Faculty of Medicine
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Item type:Publication, OSMOTIC DEMYELINATION SYNDROME(Македонско лекарско друштво = Macedonian medical association, 2023-04-07); ; ; - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Синдром на несоодветно лачење на антидиуретски хормон - честа непрепознаена причина за хипонатремија(Macedonian Medical Association/De Gruyter, 2024); Hyponatremia is the most common electrolyte disturbance encountered in clinical practice, associated with significant morbidity and mortality. Chronic hyponatremia has negative effect on brain and bone tissue, and acute severe hyponatremia can have fatal outcome. Common cause of hyponatremia is the "syndrome of inappropriate antidiuretic hormone secretion" (SIADH), a condition characterized by dilutional hyponatremia due to unregulated secretion of antidiuretic hormone. SIADH can be idiopathic, but most often it is encountered in various clinical diseases. Although hyponatremia is a common electrolyte disturbance, its diagnosis is insufficient, SIADH is often unrecognized and hyponatremia is not appropriately treated. In this article we discuss the etiology of SIADH, diagnosis of hyponatremia and management of hyponatremia. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, SIADH and Severe Hyponatremia Induced by Antipsychotic Drug(Scientific Association of Endocrinologists and Diabetologists of Republic of Macedonia, 2014-10); ; ; Background: Hyponatremia is the most common electrolyte disturbance encountered in clinical practice associated with significant morbidity and mortality. Common cause of hyponatremia is the syndrome of inappropriate antidiuretic hormone secretion (SIADH), a condition characterized by dilutionalhyponatremia due to unregulated secretion of antidiuretic hormone. In psychiatric patients SIADH is common adverse effect of antipsychotic drugs. Despite being common electrolyte disturbance, hyponatremia is frequently unrecognized and untreated in psychiatric patients. Case presentation: A 44-year old male with schizophrenia was admitted to our department following seizure and secondarily developed rhabomyolysis due to severe hyponatremia. He was receiving valproic acid, olanzapine and benzodiazepine for many years. On physical examination the patient was euvolemic and had no evidence of pulmonary, cardiac, renal, thyroid and adrenal disease. After excluding psychogenic polydipsia and other common causes of hyponatremia, a diagnosis of drug induced SIADH was established on the basis of hyponatremia, serum hypoosmolality, high urine specific gravity and high urine sodium concentration. Antipsychotic drugs were discontinued; fluid restriction and hypertonic fluid were administered. Correction of hyponatremia ensued on the third hospital day. Conclusion: Monitoring of the plasma sodium concentration in patients receiving antipsychotic drugs is recommended in order to avoid potentially fatal complication of hyponatremia. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Paraneoplastic manifestation of severe hyponatremia caused by Syndrome of inappropriate antidiuretic hormone secretion (SIADH) in small cell lung carcinoma(Publi Créations, 2018-01)Introduction Paraneoplastic syndromes are a group of clinical disorders, associated with malignant diseases, not directly related to the localization of primary or metastatic tumors. These syndromes are described in lymphoma, thymoma, mesothelioma, Ewing’s sarcoma, and a variety of carcinomas. Approximately 70% of malignancy-related cases are as result of small cell lung cancer (SCLC). Associated with lung cancer, include: neurologic, endocrine, dermatologic, rheumatologic, hematologic, ophthalmological syndromes, glomerulopathy and coagulopathy (Trousseau’s syndrome). Small-cell lung carcinoma is an aggressive form of lung cancer, strongly associated with cigarette smoking, usually presents in central airways, infiltrating the submucosa. Common symptoms: cough, dyspnea, weight loss, fatigue. Over 70% of patients present with metastatic disease: liver, adrenals, bone, brain. Due to its neuroendocrine nature, small-cell carcinomas can produce ectopic hormones, adrenocorticotropic hormone and anti-diuretic hormone (ADH, also called vasopressin). Lambert-Eaton myasthenic syndrome is paraneoplastic condition linked to small-cell carcinoma. Published data suggest that the average incidence of clinically manifested SIADH in patients with newly diagnosed small cell lung cancer is only 4%. Syndrome of inappropriate anti-diuretic hormone secretion (SIADH) was first associated with malignancy when described in two patients with bronchogenic carcinoma in 1957. Case Presentation A 60 year old male, smoker for 30 years (48 pack-per-year smoking history), was hospitalized because of one month history of weakness, dry cough, chest pain, syncope. Physical examination - normotensive, afebrile, heart rate 100/min, weight 79 kg. Rhythmic heart action. Lung auscultation revealed diminished breath sound in right lung. Abdomen: bowel sounds present, with no organomegaly. Extremities: no edema, warm, pulses positive. Initial 12 lead ECG was normal. Laboratory results - hyponatremia 117mmol/L, with normal potassium, calcium, magnesium, phosphorus, urea, creatinin, uric acid, proteins in serum and urine, tumour markers (normal CEA, CA-19-9, AFP, PSA, Cyfra 21-1), mildly elevated NSE, reduced plasma osmolality 248,3mosm/kg and urine sodium below 40mEq/L/24 hours. Chest X-ray presented parenchymal consolidation in right lung in communication with enlarged right hilus (Figure 1). The patient undrewent bronchoscopy and biopsy. Bronchoscopy revealed paresis of right vocal cord, shortened main carina, left bronchial tree was normal. Right bronchial tree with edematous carina superior lat.dex., submucous infiltration with stenosis of anterior branch of upper lobe and intermediate bronchus (Figure 3, 4). Patohystology morphologic features were consistent with small cell lung carcinoma (Figure 5). Lung CT scan presented hypodense parenchimal change next to right hilus with compression of right bronchus and atelectasis, with mediastinal lymhadenopathy (Figure 2).Also for staging abdominal ultrasound was performed, organs were normal, only enlarged adrenal glands were detected. After hyponatremia was corrected, restricted fluid intake (maximum 1000ml/day), and health status improven, further treatment was continued at Institute of Oncology. Discussion Ectopic production of large amounts of ADH leads to syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH), defined by hyponatremia, water retention, hypo-osmolality. ADH plays an important role in regulating the balance of fluids. It lowers the amount of urine the and increases the amount of water the kidneys take up. SIADH is characterized by neurological and psychiatric symptoms attributable to cerebral edema. Symptoms may be mild and vague at first, but tend to build. Severe cases may involve these symptoms: irritability and restlessness, loss of appetite, cramps, nausea and vomiting, muscle weakness, confusion, hallucination, personality changes, seizures, stupor, coma. The goal of treatment is very gradual coorrection of hyponatremia and fluid restriction. Hyponatremia inoncology practice, may be a negative prognostic factor in cancer patients based on a systematic analysis of published studies. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Recent developments in the management of acute and chronic hyponatremia(Wolters Kluwer, 2019); Purpose of review: The aim of the study is to review recent studies on the management of acute and chronic hyponatremia. Recent findings: In acute symptomatic hyponatremia, bolus infusion of hypertonic saline improves hyponatremia and neurological status more quickly than continuous infusion. In chronic hyponatremia, newly identified predictors of nonresponse to fluid restriction include a high urine osmolality (>500 mOsm/kg) and high urine sodium (>133 mmol/l). Vasopressin-receptor antagonists effectively raise the serum sodium concentration in patients with euvolemic or hypervolemic hyponatremia but have a risk of overcorrection, even at low doses. Several observational studies now support the use of urea for a more gradual correction of hyponatremia without a risk of overcorrection. Recently identified risk factors for overcorrection include lower serum sodium at presentation, polydipsia, hypovolemia, and early urine output during treatment. Specific treatments with potential efficacy are the use of intravenous albumin for hyponatremia because of liver cirrhosis, and fludrocortisone for hyponatremia in tuberculous meningitis. Summary: The recent data will help to further optimize and personalize the management of patients with acute and chronic hyponatremia. However, most data are still observational and retrospective. Therefore, the field is in need of prospective studies comparing interventions for chronic hyponatremia and focusing on patient-relevant outcomes.