https://caltcm.memberclicks.net/assets/documents/acc_aha_chf_2013_guidelines.pdf

2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines

Background Hyponatremia (serum sodium concentration, <135 mmol per liter) is a predictor of death among patients with chronic heart failure and cirrhosis. At present, therapy for acute and chronic hyponatremia is often ineffective and poorly tolerated. We investigated whether tolvaptan, an orally active vasopressin V 2 -receptor antagonist that promotes aquaresis — excretion of electrolyte-free water — might be of benefit in hyponatremia. Methods In two multicenter, randomized, double-blind, placebo-controlled trials, the efficacy of tolvaptan was evaluated in patients with euvolemic or hypervolemic hyponatremia. Patients were randomly assigned to oral placebo (223 patients) or oral tolvaptan (225) at a dose of 15 mg daily. The dose of tolvaptan was increased to 30 mg daily and then to 60 mg daily, if necessary, on the basis of serum sodium concentrations. The two primary end points for all patients were the change in the average daily area under the curve for the serum sodium concentration from baseline to day 4 and the change from baseline to day 30. Results Serum sodium concentrations increased more in the tolvaptan group than in the placebo group during the first 4 days (P<0.001) and after the full 30 days of therapy (P<0.001). The condition of patients with mild or marked hyponatremia improved (P<0.001 for all comparisons). During the week after discontinuation of tolvaptan on day 30, hyponatremia recurred. Side effects associated with tolvaptan included increased thirst, dry mouth, and increased urination. A planned analysis that combined the two trials showed significant improvement from baseline to day 30 in the tolvaptan group according to scores on the Mental Component of the Medical Outcomes Study 12-item Short-Form General Health Survey. Conclusions In patients with euvolemic or hypervolemic hyponatremia, tolvaptan, an oral vasopressin V 2 -receptor antagonist, was effective in increasing serum sodium concentrations at day 4 and day 30. (ClinicalTrials.gov numbers, NCT00072683 [SALT-1] and NCT00201994 [SALT-2].)

/pdf/tolvaptan-a-selective-oral-vasopressin-v2-receptor-34nzl2b7zt.pdf

Tolvaptan, a selective oral vasopressin V2-receptor antagonist, for hyponatremia.

Hyponatraemia, defined as a serum sodium concentration !135 mmol/l, is the most common disorder of body fluid and electrolyte balance encountered in clinical practice. It can lead to a wide spectrum of clinical symptoms, from subtle to severe or even life threatening, and is associated with increased mortality, morbidity and length of hospital stay in patients presenting with a range of conditions. Despite this, the management of patients remains problematic. The prevalence of hyponatraemia in widely different conditions and the fact that hyponatraemia is managed by clinicians with a broad variety of backgrounds have fostered diverse institution- and speciality-based approaches to diagnosis and treatment. To obtain a common and holistic view, the European Society of Intensive Care Medicine (ESICM), the European Society of Endocrinology (ESE) and the European Renal Association – European Dialysis and Transplant Association (ERA–EDTA), represented by European Renal Best Practice (ERBP), have developed the Clinical Practice Guideline on the diagnostic approach and treatment of hyponatraemia as a joint venture of three societies representing specialists with a natural interest in hyponatraemia. In addition to a rigorous approach to methodology and evaluation, we were keen to ensure that the document focused on patient-important outcomes and included utility for clinicians involved in everyday practice.

/pdf/clinical-practice-guideline-on-diagnosis-and-treatment-of-509w3449ob.pdf

Clinical practice guideline on diagnosis and treatment of hyponatraemia

A 62-year-old woman who reported dysgeusia was found to have a serum sodium level of 122 mmol per liter. The serum osmolality was 250 mOsm per kilogram of water, and the urinary osmolality 635 mOsm per kilogram of water. Chest CT showed a mass in the lower lobe of the left lung, which proved to be a small-cell carcinoma. How should her hyponatremia be treated?

/pdf/the-syndrome-of-inappropriate-antidiuresis-100sgojj4c.pdf

The Syndrome of Inappropriate Antidiuresis

http://www.svemonline.org/wp-content/uploads/2016/02/endotips-vol-03-2.pdf

Diagnosis, Evaluation, and Treatment of Hyponatremia: Expert Panel Recommendations

Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits.

Periostitis and hypertrophic osteoarthropathy: Etiologies and bone scan patterns in 115 cases

Clubbing was first described by Hippocrates more than 2.500 years ago. It may be seen alone or as part of an entity called hypertrophic osteoarthropathy which include periostitis, arthritis and sometimes thickening and edema of the skin around the affected joints. Pulmonary diseases such as cancer, abscess, empyema, bronchiectasis and cystic fibrosis are the major diseases known to be associate with hypertrophic osteoarthropathy. Digestive tract cancer, cyanogenic congenital heart disease are well known association. Many theories have attempted to explain the appearance of this sign but few have persisted. In this article, we review characteristics, relation with etiology and the basis of the pathophysiology of hypertrophic osteoarthropathy and particularly of clubbing.

http://www.amub.be/revue-medicale-bruxelles/download/41

Review on hypertrophic osteoarthropathy and digital clubbing

Point-of-care ultrasound (POCUS) is currently implemented in various medical fields by clinicians for the bedside examination of patients. Evidence supports the fact that adding an ultrasound technology in daily practice (hand-held ultrasound device), called by some 'stethoscope of the future', improves patient care and allows an earlier diagnosis in a hospital setting. In this article, we reviewed the historical evolution of the use of ultrasound in medicine and the possibilities of using POCUS for hospitalists and general internists based on the existing scientific literature.

Point-of-care ultrasound (POCUS) for hospitalists and general internists.

We report the case of a 45-year-old female patient who developed phosphate diabetes after administration of ferric carboxymaltose. Ten days after the second dose, she complained of intense fatigue and blood analysis showed a phosphate plasma level of 0.93 mg/dL with phosphate excretion rate of 23%. She received phosphate supplementation which resulted in phosphate clearance improvement which persisted for two months. We reviewed other cases described in the literature and would draw attention to this rare but potentially life-threatening side effect.

/pdf/potentially-life-threatening-phosphate-diabetes-induced-by-4labehdg71.pdf

Xavier Vandemergel

Papers

Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits.

Periostitis and hypertrophic osteoarthropathy: Etiologies and bone scan patterns in 115 cases

Review on hypertrophic osteoarthropathy and digital clubbing

Point-of-care ultrasound (POCUS) for hospitalists and general internists.

Potentially life-threatening phosphate diabetes induced by ferric carboxymaltose injection: a case report and review of the literature.