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[PMID]: 29523082
[Au] Autor:Kork F; Rimek A; Andert A; Becker NJ; Heidenhain C; Neumann UP; Kroy D; Roehl AB; Rossaint R; Hein M
[Ad] Address:Department of Anaesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany. fkork@ukaachen.de.
[Ti] Title:Visual quality assessment of the liver graft by the transplanting surgeon predicts postreperfusion syndrome after liver transplantation: a retrospective cohort study.
[So] Source:BMC Anesthesiol;18(1):29, 2018 Mar 09.
[Is] ISSN:1471-2253
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: The discrepancy between demand and supply for liver transplants (LT) has led to an increased transplantation of organs from extended criteria donors (ECD). METHODS: In this single center retrospective analysis of 122 cadaveric LT recipients, we investigated predictors of postreperfusion syndrome (PRS) including transplant liver quality categorized by both histological assessment of steatosis and subjective visual assessment by the transplanting surgeon using multivariable regression analysis. Furthermore, we describe the relevance of PRS during the intraoperative and postoperative course of LT recipients. RESULTS: 53.3% (n = 65) of the patients suffered from PRS. Risk factors for PRS were visually assessed organ quality of the liver grafts (acceptable: OR 12.2 [95% CI 2.43-61.59], P = 0.002; poor: OR 13.4 [95% CI 1.48-121.1], P = 0.02) as well as intraoperative norepinephrine dosage before reperfusion (OR 2.2 [95% CI 1.26-3.86] per 0.1 µg kg min , P = 0.01). In contrast, histological assessment of the graft was not associated with PRS. LT recipients suffering from PRS were hemodynamically more instable after reperfusion compared to recipients not suffering from PRS. They had lower mean arterial pressures until the end of surgery (P < 0.001), received more epinephrine and norepinephrine before reperfusion (P = 0.02 and P < 0.001, respectively) as well as higher rates of continuous infusion of norepinephrine (P < 0.001) and vasopressin (P = 0.02) after reperfusion. Postoperative peak AST was significantly higher (P = 0.001) in LT recipients with PRS. LT recipients with intraoperative PRS had more postoperative adverse cardiac events (P = 0.05) and suffered more often from postoperative delirium (P = 0.04). CONCLUSIONS: Patients receiving ECD liver grafts are especially prone to PRS. Anesthesiologists should keep these newly described risk factors in mind when preparing for reperfusion in patients receiving high-risk organs.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:In-Data-Review
[do] DOI:10.1186/s12871-018-0493-9

  2 / 11713 MEDLINE  
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[PMID]: 29174707
[Au] Autor:Alanzalon RE; Burris JR; Vinocur JM
[Ad] Address:Division of Pediatric Cardiology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Box 631, Rochester, NY, USA.
[Ti] Title:Brugada phenocopy associated with diabetic ketoacidosis in two pediatric patients.
[So] Source:J Electrocardiol;51(2):323-326, 2018 Mar - Apr.
[Is] ISSN:1532-8430
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Two patients without cardiac history demonstrated type 1 Brugada pattern during hospitalization for diabetic ketoacidosis (DKA). Both patients had normalization of their ECGs after treatment of marked electrolyte abnormalities and metabolic acidosis. In this report, we describe two cases of Brugada phenocopy associated with DKA in children.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1711
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:In-Data-Review

  3 / 11713 MEDLINE  
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[PMID]: 29521607
[Au] Autor:Gökce IK; Turgut H; Ozdemir R; Onal SC
[Ad] Address:Department of Pediatrics, Division of Neonatology, and.
[Ti] Title:Development of severe hyponatremia due to cerebrospinal fluid leakage following meningomyelocele surgery in a newborn.
[So] Source:J Neurosurg Pediatr;:1-4, 2018 Mar 09.
[Is] ISSN:1933-0715
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Cerebrospinal fluid leakage following meningomyelocele surgery is a frequent complication in the wound-healing period and is associated with wound dehiscence. CSF loss can cause severe hyponatremia, especially in the newborn and early infancy periods when dietary sodium content is relatively low. Hyponatremia in the newborn period can result in adverse neurodevelopmental outcomes. In addition, hyponatremia's cerebral effects can increase complications in neurosurgery patients. The authors present the case of a newborn in whom CSF leakage from the operative site and severe hyponatremia developed following meningomyelocele surgery. To the best of their knowledge, severe hyponatremia caused by CSF leakage after meningomyelocele surgery has not been previously reported in the literature.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:Publisher
[do] DOI:10.3171/2017.11.PEDS17386

  4 / 11713 MEDLINE  
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[PMID]: 29519546
[Au] Autor:Yamazoe M; Mizuno A; Kohsaka S; Shiraishi Y; Kohno T; Goda A; Higuchi S; Yagawa M; Nagatomo Y; Yoshikawa T; West Tokyo Heart Failure Registry Investigators Tokyo, Japan
[Ad] Address:Department of Bio-informational Pharmacology, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan.
[Ti] Title:Incidence of hospital-acquired hyponatremia by the dose and type of diuretics among patients with acute heart failure and its association with long-term outcomes.
[So] Source:J Cardiol;, 2018 Mar 05.
[Is] ISSN:1876-4738
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:BACKGROUND: Diuretics are the cornerstone therapy for acute heart failure (AHF) but can lead to various electrolyte disturbances and inversely affect the patients' outcome. We aimed to evaluate whether (1) the dose of loop diuretics could predict hospital-acquired hyponatremia (HAH) during AHF treatment, (2) addition of thiazide diuretics could affect development of HAH, and (3) assess their impact on long-term outcomes. METHODS: We analyzed the subjects enrolled in the multicenter AHF registry (WET-HF). Risk of HAH, defined as hyponatremia at discharge with normonatremia upon admission, was evaluated based on oral non-potassium-sparing diuretics via multivariate logistic regression analysis. Additionally, we performed one-to-one matched analysis based on propensity scores for thiazide diuretics use and compared long-term mortality. RESULTS: Of total 1163 patients (mean age 72.6±13.6 years, male 62.6%), 92 (7.9%) had HAH. Compared with low-dose loop diuretics users (<40mg; without thiazide diuretics), risks for developing HAH were significantly higher in patients with thiazide diuretics, regardless of the dose of loop diuretics (OR 2.67, 95% CI 1.13-6.34 and OR 2.31, 95% CI 1.50-5.13 for low- and high-dose loop diuretics, respectively). The association was less apparent in patients without thiazide diuretics (OR 1.29, 95% CI 0.73-2.27 for high-dose loop diuretics alone). Among 206 matched patients, all-cause and cardiac mortality rate was 27% and 14% in non thiazide diuretics users and 50% and 30% in thiazide diuretics users, respectively (HR 2.46, 95% CI 1.29-4.69, p=0.006 and HR 2.50, 95% CI 1.10-5.67, p=0.028, respectively) during a mean 19.3 months of follow-up. CONCLUSIONS: Thiazide diuretics use, rather than loop diuretics dose, was independently associated with HAH; and mortality was higher in thiazide diuretics users even after statistical matching.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:Publisher

  5 / 11713 MEDLINE  
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[PMID]: 29506479
[Au] Autor:Kim YM; Seo GH; Kim GH; Ko JM; Choi JH; Yoo HW
[Ad] Address:Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-Gu, Seoul, 05505, South Korea.
[Ti] Title:A case of an infant suspected as IMAGE syndrome who were finally diagnosed with MIRAGE syndrome by targeted Mendelian exome sequencing.
[So] Source:BMC Med Genet;19(1):35, 2018 Mar 05.
[Is] ISSN:1471-2350
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: Adrenal hypoplasia is a rare congenital disorder, which can be classified into a non-syndromic form, without extra-adrenal features, and a syndromic form, with such features. Despite biochemical and molecular genetic evaluation, etiologic diagnosis cannot be performed in many patients with adrenal hypoplasia. CASE PRESENTATION: The patient in this case was a boy born at 31 weeks of gestation with a weight of 882 g (< 3rd percentile) to non-consanguineous parents. Genital examination showed micropenis and bilateral cryptorchidism. On the third day of life, he manifested hypotension with high urine output, hyponatremia, hyperkalemia, hypernatriuria, high plasma adrenocorticotropic hormone level, and high plasma renin activity, suggesting acute adrenal insufficiency. The serum 17α-hydroxyprogesterone level was normal. Adrenal insufficiency improved following administration of hydrocortisone and 9α-fludrocortisone, but the patient died of recurrent infection at 4 months of age. He was suspected as IMAGE (Intrauterine growth restriction, Metaphyseal dysplasia, Adrenal hypoplasia congenita, and Genital anomalies) syndrome. However, no mutation in CDKN1C was identified. Targeted exome sequencing using the TruSight One Sequencing Panel (Illumina) identified a heterozygous mutation of c.2944C > T (p.R982C) in exon 3 in SAMD9. CONCLUSION: This report describes the first Korean case of MIRAGE syndrome. The patient presented with severe primary adrenal insufficiency, intrauterine growth retardation, and recurrent infection. SAMD9 mutation should be considered in patients who present with adrenal hypoplasia and extra-adrenal phenotypes.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:In-Data-Review
[do] DOI:10.1186/s12881-018-0546-4

  6 / 11713 MEDLINE  
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[PMID]: 29516370
[Au] Autor:Tabaro I; Reimondo G; Osella G; Aurizi C; Caraci P; Barbieri L; Giachino DF; Sirchia F; Terzolo M
[Ad] Address:Department of Clinical and Biological Sciences, Internal Medicine, San Luigi Gonzaga Hospital, Orbassano, University of Turin, Torino, Italy.
[Ti] Title:Novel mutation of PPOX gene in a patient with abdominal pain and syndrome of inappropriate antidiuresis.
[So] Source:Endocrine;, 2018 Mar 07.
[Is] ISSN:1559-0100
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:PURPOSE: Acute porphyrias are metabolic disorders of heme biosynthesis characterized by acute life-threatening attacks. The diagnosis is often missed since clinical presentation is aspecific mimicking other medical and surgical conditions. Variegate porphyria (VP) is an autosomal dominant inherited disease with incomplete penetrance due to decreased activity of the Protoporphyrinogen Oxydase (PPOX) gene; most VP mutations are family specific. We report the case of a 40 year-old woman who presented many times to the emergency department complaining of unexplained abdominal pain and laboratory investigations showed repeatedly hyponatremia. Syndrome of inappropriate antidiuresis (SIAD) was confirmed and measurement of urine porphobilinogen and delta-aminolevulinic acid disclosed the diagnosis of acute porphyria. The genetic analysis of PPOX gene was performed. METHODS: The entire coding sequence and exon/intron boundaries of PPOX gene were amplified in 5 different Polymerase Chain Reaction (PCR) fragments. In silico prediction of the pathogenicity of the mutation was determined by using different tools, Polyphen2, SNPs&GO, SNPs3D. RESULTS: The genetic analysis of PPOX gene revealed a novel missense variant c.1376 G > A (p.Cys459Tyr) in heterozygous state. The same variant was later found in one of her cousins with skin lesions and other three younger asymptomatic relatives. We provided evidence that this novel mutation is likely to be pathogenetic. CONCLUSIONS: Our case highlights the importance of considering VP in the differential diagnosis of SIAD and underlines the role of genetic screening in the management of such patients. The finding of a novel mutation of PPOX gene in our index case has allowed to recognize an affected family.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:Publisher
[do] DOI:10.1007/s12020-018-1569-5

  7 / 11713 MEDLINE  
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[PMID]: 29439092
[Au] Autor:Nowak KL; Yaffe K; Orwoll ES; Ix JH; You Z; Barrett-Connor E; Hoffman AR; Chonchol M
[Ad] Address:Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Kristen.Nowak@ucdenver.edu.
[Ti] Title:Serum Sodium and Cognition in Older Community-Dwelling Men.
[So] Source:Clin J Am Soc Nephrol;13(3):366-374, 2018 Mar 07.
[Is] ISSN:1555-905X
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND AND OBJECTIVES: Mild hyponatremia is a common finding in older adults; however, the association of lower serum sodium with cognition in older adults is currently unknown. We determined whether lower normal serum sodium is associated with cognitive impairment and risk of cognitive decline in community-dwelling older men. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Five thousand four hundred thirty-five community-dwelling men aged ≥65 years who participated in Osteoporotic Fractures in Men, a cohort study with a median follow-up for cognitive function of 4.6 years, were included in this analysis. Multivariable logistic regression was used to examine the association between baseline fasting serum sodium levels and the odds of prevalent cognitive impairment (cross-sectional analysis; modified Mini-Mental Status [3MS] score <1.5 SD [<84] below or Trail Making Test Part B time >1.5 SD above the mean [>223 seconds]) and cognitive decline (prospective analysis [ =3611]; decrease in follow-up 3MS score or increase in Trails B time >1.5 SD of the mean score/time change [>9 or >67 seconds]). RESULTS: Participants were aged 74±6 years with a fasting mean serum sodium level of 141±3 mmol/L. Fifteen percent ( =274), 12% ( =225), and 13% ( =242) had prevalent cognitive impairment in tertiles 1, 2, and 3, respectively. After adjustment, lower serum sodium was associated with prevalent cognitive impairment (tertile 1 [126-140 mmol/L] versus tertile 2 [141-142 mmol/L], odds ratio [OR], 1.30; 95% confidence interval [95% CI], 1.06 to 1.61). Fourteen percent ( =159), 10% ( =125), and 13% ( =159) had cognitive decline in tertiles 1, 2, and 3, respectively. Lower serum sodium was also associated with cognitive decline (tertile 1 versus tertile 2, OR, 1.37; 95% CI, 1.06 to 1.77). Tertile 3 (143-153 mmol/L) was additionally associated with cognitive decline. Results were similar in sensitivity analyses according to clinical cut-offs and by quartiles. CONCLUSIONS: In community-dwelling older men, serum sodium between 126-140, and 126-140 or 143-153 mmol/L, are independently associated with prevalent cognitive impairment and cognitive decline, respectively.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:In-Data-Review
[do] DOI:10.2215/CJN.07400717

  8 / 11713 MEDLINE  
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[PMID]: 29365179
[Au] Autor:Oh RC; Malave B; Chaltry JD
[Ad] Address:Department of Family Medicine, Martin Army Community Hospital, Fort Benning, GA 31905.
[Ti] Title:Collapse in the Heat - From Overhydration to the Emergency Room - Three Cases of Exercise-Associated Hyponatremia Associated with Exertional Heat Illness.
[So] Source:Mil Med;183(3-4):e225-e228, 2018 Mar 01.
[Is] ISSN:1930-613X
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Exertional heat illness and exercise-associated hyponatremia continue to be a problem in military and recreational events. Symptoms of hyponatremia can be mistaken for heat exhaustion or heat stroke. We describe three cases of symptomatic hyponatremia initially contributed to heat illnesses. The first soldier was a 31-yr-old female who "took a knee" at mile 6 of a 12-mile foot march. She had a core temperature of 100.9°F, a serum sodium level of 129 mmol/L, and drank approximately 4.5 quarts of water in 2 h. The second case was a 27-yr-old female soldier who collapsed at mile 11 of a 12-mile march. Her core temperature was 102.9°F and sodium level was 131 mmol/L. She drank 5 quarts in 2.5 h. The third soldier was a 27-yr-old male who developed nausea and vomiting while conducting an outdoor training event. His core temperature was 98.7°F and sodium level was 125 mmol/L. He drank 6 quarts in 2 h to combat symptoms of heat. All the three cases developed symptomatic hyponatremia by overconsumption of fluids during events lasting less than 3 h. Obtaining point-of-care serum sodium may improve recognition of hyponatremia and guide management for the patient with suspected heat illness and hyponatremia. Depending on severity of symptoms, exercise-associated hyponatremia can be managed by fluid restriction, oral hypertonic broth, or with intravenous 3% saline. Utilizing an ad libitum approach or limiting fluid availability during field or recreational events of up to 3 h may prevent symptomatic hyponatremia while limiting significant dehydration.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180307
[Lr] Last revision date:180307
[St] Status:In-Data-Review
[do] DOI:10.1093/milmed/usx105

  9 / 11713 MEDLINE  
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[PMID]: 29187749
[Au] Autor:Gómez-Hoyos E; Fernández-Peña S; Cuesta M; Ortolá A; Matía P; Pérez-Ferre N; De Luis D; Calle-Pascual A; Rubio MÁ; Runkle-De la Vega I
[Ad] Address:Endocrinology and Nutrition Department, Pharmacy Department, Hospital Clínico Universitario de Valladolid-IEN, Facultad de Medicina Universidad de Valladolid, Valladolid, Spain. emiliagomezhoyos@gmail.com.
[Ti] Title:Hyponatremia in patients receiving parenteral nutrition: the importance of correcting serum sodium for total proteins. The role of the composition of parenteral nutrition in the development of hyponatremia.
[So] Source:Eur J Clin Nutr;72(3):446-451, 2018 Mar.
[Is] ISSN:1476-5640
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND/OBJECTIVES: Hyponatremia is the most common electrolyte disorder, and is associated with high-morbimortality rates. The true prevalence of hyponatremia in patients on parenteral nutrition (PN) is unknown, and the relationship between PN composition and development of hyponatremia has yet to be studied. Hypoproteinemia, a common finding in patients receiving PN, induces an overestimation of serum sodium (SNa) levels, when using indirect electrolyte methodology. Thus, SNa should be corrected for serum total protein levels (TP). The objective was to accurately determine the prevalence of hyponatremia (indirect SNa corrected for PT) and evaluate the relationship between the composition of PN and the development of hyponatremia. SUBJECTS/METHODS: Medical records of 222 hospitalized patients receiving total PN during a 7-month period were reviewed. Composition of PN, indirect SNa-mmol/l-, and SNa corrected for TP (SNa-TP)-mmol/l-, both upon initiation and during PN administration, were analyzed. RESULTS: Hyponatremia (SNa < 135 mmol/l) was present in 81% of subjects when SNa was corrected for TP, vs. 43% without correction (p = 0.001). In total 64% of patients that were eunatremic upon initiation of PN developed hyponatremia during PN administration, as detected by SNa-TP, vs. 28% as detected by uncorrected SNa (p < 0.001). There were no significant differences in volume, osmolarity, sodium or total osmols administered in PN between patients who developed hyponatremia and those who remained eunatremic. CONCLUSIONS: A majority of patients receiving PN present hyponatremia, when indirect SNa levels are corrected for TP. The development of hyponatremia during PN is not related to the composition of the PN.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:In-Data-Review
[do] DOI:10.1038/s41430-017-0026-5

  10 / 11713 MEDLINE  
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[PMID]: 28449052
[Au] Autor:Bohl MA; Ahmad S; White WL; Little AS
[Ad] Address:Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
[Ti] Title:Implementation of a Postoperative Outpatient Care Pathway for Delayed Hyponatremia Following Transsphenoidal Surgery.
[So] Source:Neurosurgery;82(1):110-117, 2018 Jan 01.
[Is] ISSN:1524-4040
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: After transsphenoidal surgery, delayed hyponatremia (DH) is the leading cause of 30-d unplanned hospital readmissions. OBJECTIVE: To determine the impact of a DH care pathway on 30-d readmissions after transsphenoidal surgery. METHODS: Data from before and after DH care pathway implementation were retrospectively reviewed. Patient demographics and clinical characteristics were compared. Readmission causes, clinical pathway failures, sodium trends, and symptoms were evaluated. RESULTS: Before the DH care pathway implementation, 229 (55%) patients were treated (group 1); afterward, 188 (45%) were treated (group 2). Baseline characteristics were equivalent between groups, except for glucocorticoid supplementation, which was higher in group 2. The incidence of detected DH was significantly lower in group 1 (16/229, 7%) than group 2 (29/188, 15%) (P = .006) likely due to the impact of routine screening in group 2. Ten group 1 patients (4%) were readmitted for hyponatremia and 6 (3%) were managed as outpatients. Eleven group 2 patients (6%) were readmitted and 17 (9%) were managed as outpatients. Readmission rates between groups were similar (P = .49). Patients readmitted with severe hyponatremia experienced symptoms ≥24 h before presentation. The protocol failed to prevent readmission because outpatient management for mild or moderate DH (n = 4) failed, sodium levels precipitously declined after normal screening (n = 3), and severe hyponatremia developed after scheduled screenings were missed (n = 3). CONCLUSION: Although more DH patients were identified after care pathway implementation, readmission rates were not reduced and clinical outcomes were not changed. Because DH onset timing varies, some patients have highly acute presentation, and most readmitted patients develop symptoms before reaching their sodium nadir, close symptom monitoring may be a reasonable alternative to routine screening.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1704
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:In-Process
[do] DOI:10.1093/neuros/nyx151


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