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Pediatrics in Review Feb 2022
Topics: Child; Female; Humans; Polydipsia; Polyuria
PubMed: 35102404
DOI: 10.1542/pir.2020-003202 -
Clinical Kidney Journal Jan 2021The common finding of hypokalemic alkalosis in several unrelated disorders may confound the early diagnosis of salt-losing tubulopathy (SLT). Antenatal Bartter syndrome... (Review)
Review
The common finding of hypokalemic alkalosis in several unrelated disorders may confound the early diagnosis of salt-losing tubulopathy (SLT). Antenatal Bartter syndrome (BS) must be considered in idiopathic early-onset polyhydramnios. Fetal megabladder in BS may allow its distinction from third-trimester polyhydramnios that occurs in congenital chloride diarrhea (CCD). Fetal megacolon occurs in CCD while fecal chloride >90 mEq/L in infants is diagnostic. Failure-to-thrive, polydipsia and polyuria in early childhood are the hallmarks of classic BS. Unlike BS, there is low urinary chloride in hypokalemic alkalosis of intractable emesis and cystic fibrosis. Rarely, renal salt wasting may result from cystinosis, Dent disease, disorders of paracellular claudin-10b and Kir4.1 potassium-channel deficiency. Acquired BS may result from calcimimetic up-regulation of a calcium-sensing receptor or autoantibody inactivation of sodium chloride co-transporters in Sjögren syndrome. A relatively common event of heterozygous gene mutations for Gitelman syndrome increases the likelihood of its random occurrence in certain diseases of adult onset. Finally, diuretic abuse is the most common differential diagnosis of SLT. Unlike the persistent elevation in BS, urinary chloride concentration losses waxes and wanes on day-to-day assessment in patients with diuretic misuse.
PubMed: 33564404
DOI: 10.1093/ckj/sfaa172 -
American Journal of Physiology. Renal... May 2021The association between diabetes insipidus (DI) and chronic dietary K deprivation is well known, but it remains uncertain how the disorder develops and whether it is... (Comparative Study)
Comparative Study
The association between diabetes insipidus (DI) and chronic dietary K deprivation is well known, but it remains uncertain how the disorder develops and whether it is influenced by the sexual dimorphism in K handling. Here, we determined the plasma K (P) threshold for DI in male and female mice and ascertained if DI is initiated by polydipsia or by a central or nephrogenic defect. C57BL6J mice were randomized to a control diet or to graded reductions in dietary K for 8 days, and kidney function and transporters involved in water balance were characterized. We found that male and female mice develop polyuria and secondary polydipsia. Altered water balance coincided with a decrease in aquaporin-2 (AQP2) phosphorylation and apical localization despite increased levels of the vasopressin surrogate marker copeptin. No change in the protein abundance of urea transporter-A1 was observed. The Na-K-2Cl cotransporter decreased only in males. Desmopressin treatment failed to reverse water diuresis in K-restricted mice. These findings indicate that even a small fall in P is associated with nephrogenic DI (NDI), coincident with the development of altered AQP2 regulation, implicating low P as a causal trigger of NDI. We found that P decreased more in females, and, consequently, females were more prone to develop NDI. Together, these data indicate that AQP2 regulation is disrupted by a small decrease in P and that the response is influenced by sexual dimorphism in K handling. These findings provide new insights into the mechanisms linking water and K balances and support defining the disorder as "potassium-dependent NDI." This study shows that aquaporin-2 regulation is disrupted by a small fall in plasma potassium levels and the response is influenced by sexual dimorphism in renal potassium handling. The findings provided new insights into the mechanisms by which water balance is altered in dietary potassium deficiency and support defining the disorder as "potassium-dependent nephrogenic diabetes insipidus."
Topics: Animals; Antidiuretic Agents; Aquaporin 2; Deamino Arginine Vasopressin; Diabetes Insipidus, Nephrogenic; Disease Models, Animal; Drug Resistance; Female; Kidney; Male; Mice, Inbred C57BL; Phosphorylation; Potassium Deficiency; Potassium, Dietary; Risk Factors; Sex Characteristics; Water-Electrolyte Balance; Mice
PubMed: 33749322
DOI: 10.1152/ajprenal.00655.2020 -
Journal of Clinical Neuroscience :... May 2023Primary suprasellar germinoma (PSG) is a rare malignant tumor of the central nervous system. This study aimed to explore the clinical characteristics, treatment...
Primary suprasellar germinoma (PSG) is a rare malignant tumor of the central nervous system. This study aimed to explore the clinical characteristics, treatment protocol, and prognosis of patients with PSG. This case series retrospectively analyzed the clinical data of patients with PSG in Tianjin Huanhu Hospital diagnosed between January 2016 and December 2021. Fifteen patients with an average age of 19.6 years were included, in which nine of them were males. The mean duration between initial symptoms and admission was 17.0 months. The mean follow-up was 40.8 months. Ten patients had polydipsia and polyuria, visual impairments were observed in 8 patients, and 2 cases (13.3%) had symptoms both from suprasellar and pineal regions. All 15 cases were histopathologically confirmed as germinoma through craniotomy or biopsy. Most patients (80%) underwent radiotherapy combined with chemotherapy. During follow-up, all the patients showed a reduction in tumor size, especially in the bifocal cases. Symptoms of polydipsia, polyuria, and visual impairment were markedly relieved to different degrees. All patients had recovered well at discharge. Patients with polydipsia and polyuria took desmopressin daily. A histological confirmation by open biopsy through craniotomy or endoscopic biopsy might be recommended for PSG to start the appropriate treatments. Patients with PSG will usually have a good prognosis, but attention should be paid to the treatment of endocrine deficiencies.
Topics: Male; Humans; Young Adult; Adult; Female; Brain Neoplasms; Retrospective Studies; Polyuria; Germinoma; Central Nervous System Neoplasms; Head and Neck Neoplasms
PubMed: 36963125
DOI: 10.1016/j.jocn.2023.03.007 -
International Medical Case Reports... 2021Antiretroviral therapies prolong life expectancy and improve the quality of life of HIV-infected patients. Despite the documented benefits of antiretroviral drugs, its...
BACKGROUND
Antiretroviral therapies prolong life expectancy and improve the quality of life of HIV-infected patients. Despite the documented benefits of antiretroviral drugs, its use is not without side effects. Here, we report cases of new onset diabetes mellitus after taking a dolutegravir (DTG)-based ART regimen.
CASE PRESENTATION
HIV-infected patients who had been on non-nucleoside reverse transcriptase inhibitor (NNRTI)-based ART regimens for more than a decade were shifted to integrase strand transfer inhibitors (dolutegravir)-based ART regimen as recommended by the National Comprehensive HIV Care Guideline. They were diagnosed to have diabetes mellitus with or without diabetic ketoacidosis (DKA) as evidenced by polyuria, polydipsia and fatigue, severe hyperglycemia (plasma glucose level >250 mg/dl) with or without ketonuria (3+) after 1-12 months of DTG-based ART regimen. Two of the patients who presented with DKA were treated with intravenous fluids and regular insulin. NPH insulin was started following recovery from DKA, which later shifted to metformin. One of the patients who presented with severe hyperglycemia without DKA was started with NPH insulin, which later shifted to metformin. Good glycemic control was obtained with metformin, while the DTG-based ART regimen was continued.
CONCLUSION
Hyperglycemia is a potential and noticed side effect of the DTG-based ART regimen. Baseline and periodic monitoring of plasma glucose might be required in ART regimens containing dolutegravir.
PubMed: 34349567
DOI: 10.2147/IMCRJ.S323233 -
AACE Clinical Case Reports 2021Our objective is to describe how polydipsia and intake of nonsteroidal anti-inflammatory drugs (NSAIDs) after fasting while breastfeeding may result in acute symptomatic...
OBJECTIVE
Our objective is to describe how polydipsia and intake of nonsteroidal anti-inflammatory drugs (NSAIDs) after fasting while breastfeeding may result in acute symptomatic hyponatremia.
CASE REPORT
We present the case of a 24-year-old woman at 4 weeks postpartum who engaged in a 20-hour fast from both eating and drinking, during which she continued to breastfeed her newborn child. After ending her fast, she noted decreased milk supply. Attributing her decreased milk supply to dehydration, she then consumed 4 L of water with little salt and also took NSAIDs for a headache, which continued to worsen. Upon presentation to the emergency department, she was found to have a sodium level of 124 mEq/L (normal, 135-145 mEq/L) and a urine specific gravity of 1.015 (normal, 1.005 - 1.030). Thyroid function and cortisol level test results were normal. She was diagnosed with acute symptomatic hypovolemic hyponatremia. After 1 L of normal saline her sodium rapidly corrected to normal and her symptoms resolved. At 2 months of follow-up she was asymptomatic and had no further episodes of hyponatremia.
DISCUSSION
Due to the patient's gender and small body size, 4 L of water was sufficient to lower her serum sodium rapidly from normal to 124 mEq/L. She was unable to excrete this water due to a combination of hypovolemia-mediated arginine vasopressin and NSAID use.
CONCLUSION
Clinicians should be cognizant that reproductive-age women are uniquely susceptible to hyponatremia and dangerous sequelae therein. They should counsel fasting individuals, particularly lactating women, to consume solute as well as fluid after fasting.
PubMed: 34307843
DOI: 10.1016/j.aace.2021.02.005 -
Psychiatry Research Mar 2021Despite the clinical importance of polydipsia, no diagnostic criteria or severity scales that comprehensively assess this condition are available. Thus, we aimed to...
Despite the clinical importance of polydipsia, no diagnostic criteria or severity scales that comprehensively assess this condition are available. Thus, we aimed to develop diagnostic criteria and a severity scale for polydipsia based on a systematic review and well-experienced clinicians' consensus. We performed a systematic review, identified 27 studies related to diagnostic criteria or severity classification for polydipsia, and extracted items used to assess polydipsia in these studies. Ten well-experienced clinicians-5 psychiatrists and 5 nurses-participated in the Delphi method. They evaluated 39 items extracted based on the results of the systematic review regarding (1) their necessity in diagnosing and assessing the severity of polydipsia, and (2) their relative importance rated on 7-point scale among the items included in the severity scale. The Polydipsia Diagnostic Criteria (PDC) included 4 essential items-excessive drinking, low serum sodium level or low serum osmolality, abnormal normalized diurnal weight gain, and low urine specific gravity-based on consensus reached using the Delphi method. The Polydipsia Severity Scale (PSS) included 13 items with a maximum score of 59. The first diagnostic criteria and symptom scale for polydipsia were developed based on the findings of a systematic review and well-experienced clinicians' consensus.
Topics: Consensus; Humans; Osmolar Concentration; Polydipsia; Psychiatry; Severity of Illness Index
PubMed: 33461119
DOI: 10.1016/j.psychres.2021.113708 -
Mechanisms of hyponatremia and diabetes insipidus after acute spinal cord injury: a critical review.Chinese Neurosurgical Journal Nov 2023The incidence of hyponatremia after spinal cord injury was reported to be between 25 and 80%. Hyponatremia can lead to a variety of clinical symptoms, from mild to... (Review)
Review
The incidence of hyponatremia after spinal cord injury was reported to be between 25 and 80%. Hyponatremia can lead to a variety of clinical symptoms, from mild to severe and even life-threatening. Hyponatremia is often associated with diabetes insipidus, which refers to insufficient arginine vasopressin (AVP) secretion or defective renal response to AVP, with clinical manifestations of syndromes such as hypoosmolality, polydipsia, and polydipsia. Recent mechanistic studies on hyponatremia and diabetes insipidus after acute spinal cord injury have been performed in isolation, without integrating the above two symptoms into different pathological manifestations that occur in the same injury state and without considering the acute spinal cord injury patient's condition as a whole. The therapeutic principles of CSWS and SIADH are in opposition to one another. It is not easy to identify the mechanism of hyponatremia in clinical practice, which makes selecting the treatment difficult. According to the existing theories, treatments for hyponatremia and diabetes insipidus together are contraindicated, whether the mechanism of hyponatremia is thought to be CSWS or SIADH. In this paper, we review the mechanism of these two pathological manifestations and suggest that our current understanding of the mechanisms of hyponatremia and diabetes insipidus after high acute cervical SCI is insufficient, and it is likely that there are other undetected pathogenetic mechanisms.
PubMed: 37968769
DOI: 10.1186/s41016-023-00347-y -
Brain Sciences Dec 2022Cholinergic muscarinic stimulation of vast areas of the limbic brain induced a well-documented polydipsia in laboratory rats. This excessive water-drinking behavior has... (Review)
Review
Cholinergic muscarinic stimulation of vast areas of the limbic brain induced a well-documented polydipsia in laboratory rats. This excessive water-drinking behavior has not received any convincing biological and physiological interpretation for the last 50 years. This review offers such an interpretation and suggests that cholinergically induced drinking response, mostly by carbachol, is associated with activation of the ascending mesolimbic cholinergic system that serves for initiation of emotional aversive arousal of the organism. The ascending cholinergic system originates from the laterodorsal tegmental nucleus, has a diffuse nature, and affects numerous subcortical limbic structures. It is proposed that the carbachol-induced drinking response is related to the state of anxiety and does not serve the regulation of thirst. Instead, the response is anxiety-induced polydipsia that might occur as a soothing procedure that decreases the aversiveness of the negative emotional state induced by carbachol. It is concluded that carbachol-induced water-drinking behavior is a rewarding process that contributes to alleviating the feeling of anxiety by bringing some relief from the cholinergically induced aversive state, and it is a homologue to anxiety-driven polydipsia in humans.
PubMed: 36672042
DOI: 10.3390/brainsci13010060 -
The Journal of Physiology Jul 2024Aquaporin-2 (AQP2) is a member of the aquaporin water channel family. In the kidney, AQP2 is expressed in collecting duct principal cells where it facilitates water... (Review)
Review
Aquaporin-2 (AQP2) is a member of the aquaporin water channel family. In the kidney, AQP2 is expressed in collecting duct principal cells where it facilitates water reabsorption in response to antidiuretic hormone (arginine vasopressin, AVP). AVP induces the redistribution of AQP2 from intracellular vesicles and its incorporation into the plasma membrane. The plasma membrane insertion of AQP2 represents the crucial step in AVP-mediated water reabsorption. Dysregulation of the system preventing the AQP2 plasma membrane insertion causes diabetes insipidus (DI), a disease characterised by an impaired urine concentrating ability and polydipsia. There is no satisfactory treatment of DI available. This review discusses kinases that control the localisation of AQP2 and points out potential kinase-directed targets for the treatment of DI.
Topics: Aquaporin 2; Animals; Humans; Protein Kinases; Diabetes Insipidus; Cell Membrane
PubMed: 37440212
DOI: 10.1113/JP284100