1.
Where Do the Salt and Water Go? A Case of Profound Hyponatremia.
Portales-Castillo, I, Sterns, RH, Bress, J, Proano, RA
American journal of kidney diseases : the official journal of the National Kidney Foundation. 2018;(6):885-889
Abstract
Treatment of profound hyponatremia is challenging. Severe symptoms mandate correction by 4 to 6 mEq/L within hours, but with risk factors for osmotic demyelination, daily correction should be <8 mEq/L. With a therapeutic window this narrow, clinicians would like to know how serum sodium (SNa) concentration will respond to their therapy. Based on isotopic measurements, Edelman showed SNa level to be a function of exchangeable sodium and potassium divided by total-body water. Edelman defined this relationship with linear regression yielding an equation of the form y = mx + b, where y is SNa level, x is exchangeable sodium and potassium divided by total-body water, m is the slope, and b is the intercept. Edelman said that the intercept of his regression "probably is a measure of the quantity of osmotically inactive exchangeable sodium and potassium per unit of body water." Predictive formulas are derived from Edelman's original linear regression, some including and some omitting the regression's intercept. We illustrate the performance and limitations of these formulas using comprehensive data for electrolyte and fluid balance obtained during the treatment of a critically patient who presented with an SNa concentration of 101 mEq/L.
2.
Breast Implant-Associated Anaplastic Large Cell Lymphoma: Report of 2 Cases and Review of the Literature.
Hart, AM, Lechowicz, MJ, Peters, KK, Holden, J, Carlson, GW
Aesthetic surgery journal. 2014;(6):884-94
Abstract
Although primary breast lymphomas are exceedingly rare, cases of breast implant-associated anaplastic large cell lymphoma (iALCL) continue to be reported. The authors describe their experience with 2 patients and review the literature. Both patients presented with periprosthetic fluid collection. Neither had evidence of systemic disease nor received systemic therapy. Both were disease free after bilateral capsulectomies and implant removal without implant replacement, and disease did not recur. During the literature review, 63 cases of iALCL (including our 2 patients) were identified. The median time from implant placement to diagnosis was 9 years. Both saline and silicone implants were associated with iALCL. Of the 26 cases for which implant surface was reported, the surface was textured in 24. Of the 58 patients with an identifiable presentation, 39 had periprosthetic fluid collection, including 7 with an associated mass; 13 had an isolated mass at presentation, including 1 with axillary adenopathy. Forty patients had capsulectomy, 7 of whom underwent implant replacement. Of the 44 patients with known treatment, 33 received chemotherapy and 23 received radiation. Of the 49 patients with known anaplastic large cell lymphoma, 15 had disease recurrence, and 4 patient deaths were reported. Of the 18 patients presenting with a mass, 11 had disease recurrence, including all 4 patients who died. This study represents the largest review of patients with iALCL described to date. Although most cases have an indolent clinical course, the variety of presentations defined as "seroma" vs "capsular involvement" emphasizes the importance of investigating a definitive method of diagnosis, management, and treatment of this disease. LEVEL OF EVIDENCE 5.
3.
Fatal voluntary salt intake resulting in the highest ever documented sodium plasma level in adults (255 mmol L-1): a disorder linked to female gender and psychiatric disorders.
Ofran, Y, Lavi, D, Opher, D, Weiss, TA, Elinav, E
Journal of internal medicine. 2004;(6):525-8
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Abstract
Excessive ingestion of salt is a well-recognized cause of hypernatraemia in children, is uncommonly recognized in debilitated elderly persons, but is rarely diagnosed in healthy, independent adults. We report a case of fatal salt poisoning in a 20-year-old lady who suffered of post-natal depression and ingested large quantities of salt as part of exorcism ritual. She presented with the highest ever documented serum sodium level of 255 mmol L(-1), associated with severe neurological impairment that was unresponsive to aggressive hypotonic fluid replacement. Post-mortem examination ruled out any other possible probable cause of death. The medical literature was reviewed, and 16 previous cases of severe hypernatraemia in adults secondary to excessive salt ingestion were retrieved. Common features of all reported cases included female gender (95% of cases) and evidence of underlying cognitive or psychiatric disorders (all reported cases). We conclude that women with documented cognitive or psychiatric disorders, in particular depression, are susceptible for psychogenic salt poisoning. Awareness should be raised to the potentially life-risking use of salty beverages as emetics or as part of 'exorcism' rituals.
4.
Pediatric Visine (tetrahydrozoline) ingestion: case report and review of imidazoline toxicity.
Daggy, A, Kaplan, R, Roberge, R, Akhtar, J
Veterinary and human toxicology. 2003;(4):210-2
Abstract
Visine, an over-the-counter, tetrahydrozoline topical ophthalmic decongestant, possesses central and peripheral alpha2-adrenergic properties. We present a case of accidental pediatric oral exposure with resultant neurological and cardiovascular complications. Visine is not marketed in childproof containers, despite the potential severity of an accidental ingestion. Over-the-counter medications with potent pharmacological properties should be stored in areas out of the reach of children, and manufacturers should package these products in childproof containers.