Disorders of sodium and water metabolism are common in hospitalized patients and are occasionally encountered in outpatients. Both hyponatremia and hypernatremia can cause substantial morbidity and mortality, and iron...
详细信息
Disorders of sodium and water metabolism are common in hospitalized patients and are occasionally encountered in outpatients. Both hyponatremia and hypernatremia can cause substantial morbidity and mortality, and ironically, incorrect treatment can add to the problem. In this article, Dr Fall outlines a general approach to evaluation and management of both conditions, with recommendations on safe and effective therapy.
OBJECTIVE: The safety of large-volume paracentesis with plasma expander infusion in ascitic cirrhotic patients with advanced liver disease, hyponatremia, or renal failure has not been elucidated. Our aim was to invest...
详细信息
OBJECTIVE: The safety of large-volume paracentesis with plasma expander infusion in ascitic cirrhotic patients with advanced liver disease, hyponatremia, or renal failure has not been elucidated. Our aim was to investigate the safety of total paracentesis in cirrhotic patients with ascites and severe hyponatremia. METHODS: Forty-five cirrhotic patients with tense ascites were treated with total paracentesis and infusion of plasma expanders. At inclusion, 20 patients showed severe hyponatremia (serum sodium <130 mEq/L). In the remaining 25 patients, serum sodium was >130 mEq/L (range, 133-146 mEq/L). RESULTS: Plasma renin activity (PRA) and plasma aldosterone concentration (PAC) were significantly higher in patients with hyponatremia(PRA: 19.7 +/- 5.8 ng/mL/h;PAC: 217 +/- 35 ng/dL) than in those patients without hyponatremia (PRA: 4.9 +/- 1.1 ng/ml/h;PAC: 95 +/- 31 ng/dL), indicating a more severe systemic hemodynamic deterioration. After paracentesis, PRA and PAC increased similarly in both groups of patients. Serum sodium levels remained unchanged after paracentesis in patients with hyponatremia (127 +/- 0.5 to 128 +/- 1.5 mEq/L) and decreased slightly in patients without hyponatremia (137 +/- 1 to 135 +/- 1 mEq/L;p < 0.005). The incidence of complications during the first hospitalization, the probability of readmission for complications of cirrhosis, and the probability of survival at 1 yr were similar in both groups of patients. CONCLUSIONS: These results indicate that therapeutic paracentesis is a safe treatment for tense ascites in cirrhotic patients with severe hyponatremia. (Am J Gastroenterol 1999;94:2219-2223. (C) 1999 by Am. Cell. of Gastroenterology).
New hysteroscopes and resectoscopes with continuous-flow designs have greatly facilitated diagnostic and therapeutic hysteroscopy. Saline is the ideal distending medium for hysteroscopic procedures in which mechanical...
详细信息
New hysteroscopes and resectoscopes with continuous-flow designs have greatly facilitated diagnostic and therapeutic hysteroscopy. Saline is the ideal distending medium for hysteroscopic procedures in which mechanical or bipolar instruments are used;5% mannitol may be the safest medium for resectoscopic surgery. Regardless of the medium chosen, careful fluid monitoring is essential.
暂无评论