HYPONATREMIA NEJM PDF

E-mail: moc. This article has been cited by other articles in PMC. Abstract Hyponatremia is an important and common clinical problem. The etiology is multifactorial. Hyponatremia may be euvolemic, hypovolemic or hypervolemic.

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Primary adrenal insufficiency is caused by impairment of the adrenal glands, whereas secondary adrenal insufficiency is the result of corticotropin deficiency caused by either pituitary or hypothalamic disease. Clinical Pearl What is the most common cause of primary adrenal insufficiency in high-income countries? Primary adrenal insufficiency is a rare entity, and in high-income countries, autoimmune adrenalitis is the most common cause.

Clinical Pearl Do patients with adrenal insufficiency have a normal life expectancy? Patients with adrenal insufficiency have a mortality rate that is 2 or 3 times the normal rate, and they have an increased incidence of certain cancers. Morbidity is considerable. Patients often have absences from school or work, frequent hospitalizations, and alterations in work life, social life, family life, and physical activity.

Morning Report Questions Q: What are some of the clinical and laboratory findings associated with primary adrenal insufficiency? A: The signs and symptoms are nonspecific and include fatigue, dizziness, gastrointestinal illness, salt craving, and hyperpigmentation. Hyperpigmentation is almost always present in chronic primary adrenal insufficiency. There are also some case reports of chronic primary adrenal insufficiency in which hyperpigmentation is absent, most likely because there are adequate resting levels of plasma cortisol, which would prevent increased corticotropin secretion and subsequent melanocyte stimulation.

Among patients with adrenal insufficiency, hyperkalemia occurs only in those with the primary form, owing to the aldosterone deficiency. A fraction of patients with adrenal insufficiency have a peripheral eosinophilia. Figure 1.

Laboratory Abnormalities in Primary Adrenal Insufficiency. Q: How sensitive is the hydroxylase antibody test for autoimmune adrenal insufficiency? These tests are not widely available and are not specific.

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Hyponatremia: A practical approach

Therapy of dysnatremic disorders. Br J Anaesth ; In some patients, mutations of the aquaretic i. Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits. Disturbances of sodium in critically ill adult neurologic patients: This disorder, which includes both central pontine and extrapontine myelinolysis, begins with gyponatremia and affective changes generally after initial improvement of neurologic symptoms with treatmentfollowed by mutism or dysarthria, spastic quadriparesis, and pseudobulbar palsy. When diagnostic uncertainty remains, volume contraction of the extracellular fluid can be ruled out by infusing 2 liters of 0. The Clinical Problem Hyponatremia, defined as an excess hyopnatremia water in relation to the sodium in the extracellular fluid, is the most common electrolyte disorder in hospitalized patients. The best method for determining an initial rate for hypertonic saline infusion is also controversial 38 ; Table 4 presents some suggested strategies.

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A Woman with Hyponatremia

J Intensive Care Med. Epub Jan Hyponatremia: A Review. Buffington MA 1 , Abreo K 2. Hyponatremia is the most frequently occurring electrolyte abnormality and can lead to life-threatening complications.

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