patients with Severe Aortic Stenosis who Undergo Transcatheter Aortic Valve Replacement
Published in Structural Heart, 2019
Petar Saric, Jerry Lipinski, Sadeer Al-Kindi, Sandeep Patel, Daniel Kobe, Matthew Peters, Muhammad Panhwar, Toral Patel, Fahd Nadeem, Eric Bansal, Joshua Clevenger, Jun Li, Ankur Kalra, Guilherme Attizzani
This study supports the use of the GNRI as a simple prognostication tool in patients with severe AS undergoing evaluation for TAVR. The major findings of this study are: (1) lower GNRI scores were independently associated with increased mortality in this population; and (2) lower GNRI scores were also independently associated with higher incidence of hospital readmission post-TAVR. Recent research in a large Japanese cohort of patients with severe AS who underwent TAVR had similar findings—lower GNRI was associated with increased mortality and hospital readmission.5 In that study, the GNRI was also associated with increased incidence of AKI, major vascular complications, and increased post-TAVR LOS, which is similar to our findings. Our study adds further evidence to support the use of the GNRI as a risk-stratification tool in patients being evaluated for TAVR. To our knowledge, this is the first study to assess the relationship between the GNRI and outcomes in a US cohort. Our study has several limitations. First, this was a single-center, retrospective study, which can limit the ability to generalize the findings. Second, the GNRI is calculated from body weight and serum albumin, both of which can be affected by body fluid status. Patients with hypervolemia may have had their body weight and albumin values affected. Previous studies have evaluated the predictive value of several other frailty scales on outcomes in patients with severe AS who underwent TAVR.4 We did not collect data for these frailty scales in our study, and thus were unable to compare the GNRI to other risk stratification tools.
2706 km cycling in 2 weeks: effects on cardiac function in 6 elderly male athletes
Published in The Physician and Sportsmedicine, 2018
Thomas Morville, Mads Rosenkilde, Nick Mattsson, Flemming Dela, Jørn W Helge, Hanne K Rasmusen
The participants with the largest decrease in 2max developed hyponatremia (110 mmol/L vs. reference range ≥ 135 mmol/L) by the 28 h time point. Hyponatremia can be accompanied by neurological deficit, but none was observed in this study. Other cases of hyponatremia with concomitant hypervolemia have been reported after completion of endurance exercise activity [26,27]. Hypervolemia can increase preload, decrease IVRT, increase SV, and improve cardiac output and aerobic capacity. However, 2max decreased in participants of this study, possibly due to a decrease in SVmax. Assuming arteriovenous O2 difference of 15 ml O2/100 ml blood−1, we estimate a possible 8 ml (5%) decrease in SVmax, where assumed arteriovenous O2 difference is based on Fuchi et al. [28]. In support of this hypothesis, participants in this study demonstrated reduced IVRT, lowered diastolic blood pressure, and increased LVESV, which together are likely to reduce SV during exercise. This view is strengthened by studies that demonstrate acute altered cardiac function following prolonged exercise [6–9]. However, no direct evidence is available to support this hypothesis at present; therefore, the idea that study participants experienced reduced SV during exercise remains speculative. Unfortunately, we did not measure hematocrit before and after the 14 days as this would have improved our understanding of the potential shifts in plasma volume.
Phases of fluid management and the roles of human albumin solution in perioperative and critically ill patients
Published in Current Medical Research and Opinion, 2020
Christian J. Wiedermann
Managing volume status in patients with critical illness is a dynamic and delicate exercise that necessitates frequent monitoring and sound clinical judgment21 .The “fluid balance method” is the approach most widely used for managing volume replacement by fluid infusion during intensive care or perioperatively. Perceived needs and losses are summarized continuously and volume is substituted with crystalloids and colloids in proportion to their respective plasma-volume-expanding properties. It is well known that fluid overload, positive fluid balance, morbidity and mortality are interrelated. Organ dysfunction, prolonged mechanical ventilation, and higher mortality may result from volume overload and hypervolemia21,22. When compared with zero fluid balance, positive fluid balance after cardiac surgery was associated with increased incidence of acute kidney injury (AKI) 30, suggesting that fluid retention may be causally interrelated with AKI, contributing to renal retention and weight gain.
Related Knowledge Centers
- Anemia
- Ascites
- Blood Transfusion
- Diuretic
- Edema
- Kidney Failure
- Hypovolemia
- Heart Failure
- Liver Failure
- Intravenous Therapy