Search Results (86)

Gastric cancer remains a significant global health burden, with curative treatment relying on surgical resection, typically total or subtotal gastrectomy. However, the procedure frequently triggers acute metabolic and nutritional disturbances that may impact recovery. Objective: This prospective study aimed to investigate whether the type of gastrectomy (total vs. subtotal) influences early postoperative biochemical and hematological alterations, with particular attention to nutritional impact. Methods: A cohort of 295 patients (123 female, 172 male) who underwent gastrectomy for gastric cancer at the Institute of Oncology Iași (2023–2024) was evaluated. Laboratory parameters, including hemoglobin, hematocrit, lymphocyte and platelet counts, serum albumin, total protein, sodium, potassium, creatinine, and urea, were analyzed preoperatively and on postoperative day 14 using standard clinical methods. Results: Anemia was observed in over 90% of patients, irrespective of sex or procedure type. Electrolyte imbalances (notably hyponatremia and hypokalemia) and indicators of nutritional deficit (hypoalbuminemia, low creatinine) were highly prevalent, with a greater frequency among female patients. Total gastrectomy was associated with more severe biochemical and nutritional alterations compared to subtotal procedures. Conclusions: Total gastrectomy significantly exacerbates early postoperative metabolic and nutritional derangements. These findings reinforce the need for proactive, personalized postoperative nutritional and electrolyte management strategies to support recovery and reduce complication risks. Full article

Background/Objectives: Pseudohypoaldosteronism type 1 (PHA-1) is a rare disorder characterized by aldosterone resistance, leading to hyponatremia, hyperkalemia, and elevated renin and aldosterone levels in neonates and infants. While genetic mutations in NR3C2 (mineralocorticoid receptor, MR) and SCNN1A/B/G (epithelial sodium channel, ENaC) are established causes of primary PHA-1, cases without detectable mutations have also been reported. This study aimed to compare the clinical characteristics of genetically confirmed PHA-1 cases—with or without mutations—and to assess genotype–phenotype correlations. Methods: A literature review was conducted using the Medline database, covering studies published from 1966 to October 2023. Included cases were diagnosed with PHA-1 and had undergone genetic testing for NR3C2 and SCNN1A/B/G. Clinical and biochemical data were compared across three groups: MR, ENaC, and non-mutation. Additional subgroup analysis based on mutation type (truncating vs. non-truncating) was also performed. Results: A total of 164 patients from 64 studies met the inclusion criteria. The ENaC group showed significantly higher serum potassium levels than the MR and non-mutation groups. Serum aldosterone levels were significantly higher in the MR group compared to the non-mutation group. A genotype–phenotype correlation was evident in the ENaC group, with truncating variants associated with more severe hyperkalemia. No such correlation was observed in the MR group. Conclusions: This review highlights distinct clinical features of PHA-1 according to genetic status. Aldosterone levels may aid in guiding decisions regarding genetic testing. Furthermore, variant type in ENaC-related PHA-1 may predict biochemical severity and should be considered in clinical management strategies. Full article

Background/Objectives: Potomania and beer potomania are rare but important causes of dilutional hyponatremia, resulting from excessive fluid intake combined with low solute consumption. This systematic review aimed to identify and describe the clinical presentations, underlying causes, complications, and management approaches in published case reports of these conditions. Methods: A systematic search was conducted in PubMed, Embase, Web of Science, and Scopus. Inclusion criteria were case reports and letters to the editor with confirmed diagnoses of potomania or beer potomania. The Joanna Briggs Institute (JBI) checklist was used to evaluate study quality. The SPIDER framework guided the selection process. A qualitative, narrative synthesis was performed. Results: Forty-four cases were included. Hyponatremia was the most frequent finding, commonly accompanied by neurological symptoms such as confusion and seizures. Beer potomania was more prevalent among male patients and associated with alcohol consumption and poor nutrition. Potomania was linked to restrictive diets, psychiatric disorders, or excessive intake of various non-alcoholic fluids. Management typically involved fluid restriction, correction of electrolytes, nutritional support, and psychiatric care. Five cases developed osmotic demyelination syndrome due to rapid sodium correction. Conclusions: Increased clinical awareness of potomania and beer potomania is essential to prevent severe outcomes. Early identification, individualized management, and cautious correction of serum sodium are crucial. Despite the limitations of case report evidence, this review provides meaningful insights into diagnosis and treatment. Full article

Background: Hyponatremia has been identified as a marker of disease severity in various inflammatory conditions. However, its role in predicting acute complicated appendicitis (ACA) in children remains under investigation. This study evaluated the association between preoperative hyponatremia and ACA in a pediatric population. Methods: A retrospective study was conducted on pediatric patients treated for acute appendicitis in two major pediatric centers in Greece. Patients were categorized into groups based on the presence of acute uncomplicated appendicitis (AUA) and acute complicated appendicitis (ACA). Preoperative laboratory parameters were analyzed to identify potential predictors of ACA. Results: This study included 491 pediatric patients, with a mean age of 10 years. ACA patients exhibited significantly lower Na levels compared to those with AUA (136 vs. 138 mmol/L, p < 0.001). Hyponatremia (<135 mmol/L) was present in 38.4% of ACA cases compared to 2.2% of AUA cases (p < 0.001), and was associated with a significantly increased risk of ACA (OR = 18.30, p < 0.001). A sodium threshold of 135 mmol/L also demonstrated a sensitivity of 48% and a specificity of 92.1% Conclusions: Hyponatremia is a strong and specific predictor of ACA in children. When combined with other inflammatory markers, it may enhance early risk stratification, aiding in timely surgical decision making. Full article

Background: Immune checkpoint inhibitors (ICIs) offer a novel approach to cancer treatment by enhancing immune responses against malignant cells. However, ICIs are associated with immune-related adverse events (irAEs), including hyponatremia, a potentially severe electrolyte disturbance. The risk of hyponatremia increases further when ICIs are combined with cisplatin, a nephrotoxic chemotherapy agent widely used in treating respiratory and intrathoracic cancers. This study investigated the incidence, severity, and temporal dynamics of hyponatremia in patients treated with ICIs alone or in combination with cisplatin. Methods: A retrospective cohort study was conducted using data from the TriNetX global health research network. Patients with respiratory or intrathoracic malignancies (n = 14,026) were divided into two groups: ICI-only (n = 7013) and ICI with cisplatin combination (n = 7013), matched using propensity scores. Hyponatremia was categorized into mild (130–134 mmol/L), moderate (125–129 mmol/L), and severe (<125 mmol/L). Temporal trends and cumulative incidence over 90 days were analyzed using Poisson regression. Results: The combination group exhibited a higher cumulative incidence of hyponatremia across all severity levels, with early-phase risk peaking within 20 days of treatment. Rate ratios for mild, moderate, and severe hyponatremia were significantly elevated in the combination group (p < 0.01). Conclusions: Hyponatremia is a significant complication in patients receiving ICIs, particularly when combined with cisplatin. Early monitoring and tailored management are essential to mitigate risks and optimize treatment outcomes. Full article

Aim: The aim of this study was to analyze the clinical characteristics and prognostic factors of profound hyponatremia in solid cancer patients admitted to the oncologic emergency department. Methods: We gathered data retrospectively from cancer patients who visited the emergency department of the National Cancer Center of China between October 2019 and February 2023 with a serum sodium (Na) level of less than 125 mmol/L. The demographic and clinical characteristics, medical history, admission symptoms, laboratory parameters, and outcomes of the patients were recorded. Results: This study comprised 307 patients with severe hyponatremia in total. With 39.4% of all tumors being lung cancer (n = 121), nausea and vomiting were the most common admission symptoms for patients with severe hyponatremia. The 30-day mortality rate of profound hyponatremia cancer patients in the emergency department was 13.4%. The albumin level (p < 0.001), the hemoglobin level (p = 0.033), the TNM stage (p = 0.004), the Eastern Cooperative Oncology Group Performance Status (ECOG-PS) score (p < 0.001), hypocalcemia (p = 0.006), renal insufficiency (p = 0.035), and the efficacy of sodium supplementation (p = 0.006) were significantly associated with 30-day mortality. Binary logistic regression analysis showed that a lower albumin level (OR 0.924, 95% CI 0.861–0.991, p = 0.028) and higher ECOG score (OR 8.443, 95% CI 3.568–19.976, p < 0.001) were independent risk factors for 30-day mortality. The overall survival of emergency cancer patients with severe hyponatremia was also examined. The results of the COX regression analysis demonstrated that the efficacy of sodium supplementation (OR = 2.643, 95% CI 1.593–4.386, p < 0.001), a low albumin level (OR = 0.654, 95% CI 0.463–0.923, p = 0.016), the TNM stage (OR = 4.606, 95% CI 2.846–7.455), and a higher ECOG score (OR = 1.738, 95% CI 1.292–2.338, p < 0.001) were independent risk factors for overall survival. Conclusions: The clinical manifestations of severe hyponatremia in emergency cancer patients are varied. Hypoalbuminemia and a higher ECOG score are independent risk factors for 30-day mortality and overall survival. Severe hyponatremia patients with a high ECOG score and/or a low albumin level should be monitored and followed more closely. Full article

Lyme disease (LD), caused by the spirochete Borrelia burgdorferi, is the most prevalent tick-borne disease in Europe, including Romania, where endemic areas are well documented. It has a wide range of clinical manifestations and severity, including rare neurological complications. Persistent hyponatremia is an atypical presentation of Lyme neuroborreliosis and can be associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). SIADH is characterized by unregulated antidiuretic hormone release, leading to impaired water excretion, dilutional hyponatremia, and low serum osmolality. We report the case of a 16-year-old female with clinically well-tolerated, but severe, refractory hyponatremia, who was poorly responsive to intravenous sodium supplementation and fluid management. Complex investigations ruled out multiple causes of hyponatremia; neuroborreliosis was confirmed via positive Borrelia serologies, despite the absence of a suggestive history of exposure. SIADH likely symptomatology resulted from central nervous system inflammation induced by Borrelia, a mechanism rarely documented in the medical literature. Treatment with antibiotics and fluid restriction led to a gradual improvement in fluid balance and sodium homeostasis. This case emphasizes the importance of considering rare infectious causes, such as LD, in patients with unexplained SIADH, especially in endemic areas. It highlights the importance of a multidisciplinary approach in intricate, complex cases. Full article

Background: Falls in hospitalized patients cause injuries of varying severity and even death. There is a link between falls and low blood sodium levels in older patients. Identifying and treating hyponatremia could help prevent falls and reduce hospital stays. The purpose of this study was to evaluate the effectiveness of the correction of hyponatremia on reducing the incidence of falls and the mean stay of hospitalized patients aged more than 65 years. Methods: A crossover ecological clinical trial was conducted in adult hospitalization units of a hospital in Madrid (Spain) over 12 months. Patients meeting inclusion criteria were divided into two randomized groups. The intervention was applied in two six-month phases, alternating between groups with a 15-day washout period. Early diagnosis and treatment of hyponatremia were implemented in the intervention group, while the control group received standard care. Primary outcomes included fall incidence and length of hospital stay. Data were collected using REDCap and analyzed with SPSS v.21. Statistical significance was set at p < 0.05 (ClinicalTrials identifier of the manuscript: NCT03265691). Results: A total of 1925 patients were included (408 intervention, 1517 control). Fall incidence was significantly lower in the intervention group (6.7 vs. 9.8, p = 0.000). Hyponatremia was corrected in 72% of cases. No significant differences were found in functional scores. The intervention effectively reduced falls compared to standard care. Conclusions: Early hyponatremia treatment reduces falls and hospital stay in older patients, supporting its inclusion in fall prevention strategies. Full article

Background: Alcohol use and hypertriglyceridemia are the second and third common causes of acute pancreatitis after choledocholithiasis. Still, few studies directly compare the severity and outcomes of these two groups, which share pathophysiology pathways. Methods: In our study, we compared the biologic profile, severity according to the Atlanta classification and Balthazar index, intensive care unit admissions, and mortality between patients with hypertriglyceridemia-induced pancreatitis (HTGP) and alcohol-induced acute pancreatitis (AAP). A total of 78 patients were included in this study, 37.17% of which had HTGP, and 62.82% had AAP. Results: HTGP was more severe in terms of the Atlanta revised classification severity assessment (82.76% vs. 46%, p = 0.014), led to more extended hospitalizations (p = 0.024), and resulted in similar serum CRP levels among patients, with a significant difference regarding median serum fibrinogen values (739 vs. 563 mg/dL, p = 0.030) and necrotizing forms (24.13% vs. 10.20%). Hyponatremia was more significant in HTGP patients compared with AAP patients (130 vs. 137 mmol/L, p < 0.000). No differences were found in other inflammation indexes such as NLR (neutrophil count/lymphocyte count), PLR (platelet count/lymphocyte count), MLR (monocyte/lymphocyte count), SII (systemic immune-inflammation index), or SIRI (systemic inflammation response index). Conclusions: The pattern of acute pancreatitis is related to its etiology and may have different grades of severity. In our study, we found that hypertriglyceridemia-induced pancreatitis required twice as many admissions to the intensive care unit and was associated with lower serum sodium levels, and almost twice as many patients with HTGP had moderate or severe forms of acute pancreatitis compared to alcohol-induced pancreatitis cases. Full article

Background: The increased hospital morbidity and mortality associated with hyponatremia is well recognized in the critically ill pediatric population. Neonates and infants exposed to vasopressin following cardiopulmonary bypass (CPB) may be at increased risk for hyponatremia. We aimed to determine the associated effect and potential risk factors leading to hyponatremia and sodium variability in the immediate postoperative period in neonates and infants up to 90 days of age exposed to vasopressin following surgery for congenital heart disease. Methods: This was a retrospective review of 75 consecutive patients at a single tertiary cardiac intensive care unit (CICU) from 2018 to 2020. Using mixed-effects linear regression, we compared sodium trends and variability between the groups who did and did not receive vasopressin. Results: While sodium levels fell in both groups, beyond the first postoperative day, the group exposed to vasopressin had a significantly increased fall in sodium relative to the control (p < 0.001). Vasopressin exposure was associated with increased within-day sodium variability on postoperative days one and two (p < 0.05). Total incidents of moderate to severe hyponatremia (sodium < 130 mmol/L) were higher in the vasopressin group but did not reach statistical significance. Age, volume of modified ultrafiltration, and total diuretic dose were not risk factors for either effect in this study. Conclusions: While all patients in this study appeared to be at risk of postoperative hyponatremia, cumulative vasopressin dose appeared to increase the risk for absolute hyponatremia as well as greater sodium variability within the early postoperative period. Full article

Background and Clinical Significance: Lung cancer, a leading cause of global cancer diagnoses, maintains the highest mortality risk despite advances in treatment. Immunotherapy agents, such as anti-programmed death-1/programmed death ligand-1 (PD-1/PD-L1), have revolutionized care for non-small cell lung cancer (NSCLC). However, the success is tempered by the emergence of immune-mediated adverse reactions, including the rare onset of type I diabetes. The incidence of diabetes mellitus increased during the SARS-CoV-2 pandemic. While there are several cases of new-onset diabetes after COVID-19 and COVID-19 vaccination, no case of new-onset type 1 diabetes after COVID-19 was described in an immune checkpoint inhibitor (ICI)-treated patient. Case Presentation: A 57-year-old male with stage IV NSCLC (brain and liver metastases) who had been treated with nivolumab for 4 years appeared positive for SARS-CoV-2 infection at a routine check. After two weeks, he was admitted to our clinic with severe fatigue, hyperglycemia, hyponatremia, and hyperkalemia. HbA1c level was normal and serum peptide C was undetectable. Nivolumab treatment was ceased, and the patient became fully dependent on basal–bolus insulin. After 3 months, the patient showed a complete imagistic remission. Conclusions: The case presented significant challenges due to the unclear etiology of newly onset diabetes and the uncommon age at which type 1 diabetes is developed. The outcome suggests that anti-PD-1 and SARS-CoV-2 infection can act synergistically. Full article

Management of severe dengue remains a clinical challenge. This retrospective study evaluated clinical features and laboratory biomarkers associated with severe dengue at Hospital Sultanah Aminah Johor Bahru from 1 January 2022 to 31 March 2023. Records of 99 patients, categorized into ICU (51) and non-ICU (48) groups, were identified and analyzed using SPSS version 28.0. Sociodemographic details, clinical features and laboratory biomarkers were collected. Patients aged 50 and older, those with obesity, and those with pre-existing comorbidities were significantly more likely to be admitted to the ICU. The four most common warning signs in both cohorts were lethargy/restlessness/confusion, abdominal pain, persistent vomiting, and diarrhea. Fever, or history of fever, and thrombocytopenia were the two most common severe dengue criteria present in both cohorts. ICU patients exhibited more signs of plasma leakage and abnormal laboratory findings, including normal white cell count, hypoalbuminemia, hyperbilirubinemia, and elevated creatine kinase. In contrast, leukopenia and normal albumin, bilirubin, and creatine kinase levels were more common in non-ICU patients. Hyponatremia and raised lactate dehydrogenase were seen in both groups. This study highlighted key differences and similarities in clinical features and laboratory biomarkers between ICU and non-ICU patients, emphasizing the need for further research to develop a comprehensive risk assessment tool for predicting severe dengue that resulted in ICU admission. Full article

A 3-year-old spayed male mixed-breed Labrador presented to the Emergency and Critical Care Unit with lethargy, loss of appetite, vomiting, a recent history of presyncopal episodes, and severe exercise intolerance. On admission, the patient had bradycardia, low blood pressure, and mild abdominal pain. Serum biochemistry information revealed severe hyperkalemia, hyponatremia, hypoglycemia, and mildly increased liver and kidney parameters. Upon taking these findings into consideration, hypoadrenocorticism was suspected, and a basal cortisol level was determined; it was below 1.0 µg/dL. Upon examination with ultrasound, we observed that the size of the adrenal glands was considerably reduced. Due to the bradycardia, a complete cardiologic examination consisting of 5 min of six-lead electrocardiography and echocardiography (ECG) was performed. Six-lead ECG revealed a complete atrio-ventricular block with an atrial rate of 140 bpm and a ventricular rate of 60 bpm. The PQ interval was variable, without any evidence of atrio-ventricular conduction. Treatment for hyperkalemia was initiated immediately after admission, followed by dexamethasone sodium phosphate administration, which led to an improvement in the patient’s general condition, and the normalization of the ECG readings, after 24 h of therapy. Afterward, prednisolone (0.5 mg/kg/24 h p.o.) and desoxycorticosterone pivalate (2.2 mg/kg s.c.) were administered. This case shows that a third-degree atrioventricular block might be a reversible problem in dogs with hypoadrecorticism that can be managed with specific treatment for this disorder, without requiring pacemaker implantation. Full article

Trigeminal neuralgia (TN) is chronic pain caused by damage to the somatosensorial system on the trigeminal nerve or its branches, which involves peripheral and central dysfunction pain pathways. Trigeminal pain triggers disruptive pain in regions of the face, including within and around the mouth. Besides clinical experiences, translating the language of suffering into scientific terminology presents substantial challenges. Due to the complex and multifactorial pathophysiology underlying trigeminal pain, elucidating its social impact presents significant difficulties. Carbamazepine and oxcarbazepine are first-line treatments for TN, achieving approximately 50% pain reduction in 60–70% of treated patients. However, their efficacy is often limited by common side effects, such as dizziness, vertigo, nausea, seizures, and cognitive symptoms. In some cases, patients experience severe side effects, including myelosuppression, hyponatremia, hormonal imbalances, liver toxicity, suicidal ideation, teratogenicity, and other adverse reactions. Given these clinical limitations, the search for new painkiller candidates continues. Hence, we focused this review on salvinorin A (SalA), a natural agonist of κ-opioid receptors (KORs), which demonstrated anti-nociceptive, anti-inflammatory, and anti-neuropathic properties in various experimental models of the spinal sensory system. Furthermore, preclinical evidence indicates that SalA does not induce dependence and demonstrates a favorable toxicological and safety profile in comparison with currently marketed opioid drugs. We propose Salvinorin A as a promising candidate for treating trigeminal neuralgia, offering the potential for reduced adverse effects. Full article

The COVID-19 pandemic has introduced challenges in pediatric care, especially due to the emergence of Multisystem Inflammatory Syndrome in Children (MIS-C), a severe condition associated with SARS-CoV-2 infection. This study investigated the impact of hyponatremia and antidiuretic hormone (ADH) secretion corelated to clinical outcomes in these patients. We conducted a retrospective cohort study, including 118 pediatric patients, with a detailed sub-cohort analysis of 53 patients for ADH secretion markers. Hyponatremia, defined by age-specific sodium thresholds, was present in 47.22% of MIS-C cases and 28.04% of COVID-19 cases. Ordinal logistic regression analysis revealed that severe hyponatremia significantly increased the likelihood of more severe clinical outcomes (β = 3.514, p < 0.001). A significant correlation was found between hyponatremia and prolonged hospitalization. For ADH secretion, a predictive model using ridge regression was analysed, which demonstrated that serum sodium level, U/P ratio, and hospitalization duration are key predictors of SIADH. This model fit was assessed using the ROC curve with an AUC of 0.96, indicating reliable model performance. Our findings underscore the significant role of hyponatremia on the clinical severity and hospitalization outcome of COVID-19 and MIS-C in pediatric patients. Full article