HIGH SODIUM-HYPERNATREMIA-II-CONTINUED

HYPERNATREMIA-DRUG ABUSES AND OTHER CAUSES

Hypernatremia occurs due to the improper use of certain drugs such as osmotic diuretics.

Osmotic diuretics are drugs producing diuresis to excrete more urea nitrogen and glucose and competitively inhibit the excretion of sodium and water. They increase the blood and extracellular water and sodium level and thereby produce hypernatremia.
Other medications such as anabolic steroids(Durabolin), ACTH (Adreno Cortico Tropic Hormone) and female sex hormones also produce hypernatremia 

The best examples for osmotic diuretics are mannitol and isosorbide.
The concept of osmotic diuretics is to produce high osmotic pressure between blood capillaries and kidney tubules and thereby suck more solvent towards the tubules for excretion. But in this case urea, glucose and blood urea nitrogen are the solutes that suck the water towards the tubules and thereby raise the mineral content of the blood including sodium.
Glucocorticoids on the contrary inhibit the excretion of the solvent along with sodium by the kidneys and thereby raise the blood volume and sodium.

Those who have diabetes mellitus, kidney failure with high blood urea nitrogen(BUN) should avoid the use of mannitol and isosorbide in their B.P.drugs profile.

Mannitol is usually recommended by the eye specialist to reduce intraocular pressure(IOP) in the treatment of glaucoma. Similarly both mannitol and isosorbide are drugs of choice to reduce intracranial pressure for B.P. patients. Before starting with this drug you must submit your full medical history including diabetes and kidney problems.
Other medications such as sodium chloride (table salt), and sodium bicarbonate (Baking salt) also can raise your blood and extracellular sodium level if used in high quantity.
Chronic use of corticosteroids such as aldosterone(Aldomet) can raise blood sodium levels by increasing potassium loss with the exchange of sodium by the distal tubule of the kidneys.
Glucocorticoids such as hydrocortisone and cortisol also produce hypernatremia by suppressing the secretion of ADH by the brain.
Male and female sex hormones can also produce hypernatremia

Foods with high sodium contents:-

Foods such as salty foods and beverages such as Soup, and vegetable juice
Instant puddings,
Shrimps
Cottage cheese
Salads
Pizzas.
These foods should be avoided if you are positively diagnosed with hypernatremia.

Symptoms:-

1. The main symptoms are lethargy and confusion verily in the case of Diabetes Insipidus.

2. Craving for salt is one of the symptoms that you have high sodium in your body.

3.Extreme thirsty which indicates you have high osmotic pressure between your lower intracellular fluid volume and higher extracellular fluid volume.

4.Frequent Urinations

5.Swellings

6.Episodes of Headaches

7. Hesitate to take food in spite of hungry.

Diagnosis:-

Blood and urine tests.

Treatments:-

For acute cases slow intravenous drip of 5% glucose.

For chronic cases intravenous drip of half-normal saline (0.045%)

HIGH SODIUM-HYPERNATREMIA-I

HIGH-LEVEL SODIUM-D

THE SODIUM ION

If a patient's sodium level in the blood goes above 145 mmol/Liter (normal range is 130 to 145 mmol/Liter) then the patient is said to be suffering from high blood sodium level or Hypernatremia.

Etiology:-

There are many causes of the increased sodium level in the body.

But very importantly improper uses of some drugs such as diuretics which may drain out extra water from the body by leaving sodium in.

Insufficient water or fluid consumption during severe thirsty leading to hypovolemia in the serum as well as in the extracellular fluid which results in the elevation of sodium level in the body.

Hormonal defects such as insufficient secretion of an antidiuretic hormone known as vasopressin from the posterior pituitary which is known as Diabetes Insipidus.

 In diabetes-insipidus (DI) kidney fails to excrete sodium and drain out only empty water in urine.

Anti Diuretic Hormone (ADH) or Vasopressin is a hormone produced by the hypothalamus in the brain and stored in and released from the posterior part of the pituitary gland.
During the time of hot sun and dehydration the secretion of ADH is raised which sends signals to the kidney to reabsorb more water.
But during winter season ADH secretion is diminished and the kidney will drain out more water as urine.
There are many causes for the occurrence of Diabetes Insipidus (DI).

Central DI occurs when there is insufficient secretion of ADH from the pituitary. This is due to any one of the following reasons.
1.A head injury that causes damage to either the hypothalamus or pituitary gland or both.
2.Due to genetic defects.
3.Head tumors
4.Head surgery

Nephrogenic DI is another kind and more dangerous which occurs when the kidney does not respond to ADH in spite of the hormone's proper availability.
Nephrogenic DI can occur due to chronic kidney failure.

Dipsogenic DI is not due to pituitary or hypothalamus damage and dissimilar to nephrogenic DI and it is due to the kidney's inability to respond to ADH without any damage. In nephrogenic DI there are other causes to damage the kidney such as hypertension, hypotension, hyperglycemia, kidney stones, and certain drugs.
But in dipsogenic DI the main reasons for the kidney's inability to respond to ADH without any damage is due to chronic heavy fluid intake which suppresses the secretion of ADH. Hence frequent intake of alcoholic drinks, cool drinks, or even water unnecessarily should be avoided.

Gestagenic DI occurs during pregnancy. But it is temporary and will go after the completion of the pregnancy. But it may relapse during the next pregnancy. It is very mild and not dangerous. The reason is a placental secretion which elevates blood calcium level and thereby suppresses ADH secretion.

Symptoms:

All types of DI have the following common symptoms.

1.High, frequent, colorless watery urine output -Polyurea which may exceed 2.5 to 3 liters /day

2.Excessive Thirsty-Polydipsia

3.Dry mouth.

4.Tiredness and Weakness due to heavy loss of fluids

5.Heart failure due to low B.P.

6.Dry skin

7.Constipation.

8.Urinary incontinence -Bedwetting.

Diagnosis:-

Diagnosis involves mainly a urine test. The doctor will see the color and odor of it. Also a blood test is required for the amount of sodium and other minerals.

ADH tests also should be performed in the blood.

Treatments:-

Diabetes Insipidus is not curable but can be controlled.

The following medicines are recommended:-

1.Desmopressin-A synthetic vasopressin

 2.Vasopressin

Both are available as nasal sprays.

Other etiologies of Hypernatremia will be discussed later in the following next post.

                                       -Will be continued

MEDICAL BITS-8-ORTHOPEDICS

MUST TO KNOW BITS (ORTHOPEDICS)

1.BACK PAIN

Lower back pains may be sudden or gradual for some people when they do their daily routine works such as lifting heavy weights improperly, anaerobic exercises, or due to some underlying causes.

Cauda Equina Syndrome is a rare condition that develops when something damages or compresses a bundle of nerves known as Cauda Equina at the lower part of the spinal cord. This condition may occur due to herniated disc, spinal stenosis, infections tumors, or injuries that damage the spine.

The symptoms include numbness in legs, difficulty walking, severe back pain, bowel and bladder malfunctions, etc.

Cauda Equina is a medical emergency and surgery is the only option as treatment.

2. Collagen is a protein that maintains skin elasticity. Also it helps to provide structural support in connective tissues, muscles, and skin.

It plays an important role in healthy bone and joints.

2.HEALTHY SKIN

During aging the functions of collagen are affected and retarded and hence the skin wrinkles and other posture disabilities develop and appear gradually.

Collagen supplements are available in the market and can be used according to doctor's advice without any harm.

3.POSTURE AND FITNESS

Posture is very important and bad posture can damage your health as follows.

Bad postures can cause back pain, breathing trouble, headaches, urinary troubles, constipation, and heartburn.

Some exercises can help to keep good posture such as bridge, plank, and chest expanding.

There are medical devices such as chair are available.

4.SPRAINS

A sprained ankle can be experienced by pain and swellings.

Sprains are due to the ligaments that connect the ankle gets damaged, stretched, or torn. Sprains differ from the strain that sprain affects ligaments, where strains injure muscle or tendons.

Hence an ankle sprain can cause deep severe pain so that it is very difficult to move the ankle and sometimes a sprained ankle may feel like a broken bone.

CALCIUM IRREGULARITIES DUE TO DISEASEs-3

pharmalatest2-21

HYPERCALCEMIA-ADDISON'S DISEASE

Prelude:-

Addison's Disease is a rare pathological condition that affects 1 in 100000 persons in the world. This disease affects almost all systems of the body's physiology, including minerals homeostasis.

Hypercalcemia is commonly associated with this disease due to adrenal cortex insufficiency and overactivity of the parathyroid hormone.

The etiology is unknown but it is believed that there is some abnormal elevation of the body's own defense mechanism which destroys the body's vital organs such as the adrenal cortex.

Because of the insufficient adrenal corticosteroids circulating in the blood there is an overstimulation of the anterior hypophysis to secret more and more Adreno Cortico Tropic Hormone (ACTH) to further complications.

Addison's disease is a fatal condition in which the body experiences insufficient adrenal activities. This is defined in short as an adrenal failure.

Adrenals are small in size and look like two small mushroom caps fitted above the heads of the two kidneys.
In this article we are not going to study adrenal glands but to have a prompt study about mineral metabolism including the calcium irregularities due to adrenal failure during Addison's disease.
Why only calcium?
because its irregular metabolism is more serious than other minerals metabolism even it may bring death within a year if it left unnoticed and untreated.
A lake of ADH (anti-Diuretic Hormone)secretion from the pituitary gland may raise sodium level by draining out empty water content in the urine.
In Addison's disease lake of aldosterone a mineralocorticoid may lead to severe potassium loss by distal tubule of the kidneys.
In Addison's disease the impaired adrenal glands do not sufficiently secrete glucocorticoids such as cortisol and hydrocortisone.
Glucocorticoids are responsible for the correction of serum calcium levels by eliminating extra calcium in the urine.
This is performed by increasing the glomerular filtration of calcium and reducing its reabsorption by the kidneys.
In Addison's disease this process is impaired due to insufficient glucocorticoids and the result is hypercalcemia.
In Addison's disease there is a high calcium input into the extracellular fluids leads to many complications such as vascular and nephron calcification and cardiac problems.
Further high bone resorption pours more calcium into the blood and makes the condition from worse to worst.
The serum dihydroxy vitamin D3 content becomes low.
Parathyroid activity is impaired.
Even though calcium irregularities associated with Addison's disease is rare but if hyperparathyroidism or treated hypoparathyroidism is followed by Addison's disease then here is 99% possibility to get hypercalcemia

Symptoms of Addison's Disease:

Although Addison's disease is uncommon and rare the medical condition is fatal. If you experience the following symptoms see a doctor.

1.More skin darkening areas like pigments

2.Deep tiredness, fatigue, and weakness.

3.Weight loss

4.G.I distress, nausea and vomiting, stomach pain.

5.Headache

6.Craving for salt.

7.Joint pain.

Addison's disease can be treated by administration fludrocortisone an analog of aldosterone to correct sodium and potassium level.
Glucocorticoid can be given to correct calcium metabolism 
Alternatively bisphosphonates, plicamycin, calcitonin (a parafollicular hormone of the thyroid gland), and loop diuretics along with rigorous rehydration can also be engaged by your according to the situations.
The administration of ACTH is a diagnostic test to find out the presence of Addison's disease.

KNOW YOUR CALCIUM IRREGULARITIES-DUE TO DISEASES-2

HYPERCALCEMIA-ZOLLINGER-ELLISON'S SYNDROME(ZES)

This condition usually affects the stomach, duodenum, jejunum, and pancreas, but some times it spreads its wings to (metastasize) outside the digestive system such as to the heart lungs and parathyroid.

The feature of this disease is formations of extra tumors to produce more secretions of the concerned organ of the body.

If it is stomach and duodenum the formed tumors over stimulates gastrin secretions which in turn causes more acid secretions into the stomach which causes ulcerations.

Similarly if it affects the parathyroid gland then there are higher secretions of Para-Thyroid Hormone (PTH) which in turn causes elevations of calcium ion in the blood.

PTH stimulates osteoclastic cells (bone cells) which causes erosion and resorption of calcium in the form of hydroxyapatite crystals to result in hypercalcemia associated with Zollinger- Ellison's Disease.

Elevations of calcium ion in the serum cause many complications such as calcium deposits in the blood vessels (vascular calcifications), kidney stones, and nephro-calcifications. 

Experiments have been demonstrated as patients having extra stomach tumors and have parathyroid hyperplasia (Zollinger-Ellison's Syndrome of both the organs) have got higher secretions of gastrin and gastric acid because of the elevated calcium ion in the blood due to parathyroid hyperplasia.

Hence experimentally it was shown that a parathyroidectomy (removal of the extra tumors of the hyperplastic parathyroid) causes a reduction in the serum calcium level and thereby controls the gastric acid secretions.

Hypercalcemia due to any etiology can cause

1.Kidney stones

2.High Blood Pressure due to vascular calcification

3.Cardiac Arrhythmias

4. High blood calcium may increase insulin resistance and decrease insulin receptor activities. Hypercalcemia also decrease insulin's action on fat cells due to a reduced number of glucose transporters (GLUT4)
High blood calcium due to hyperactivity of PTH can cause high blood glucose due to raised tissue insulin resistance.
5. Pancreatic hyperplasia may also be due to Zollinger-Ellison's tumors developed in the pancreas results in elevated pancreatic secretions.

KNOW YOUR CALCIUM IRREGULARITIES- DUE TO DISEASES-1

HIGH CALCIUM-PAGET'S DISEASE

                                

Calcium is an important mineral in regulating many physiological activities in our body system.

If the serum calcium level is above the normal range (8 to 10mg/dl or 2 to 2.5 mmol/L) the condition is known as Hypercalcemia
In this article, we are mainly going to see hypercalcemia due to Paget's disease.
Serum calcium level is raised alarmingly due to many causes such as over consumptions of calcium supplementations and comorbidities such as milk-alkali syndrome, overactivity of the parathyroid gland, use of certain drugs like thiazide diuretics, an oversupply of vitamin A and D.etc, etc.
But there are certain cancers such as cancerous neoplasms, Paget's Bone Disease, Addison's Disease, Zollinger-Ellison's syndrome, and Sarcoids can also raise serum calcium level alarmingly as a cancer marker.

1.Paget's Bone Lesions:-

This is a condition in which the normal bone tissue recycling process by the body is modified and the bone become fragile with painful lesions.

Paget's disease mostly occurs at the skull, pelvis, spine, breast, and legs.

The common sign is the formation of oozing eczema-like lesions with scaly skins at the site. If it is at the breast the nipple skin becomes hardened and scaly.

The doctor can diagnose if the above symptoms persist with x-ray alone or with blood tests and bone scans.

A blood test at the beginning will show the raising level of an enzyme known as Serum Alkaline Phosphate (SAP).SAP is normally produced by the bone cells to wear out the old bone cells to be replaced by new cells without affecting the serum calcium level.

But in diseased bones the cells double their production of SAP and the formation of new bone cells (bone sorption or formation) is overwhelmed by bone resorption or deformation and the malignant condition is known as Paget's disease.

At the beginning of the disease the calcium levels may be normal but in due course of time the calcium level becomes alarmingly raise due to severe and uncontrolled bone resorption. Some times the body uses the old bones to form abnormal new bones without using serum calcium.

Hence in blood test high levels of SAP are the indicator marker for Paget's disease.

The symptoms are very similar to arthritis and usually occur as joint pain, redness of the skin, swelling, and tenderness of the skin.
Paget's disease differs from osteoporosis, that in osteoporosis the bone becomes weakened by decreased bone mass and skeletal architecture due to focussed bone resorption, and the serum calcium level rises.
In Paget's disease the body absorbs old bones to remodel and form irregular bones without using serum calcium and phosphate.
Paget's disease may cause several complications including cancer as follows:-
1.Hearing Loss
2.Arthritis
3. Cardiac or heart problems
4.Nerve problems
5. Sarcoma but the possibility is 1 in 100
6.Tooth Problem
7.Vision problems

Causes

Doctors believe that a measles attack at the childhood age may cause Paget's disease later on.

Treatments

Treatments can control the progression of the disease but will not bring a full cure.

Bisphosphonates such as Etidronate and Pamidronate can be the drugs along with aggressive intake of Calcium and vitamin D

Etidronate can be given either by oral or IV route 

Pamidronate is the drug of choice for those who prefer the IV routes.

It is recommended for the age between 50 to 70 years 1000mg of calcium and 700 units of vitamin D per day should be given while taking bisphosphonates provided that hypercalcemia and hyperparathyroidism are ruled out.

For the age group above 70 years vitamin D should be given at the rate of 800 units per day.

Bisphosphonates and calcium should be given with a time interval of at least two hours as calcium may interfere with the absorption of oral bisphosphonates.
In both, the above cases calcium and phosphorous should be administered if the condition is not associated with hypercalcemia and hyperparathyroidism.

Bisphosphonates can inhibit the bone resorption process by reducing the functions of osteoclasts and the formation of hydroxyapatite crystals in remodeling the bones.
Also bisphosphonates reduce the reabsorption of calcium and phosphates by the kidneys and increase their excretion.

Side Effects:-

1. Pain in the pagetic lesions is often experienced

2.Nephrotoxicity (Kidney Failure)

There are other drugs such as calcitonin, gallium nitrate plicamycin that can also be used to treat hypercalcemia associated with Paget's Disease.

KNOW YOUR LOW SODIUM-HYPONATREMIA

LOW SODIUM

Sodium-Ion

Sodium is a light weighted metal. It is a strong basic metal and is present abundantly in our body fluids as a sodium ion.
It is a monovalent ion that can able to form a single electrovalent bond with a negatively charged monovalent ion such as chloride or bicarbonate ion.
In our body sodium is present in the extracellular fluids.
 The normal blood sodium level is 130 to 140 Milli Equivalents per liter. If the blood sodium level goes below 120 Milli Equivalents the condition is known as Hyponatremia
Sodium helps cells to be activated. Low sodium cause the following symptoms:-
1.Tiredness, Vertigo, and Giddiness
2.Nausea and Vomiting
3.Headache due to the osmotic effects in between the brain cells.
Due to low sodium in the intercellular fluids, and hypotonicity more solvent is drawn into the cells which may become bulged and ruptured and damaged.
Due to brain and nerve cell damage, one can experience along with headache, confusion, loss of energy, drowsiness, and fatigue.
4. Restlessness and irritability.
5.Muscle weakness and cramps.
6. Damaged cells cause seizures and coma.

Causes:-

Generally sodium is needed by our body to maintain normal body fluid balance, normal blood pressure, and to support the activities of nerves and muscles.

The following medications and lifestyle changes cause low sodium in our body:-

1. Long time use of diuretics (thiazide, loop diuretics), antidepressants, pain killers may cause low sodium.

2. Congestive heart failure and liver failure may cause more fluid accumulation in our body and can dilute sodium levels. 

3 High Anti-Diuretic Hormone (SHAH). High-level secretion of Vasopressin an antidiuretic hormone from the posterior pituitary may cause more ion free water to be reabsorbed by the kidney which dilutes blood sodium.

4. Dehydration due to severe chronic diarrhea, vomiting, and summer weather may cause sodium loss.

5. Drinking more water also may cause low sodium due to the dilution of body sodium ion.

6.Hormonal Disturbances, such as insufficient adrenal gland activity (Addison's Disease), in which there are insufficient secretions of adrenal hormones such as aldosterone to maintain normal mineral balances 

7. Low thyroid activity also can cause low sodium

8. Drug abuses such as amphetamine can cause a dangerous low sodium level.

Diagnosis

1.Blood Tests

2.Urine Tests

Treatments

1. If you are under medications such as diuretics and fluid intake then your doctor will advise you to adjust the diuretic dosage and cut back the fluid intake.

2.IV infusions of sodium fluids. Mostly a half normal saline (0.45% sodium chloride) can be used to raise the sodium level slowly in chronic hyponatremia.

The slow raising of sodium is very important as the rapid raising of sodium may cause brain damage.

3. To treat acute hyponatremia 

4. If a person can tolerate oral fluids he can drink saltwater or any salt preparation if there is no emergency.

5. Symptoms such as headaches, nausea, and vomiting can be treated with appropriate medicines

Cancer Marker

The following cancer incidence can be predicted by the low sodium from the time when it is diagnosed six months to one year time is for the occurrence of the following cancers.

1.Lungs

2.Liver

3.Brain

4.Pancreas

5.Kidney

6.Esophagus

7.Pharynx

8.Non-Hodkin lymphoma