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Biagio Murta e Di Flora F, Machado Oliveira MV, Henrique Torres Menezes P, Delgado MA. Central pontine myelinolysis after liver transplant: A case report and an updated review. Saudi J Anaesth 2023; 17:275-277. [PMID: 37260634 PMCID: PMC10228860 DOI: 10.4103/sja.sja_709_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 03/11/2023] Open
Abstract
Based on brain magnetic resonance imaging results, the second and third most frequent causes of central pontine myelinolysis (CPM) were liver transplant (LT) and cirrhosis, which together accounted for 13.7% and 12.5% of all diagnoses of CPM. Medical diseases including cirrhosis, LT, malnutrition, and alcoholism are well-known conditions associated with CPM in addition to hyponatremia. The prognosis is poor and depends on early diagnosis and treatment to achieve better outcomes. This is a case report of CPM occurring after a deceased donor LT in a patient presenting many risk factors such as chronic hyponatremia, previous episodes of encephalopathy, and tacrolimus immunosuppression. We briefly discuss the pathophysiology, risk factors, diagnosis, and treatment, highlighting the role and challenges of the anesthesiologist in managing this kind of patient and preventing the syndrome in the context of major surgery.
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Affiliation(s)
- Francisco Biagio Murta e Di Flora
- Unidade de Cirurgia e Anestesiologia, Hospital das Clínicas de Belo Horizonte, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Maurício Vitor Machado Oliveira
- Unidade de Cirurgia e Anestesiologia, Hospital das Clínicas de Belo Horizonte, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Pedro Henrique Torres Menezes
- Unidade de Cirurgia e Anestesiologia, Hospital das Clínicas de Belo Horizonte, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Marina Ayres Delgado
- Unidade de Cirurgia e Anestesiologia, Hospital das Clínicas de Belo Horizonte, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Zade A, Ingule A, Trivedi C, Jha S, Agrwal A. Incidentally Detected Hypermetabolism in Pons Suggestive of Pontine Myelinolysis on 18F-FDG PET/CT Scan. Clin Nucl Med 2021; 46:e501-e502. [PMID: 34034309 DOI: 10.1097/rlu.0000000000003709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Central pontine myelinolysis (CPM) is demyelinating condition of pons caused by osmotic stress due to rapid correction of hyponatremia. We present a case where CPM was an incidental finding on FDG PET/CT scan. To the best of our knowledge, only 3 case reports have been published till date describing CPM on 18F-FDG PET/CT scans.
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Affiliation(s)
- Anand Zade
- From the Departments of Nuclear Medicine
| | - Amol Ingule
- Radiology, Apollo Hospitals, Navi Mumbai, India
| | | | - Smriti Jha
- Radiology, Apollo Hospitals, Navi Mumbai, India
| | - Anup Agrwal
- Radiology, Apollo Hospitals, Navi Mumbai, India
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Yoshioka K. Patient with Bartter syndrome in whom chronic potassium depletion was considered one of the causes of hyponatremia. BMJ Case Rep 2021; 14:14/3/e240898. [PMID: 33692070 PMCID: PMC7949381 DOI: 10.1136/bcr-2020-240898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 53-year-old man was admitted to our hospital because of general fatigue and disorientation. He had been diagnosed with Bartter syndrome in his teens and had been taking potassium preparations since then. However, his serum potassium concentration (K+ s) remained persistently low. Ten days before admission, he developed fever. He was diagnosed as having bronchitis and was treated with antibiotics. Although his fever subsided, general fatigue worsened. Laboratory examination showed hyponatraemia (127 mEq/L), while K+ s was 2.3 mEq/L. C reactive protein was negative. On admission, laboratory examination revealed deterioration of hyponatraemia (125 mEq/L). Although his serum sodium concentration (Na+ s) was refractory to electrolyte replacement, the level increased towards normal after spironolactone administration, following normalisation of K+ s, suggesting that hyponatraemia was caused by K+ depletion. Physicians should be aware of the importance of the effects of exchangeable K+ (K+ e) on Na+ s.
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Mutti C, Ciliento R, Parrino L, Florindo I, Pavesi G, Zinno L. Apathetic encephalopathy in thyreotoxicosis: an unsual cause of wernicke encephalopathy and osmotic demyelinating syndrome. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021055. [PMID: 33682841 PMCID: PMC7975956 DOI: 10.23750/abm.v92i1.9473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/06/2020] [Indexed: 11/23/2022]
Abstract
Non-alcoholic Wernicke Encephalopathy (WE) is an overlooked complication of malnourishment in all its forms including undernutrition, inadequate vitamine intake and endocrinological diseases. Both delay in treatment and overtreatment can lead to severe neurological life-long consequences. Inadequate management in patients with chronic malnutrition may cause abrupt osmolytes unbalance and subsequent osmotic demyelination syndromes. We describe a 65-year old man with apathetic encephalopathy caused by thyreotoxicosis and associated with malnutrition and severe thiamine depletion.
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Affiliation(s)
| | - Rosario Ciliento
- Neurology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Liborio Parrino
- Sleep Medicine Center, Neurology Unit, Department of General and Specialistic Medicine, University Hospital of Parma, Parma, Italy.
| | - Irene Florindo
- Neurology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Giovanni Pavesi
- Neurology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Lucia Zinno
- Neurology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy.
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Pose-Reino A, Runkle de la Vega I, de Jong-Laird A, Kabra M, Lindner U. Real-World, Non-Interventional, Retrospective Study (SAMPLE) of Tolvaptan in Patients with Hyponatraemia Secondary to the Syndrome of Inappropriate Antidiuretic Hormone Secretion. Adv Ther 2021; 38:1055-1067. [PMID: 33306187 DOI: 10.1007/s12325-020-01560-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/04/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most common cause of hyponatraemia in hospital inpatients. We present data on treatment setting, patient characteristics, and outcomes for patients treated with tolvaptan for SIADH across a range of real-world settings in Germany and Spain. METHODS This was a non-interventional, observational, retrospective chart review study. Management was at the discretion of the treating physician, with tolvaptan prescribed according to local clinical practice. Hospital notes and/or medical charts were reviewed from treatment initiation for 6 weeks. Follow-up data were collected when patients were discharged early. Patients were eligible for inclusion if they were ≥ 18 years of age and had been treated with ≥ 2 doses of tolvaptan for one episode of hyponatraemia secondary to SIADH in 2014. RESULTS The Full Analysis Set comprised 100 patients from 8 centres. The mean age of patients was 73.9 years. The primary endpoint of the mean increase in serum sodium level from baseline to hospital discharge, or to final available measurement, was 10.3 mmol/L (SD 6.4; 95% CI 9.0, 11.6), from 123.0 mmol/L (SD 6.0) to 133.3 mmol/L (SD 4.9). Seventy-seven patients (77.0%) achieved sodium normalisation within 6 weeks of tolvaptan initiation. Mean daily dose of tolvaptan was 12.7 mg (SD 9.2), and mean treatment duration 28.0 days (SD 16.5). Tolvaptan at off-label doses (< 15 mg/day) was prescribed to 72 patients at some point. A favourable safety and tolerability profile was reported. CONCLUSIONS Tolvaptan was well tolerated and effectively corrected sodium levels in hospitalised adults with hyponatraemia secondary to SIADH in real-world settings. CLINICALTRIALS. GOV IDENTIFIER NCT02545101.
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Affiliation(s)
- Antonio Pose-Reino
- Department of Internal Medicine, Facultad de Medicina, Universidad de Santiago de Compostela, A Coruña, Spain
| | - Isabelle Runkle de la Vega
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos- IdISSC, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Anne de Jong-Laird
- Otsuka Pharmaceutical Companies Europe, Wexham Springs, Framewood Road, Wexham, Slough, UK
| | - Madhu Kabra
- Otsuka Pharmaceutical Companies Europe, Wexham Springs, Framewood Road, Wexham, Slough, UK
| | - Uwe Lindner
- Department of Endocrinology and Diabetology, Klinikum Chemnitz gGmbH, Klinikum Chemnitz gGmbH, Chemnitz, Germany.
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Magnesium, Calcium, Potassium, Sodium, Phosphorus, Selenium, Zinc, and Chromium Levels in Alcohol Use Disorder: A Review. J Clin Med 2020; 9:jcm9061901. [PMID: 32570709 PMCID: PMC7357092 DOI: 10.3390/jcm9061901] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/15/2020] [Indexed: 02/07/2023] Open
Abstract
Macronutrients and trace elements are important components of living tissues that have different metabolic properties and functions. Trace elements participate in the regulation of immunity through humoral and cellular mechanisms, nerve conduction, muscle spasms, membrane potential regulation as well as mitochondrial activity and enzymatic reactions. Excessive alcohol consumption disrupts the concentrations of crucial trace elements, also increasing the risk of enhanced oxidative stress and alcohol-related liver diseases. In this review, we present the status of selected macroelements and trace elements in the serum and plasma of people chronically consuming alcohol. Such knowledge helps to understand the mechanisms of chronic alcohol-use disorder and to progress and prevent withdrawal effects, also improving treatment strategies.
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Matsuura H, Takiue K, Nakato H, Nishihara C, Sasaki E, Suganami Y, Kishida M. Mexican hat sign. Postgrad Med J 2019; 96:303. [PMID: 31653665 DOI: 10.1136/postgradmedj-2019-137078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/10/2019] [Accepted: 10/17/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Hiroki Matsuura
- General Internal Medicine, Okayama City Hospital, Okayama, Japan
| | - Keiichi Takiue
- General Internal Medicine, Okayama City Hospital, Okayama, Japan
| | - Hikari Nakato
- General Internal Medicine, Okayama City Hospital, Okayama, Japan
| | - Chika Nishihara
- General Internal Medicine, Okayama City Hospital, Okayama, Japan
| | - Erika Sasaki
- Endocrinology, Okayama City Hospital, Okayama, Japan
| | - Yuu Suganami
- General Internal Medicine, Okayama City Hospital, Okayama, Japan
| | - Masayuki Kishida
- General Internal Medicine, Okayama City Hospital, Okayama, Japan.,Endocrinology, Okayama City Hospital, Okayama, Japan
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Sullivan EV, Pfefferbaum A. Brain-behavior relations and effects of aging and common comorbidities in alcohol use disorder: A review. Neuropsychology 2019; 33:760-780. [PMID: 31448945 PMCID: PMC7461729 DOI: 10.1037/neu0000557] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Alcohol use disorder (AUD) is a complex, dynamic condition that waxes and wanes with unhealthy drinking episodes and varies in drinking patterns and effects on brain structure and function with age. Its excessive use renders chronically heavy drinkers vulnerable to direct alcohol toxicity and a variety of comorbidities attributable to nonalcohol drug misuse, viral infections, and accelerated or premature aging. AUD affects widespread brain systems, commonly, frontolimbic, frontostriatal, and frontocerebellar networks. METHOD AND RESULTS Multimodal assessment using selective neuropsychological testing and whole-brain neuroimaging provides evidence for AUD-related specific brain structure-function relations established with double dissociations. Longitudinal study using noninvasive imaging provides evidence for brain structural and functional improvement with sustained sobriety and further decline with relapse. Functional imaging suggests the possibility that some alcoholics in recovery can compensate for impairment by invoking brain systems typically not used for a target task but that can enable normal-level performance. CONCLUSIONS Evidence for AUD-aging interactions, indicative of accelerated aging, together with increasing alcohol consumption in middle-age and older adults, put aging drinkers at special risk for developing cognitive decline and possibly dementia. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Edith V. Sullivan
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Adolf Pfefferbaum
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
- Center for Health Sciences, SRI International, Menlo Park, CA
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Chinoy A, Wright N, Bone M, Padidela R. Severe hypokalaemia in diabetic ketoacidosis: a contributor to central pontine myelinolysis? Endocrinol Diabetes Metab Case Rep 2019; 2019. [PMID: 31368676 PMCID: PMC6548219 DOI: 10.1530/edm-19-0034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Hypokalaemia at presentation of diabetic ketoacidosis is uncommon as insulin deficiency and metabolic acidosis shifts potassium extracellularly. However, hypokalaemia is a recognised complication of the management of diabetic ketoacidosis as insulin administration and correction of metabolic acidosis shifts potassium intracellularly. We describe the case of a 9-year-old girl with newly diagnosed type 1 diabetes mellitus presenting in diabetic ketoacidosis, with severe hypokalaemia at presentation due to severe and prolonged emesis. After commencing management for her diabetic ketoacidosis, her serum sodium and osmolality increased rapidly. However, despite maximal potassium concentrations running through peripheral access, and multiple intravenous potassium ‘corrections’, her hypokalaemia persisted. Seventy two hours after presentation, she became drowsy and confused, with imaging demonstrating central pontine myelinolysis – a rare entity seldom seen in diabetic ketoacidosis management in children despite rapid shifts in serum sodium and osmolality. We review the literature associating central pontine myelinolysis with hypokalaemia and hypothesise as to how the hypokalaemia may have contributed to the development of central pontine myelinolysis. We also recommend an approach to the management of a child in diabetic ketoacidosis with hypokalaemia at presentation.
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Affiliation(s)
- A Chinoy
- Department of Paediatric Endocrinology, Royal Manchester Children’s Hospital, Manchester, UK,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - N Wright
- Department of Paediatric Radiology, Royal Manchester Children's Hospital, Manchester, UK
| | - M Bone
- Department of General Paediatrics, Royal Manchester Children’s Hospital, Manchester, UK
| | - R Padidela
- Department of Paediatric Endocrinology, Royal Manchester Children’s Hospital, Manchester, UK,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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