Vasopressin-induced hyponatremia in an adult normotensive trauma patient:A case report

BACKGROUND Arginine vasopressin is a neuropeptide produced in the hypothalamus and released by the posterior pituitary gland.In addition to maintaining plasma osmolarity,under hypovolemic or hypotensive conditions,it helps maintain plasma volume through renal water reabsorption and increases systemic vascular tone.Its synthetic analogues are widely used in the intensive care unit as a continuous infusion,in addition to hospital floors as an intravenous or intranasal dose.A limited number of cases of hyponatremia in patients with septic or hemorrhagic shock have been reported previously with vasopressin.We report for the first time a normotensive patient who developed vasopressin-induced hyponatremia.CASE SUMMARY A 39-year-old man fell off a forklift and sustained an axial load injury to his cranium.He had no history of previous trauma.Examination was normal except for motor and sensory deficits.The Imagine test showed endplate fracture at C7 and acute traumatic disc at C7 with cortical degeneration.He underwent cervical discectomy and fusion,laminectomy,and posterior instrumented fusion.After intensive care unit admission post-surgery,he developed hyponatremia of 121-124 mEq/L post phenylephrine and vasopressin infusion to maintain blood pressure maintenance.He was evaluated for syndrome of inappropriate secretion of antidiuretic hormone,hypothyroid,adrenal-induced,or diuretic-induced hyponatremia.At the end of extensive evaluation for the underlying cause of hyponatremia,vasopressin was discontinued.He was also put on fluid restriction,given exogenous desmopressin,and a dextrose 5%in water infusion to prevent osmotic demyelination syndrome caused by sodium overcorrection which improved his sodium level to 135 mmol/L.CONCLUSION The presentation of vasopressin-induced hyponatremia is uncommon in normotensive patients,and the most difficult aspect of this condition is determining the underlying cause of hyponatremia.Our case illustrates that,considering the vast differential diagnosis of hyponatremia in hospitalized patients,both hospitalists and intensivists should be aware of this serious complication of vasopressin therapy.

The influence of the blood pressure on the venous cerebral flow measured by magnetic susceptibility (SWI) technique

Susceptibility Weighted Image (SWI) is a Magnetic Resonance Imaging (MRI) technique that combines high spatial resolution and sensitivity to magnetic susceptibility differences between tissues, it is extremely sensitive to venous blood due to its iron content of deoxyhemoglobin. The aim of this study was to evaluate the differences in the cerebral venous vasculature produced by the value’s variation of blood pressure. 20 subjects (10 hypertensive and 10 normotensive patients) underwent a MRI system with field strength of 1.5 T using a synergy head coil (7 channels). The obtained sequences were T1w, T2w-FLAIR, T2* and SWI. The value of Contrast-to-Noise Ratio (CNR) was assessed in MinIP (Minimum Intensity Projection) and Magnitude images, through drawing free hand ROIs in venous structures: Superior Sagittal Sinus (SSS) Internal Cerebral Vein (ICV) and Sinus Confluence (SC). The obtained values were presented in descriptive statistics-quartiles and extremes diagrams. The results were compared between groups. CNR shown higher values for normotensive group in MinIP (108.89 ± 6.907) to ICV;(238.73 ± 18.556) to SC and (239.384 ± 52.303) to SSS. These values are bigger than images from Hypertensive group about 46 au in average. Comparing the results of Magnitude and MinIP images, there were obtained lower CNR values for the hypertensive group. There were differences in the CNR values between both groups, being these values more expressive in the large vessels-SSS and SC. The SWI is a potential technique to evaluate and characterize the blood pressure variation in the studied vessels adding a physiological perspective to MRI and giving a new approach to the radiological vascular studies.

A study of the levels of urinary microalbumin in non-diabetic normotensive obese individuals

Diabetes mellitus, hypertension and obesity are associated with endothelial dysfunction. Microalbuminu-ria is an early sign of endothelial dysfunction. The occurrence of microalbuminuria in long standing diabetes mellitus and hypertension is well established. This study intends to find the occurrence of microal-buminuria in non-diabetic normotensive obese individuals. Objectives: To estimate urinary albumin creatinine ratio (UACR) in non-diabetic normotensive obese individuals. Design and Methods: 41 non- diabetic normotensive obese adults with Body Mass Index > 23 kg/m2 were taken as cases and 41 age and sex matched healthy non-obese adults with Body Mass Index < 23 kg/m2 were taken as controls. An-thropometric measurements (Body Mass Index and Waist circumference) and biochemical estimations (fasting blood glucose, lipid profile & spot urinary albumin creatinine ratio) were carried out. Results: urinary albumin creatinine ratio was lesser than the established microalbuminuric range of 30 - 300 mg/g, in both cases and controls irrespective of the values obtained for lipid profile and anthropometric indices. Conclusion: Microalbuminuria may not be present in obese patients without diabetes and/hypertension.

The Level of Soluble FMS-Like Tyrosinkinase-1, Placental Growth Factor and Vitamin E in Pre-Eclampsia and Normotensive Pregnancy

Background: This study aims to determine the differences of angiogenic markers sFlt-1 (soluble FMS-like tyrosine kinase-1), Placental Growth Factor (PlGF) and antioxidant (vitamin E) levels in pre-eclampsia compared with normotensive pregnancies. Methods: In a cross-sectional study performed on 40 normotensive pregnancies and 40 pre-eclampsia women, serum levels of sFlt-1, PlGF and vitamin E were measured with ELISA methods. Statistical analysis used Mann Whitney. Results: The serum levels from the group of normotensive pregnancy and pre-eclampsia women consecutively are as follows: sFlt-1 2251.32 ± 416.17 pg/mL and 2950.78 ± 221.34 pg/mL, having a very significant difference (p = 0.00);PlGF 391.67 ± 293.92 pg/mL and 150.15 ± 105.34 pg/mL, having a very significant difference;vitamin E 8537.21 ± 6299.74 unit and 700.61 ± 233.70 unit, having a very significant difference. Conclusion: There is a very significant difference between an-giogenic markers and antioxidant levels in pre-eclampsia and normotensive pregnancies.

Fibrinogen Levels in Hypertensive and Normotensive: A Cross-Sectional Study from El-Obied City, Sudan

Hypertension (HTN) has been defined as a blood pressure level at which an otherwise healthy person would have an increased risk of cardiovascular disease that could be mitigated through blood pressure-lowering treatment. Worldwide, hypertension is one of the most common causes of death. The prevalence of hypertension and cardiovascular disease increases with age, and has been found to be higher in those of South Asian and African ancestry, and in Aboriginal populations. Hypertension is not only one of the most important risk factors for cardiovascular disease, but also the number one modifiable risk factor for stroke. Alterations in blood coagulation system have been reported in patients of hypertension. Fibrinogen has been identified as a major independent risk factor for cardiovascular diseases. This was a descriptive cross-sectional study, conducted in Elobied teaching hospital during period from March to June 2014. The aim of this study is to determine the level of fibrinogen among hypertensive patients. Seventy percent of the patients (about 35 patients) had high fibrinogen level above 400 mg/dl compared with the control and about 30% (15 patients) were within the normal range of 200 mg - 400 mg/dl. This study has concluded that there was a significant increase in fibrinogen level in hypertensive patients compared to control, while the gender has no effect on the level of fibrinogen.