Management of poisoning
Bev-Lorraine True, Robert H. Dreisbach in Dreisbach’s HANDBOOK of POISONING, 2001
The type of diuresis may vary from one patient to another. The following are examples: If the return of tubular function is delayed, the patient’s urine may be essentially a glomerular filtrate with large volume and low specific gravity. These patients continue to lose large amounts of potassium, sodium, and other ions. Adequate management requires analysis of daily 24-h urine samples for total sodium and potassium losses, and replacement as needed.The diuresis may be accompanied by retention of sodium and a consequent rapid rise in serum sodium and chloride. Treatment in this case consists of providing sodium-free water.
History and Examination
Linda Cardozo, Staskin David in Textbook of Female Urology and Urogynecology - Two-Volume Set, 2017
IncreAsed fluid intAke And urine output; normAl blAdder cApAcity osmotic diuresis (e.g., diAbetes mellitus). AbnormAl Antidiuretic hormone production (e.g., diAbetes insipidus). PolydipsiA; often the womAn enjoys drinking A fAvorite beverAge And only rArely is the behAvior psychotic. reduced functionAl blAdder cApAcity InflAmed blAdder, increAsing blAdder sensAtion (e.g., Acute bActeriAl cystitis, interstitiAl cystitis) Detrusor overActivity HAbit or feAr of Urinary incontinence Urinary residuAl secondAry to detrusor hypotoniA or outlet obstruction (rAre) IncreAsed blAdder sensAtion, normAl blAdder (e.g., Anxiety) reduced structurAl blAdder cApAcity Fibrosis After infection (e.g., tuberculosis) noninfective cystitis (e.g., interstitiAl cystitis, cArcinomA) IrrAdiAtion fibrosis (e.g., for blAdder or cervicAl cArcinomA) Postsurgery (e.g., pArtiAl cystectomy) Detrusor hypertrophy DecreAsed Urinary frequency Detrusor hypotoniA ImpAired blAdder sensAtion (e.g., diAbetic neuropAthy) reduced fluid intAke
Pharmacology and Toxicology of Loop Diuretics in Pediatrics
Sam Kacew in Drug Toxicity and Metabolism in Pediatrics, 1990
Although the therapeutic benefit derived from ethacrynic acid use in infants with acute glomerulonephritis was questioned,119 Sparrow et al.120 reported a significant diuresis and clinical improvement in all children with congestive heart failure after administration of this diuretic. The observed diuresis was rapid, did not change serum electrolyte concentration, and failed to produce any apparent side effects. Similarly, Willard and Geisett121 found that ethacrynic acid was effective in the treatment of congestive heart failure in newborns. Thus, it is apparent that ethacrynic acid is of therapeutic benefit in the therapy of fluid overload associated with congestive heart failure in infants and is of questionable value in idiopathic edema in newborns.
Acute toxic kidney injury
Published in Renal Failure, 2019
Nadezda Petejova, Arnost Martinek, Josef Zadrazil, Vladimir Teplan
An underlying feature in its pathophysiology is rapid decline in kidney excretory and metabolic functions with accumulation of nitrogen metabolism end-products such as blood urea and creatinine. A decrease in diuresis (oliguria/anuria) is often present. Patients with acute kidney injury (AKI) are classified into three clinical stages based on increase in creatinine and/or decrease in urine output, according to KDIGO (Kidney Disease Improving Global Outcomes) recommendations [1]. The etiology of AKI is generally divided, according to pathophysiological principle, into pre-renal, renal and post-renal. In recent years, there has been a change in definition based on epidemiology as: (1) community-acquired AKI, (2) nosocomial AKI and (3) AKI in the critically ill. AKI induced by poisonous or primarily nephrotoxic substances, may be regarded as community acquired with ingestion or inhalation of toxic substances or nosocomial, i.e. hospital acquired. In special circumstances, the AKI can develop in critically ill patients in intensive care units (ICUs) after administration of nephrotoxic treatments or, in susceptible patients undergoing radiological examination with the use of high osmolar iodinated radiographic contrast media [2].
Careful use to minimize adverse events of oral antidiabetic medications in the elderly
Published in Expert Opinion on Pharmacotherapy, 2021
André J. Scheen
Some of adverse events are easily explained by the mechanisms of action, such as genital mycotic infections (related to glucosuria), which are rather common but rarely severe in T2D patients treated with SGLT2is [121]. A retrospective cohort study showed that the use of SGLT2is among women and men aged 66 years or older is associated with increased risk of genital mycotic infections within 30 days (almost x 2.5 compared with DPP–4is), but without associated increased risk of urinary tract infections [128]. Some cases of aggravation of urinary incontinence due to osmotic diuresis have been reported in older patients. Perineal hygiene might reduce genital infections and avoid the development of Fournier disease, a rare necrotizing infection of the external genitalia, perineum, and perianal region, apparently favored by obesity but not specifically by aging [121]. (3) Volume reduction
Acute kidney injury on chronic kidney disease: from congestive heart failure to light chain deposition disease and cast nephropathy in multiple myeloma
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Sana Shaikh, Christian Nwankwo, Alexandre Lacasse, Steven Cheng
Admission diagnosis for this patient was acute cor pulmonale or decompensated right-sided congestive heart failure. Following intravenous diuresis, subjective improvement was reported and there was an appropriate response in the urine output. However, certain subtle laboratory findings pointed towards an alternative diagnosis. Serial creatinine measurements continued to trend upwards in spite of several diuretic regimen adjustments. Urine protein quantification showed nephrotic-range proteinuria, although falsely elevated by concomitant red blood cell lysis. Hematuria was attributed to trauma from renal calculi, but nephritic syndromes could not be excluded. The presence of glycosuria in the setting of normoglycemia and normal hemoglobin A1c was concerning for proximal tubular dysfunction. Despite preexisting CKD, both kidneys were paradoxically enlarged on ultrasound. In an attempt to find a unifying diagnosis, serum and urine protein electrophoresis and immunofixation were sent, and findings were consistent with an immunoglobulin overproduction process. Diagnosis of MM was thus obtained in the absence of hypercalcemia, albuminocytologic dissociation, bony lytic lesions, weight loss or fatigue. Renal lesion identified on biopsy was a combination of LCDD and CN. Amyloidosis was suspected based on kidney size, potential amyloid-associated cystic lung disease and presence of diastolic heart failure, but this was not settled by biopsy.
Related Knowledge Centers
- Body Water
- Kidney Failure
- Urination
- Urine
- Polyuria
- Heart Failure
- Kidney
- Renal Physiology
- Fluid Balance
- Drinking