#16
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ÍÅ çíàþ -âîò âñÿêîì ñëó÷àå ðÿäîì êîãäà â íàøó ñòðàíó ïîñòóïèë íà àïðîáàöèþ ïðåïàðàò äëÿ ëå÷åíèÿ ýòîãî ñîñòîÿíèÿ, ïàöèíåòîâ íå íàøëè
( âåðîÿòíî , âðà÷àì íå äî íàòðèÿ ). È åùå îäíî - òåðìèí "àïóäîìà" óõîäèò â ïðîøëîå ( íå íàäî áûòü îïðåäeëåííîé îïóõîëüþ , ÷òîáû ýêñïåðåññèðîâàòü ïðîäóêöèþ íåóìåñòíûõ ïåïòèäîâ ) Ïîêà áûë òåðìèí àïóäîìà , ó íàñ íå ñõîäèëñÿ äåáåò ñ êðåäèòîì - ïðîèñõîæäåíèå ñ ïðîäóêöèåé Âî âñÿêîì ñëó÷àå è â Ãðèíñïåíå, è â Óèëüÿìñå ( ðóññêèå ïåðåâîäû ïîÿâÿòñÿ äî Íîâîãî ãîäû ) íà ýòó òåìó íàðèñîâàíî ìíîãî - ÿ ñåé÷àñ ïðîñòî áîþñü ïèñàòü ÷òîáû íå íàâðàòü â äåòàëÿõ
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Ã.À. Ìåëüíè÷åíêî |
#17
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Ñðåäè øêîëüíûõ ó÷èòåëåé ÷àñòî ïîïàäàþòñÿ æåíùèíû â âîçðàñòå 50 - 60 ëåò ñ îòñóòñòâèåì æàæäû è âûñîêèì óäåëüíûì âåñîì ìî÷è. Æàëóþòñÿ, ÷òî êîãäà-òî ýïèçîäè÷åñêè ïðèíèìàëè äèóðåòèêè ïî ïîâîäó îòåêîâ íà íîãàõ è ïîñëå ýòîãî íà äëèòåëüíîå âðåìÿ ïðîïàäàëà æàæäà è ðåçêî ñíèæàëîñü êîëè÷åñòâî âûäåëåííîé ìî÷è. Íå âàðèàíò ëè ýòî òîãî ñàìîãî ãèïåðãèäðîïåêñè÷åñêîãî ñèíäðîìà?  ýòîé ãðóïïå ýìîöèè ìîãëè áû áûòü íà ïåðâîì ìåñòå â êà÷åñòâå ïðè÷èíû. Èëè äèóðåòèêè. Íå âäàâàÿñü â ìåõàíèçìû, ìîæíî ïðåäïîëîæèòü, ÷òî ýìîöèè è ñòðåññ êàê-òî áëèæå ê ãèïîòàëàìóñó è ãèïîôèçó, ÷åì ëåãî÷íàÿ ïàòîëîãèÿ.
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#18
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ÍÅò- âîîáùå òí ñ-ì Ìàõà íå åñòü SIADH
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Ã.À. Ìåëüíè÷åíêî |
#19
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Òàê ýòè ïàöèåíòêè íå æàëóþòñÿ íà îòåêè. Èõ áåñïîêîèò îòñóòñòâèå æàæäû. Äèóðåòèêè ïðèíèìàëè êîãäà-òî ðàíåå è ïîñëå ýòîãî ïðîïàëà æàæäà. Ñîçäàåòñÿ âïå÷àòëåíèå, ÷òî äèóðåòèêè èíèöèèðîâàëè íå÷òî, ÷òî ñåé÷àñ ïðîÿâëÿåòñÿ òîëüêî îòñóòñòâèåì æàæäû. Ïðè÷åì íà îòñóòñòâèå æàæäû îáðàùàþò âíèìàíèå ñîñëóæèâöû - èõ êîëëåãè ðåæå ïüþò íà ïåðåìåíàõ ÷àé. Ïîäîçðåâàþ, ÷òî åñëè áû äåëî áûëî â îòåêàõ è âîëåâîì îãðàíè÷åíèè æèäêîñòè, òî æåíùèíû ïðîñòî "çàåäàëè" áû ÷àé ôóðîñåìèäîì. Ïîõîæå, ÷òî ó íèõ äåéñòâèòåëüíî óìåíüøàåòñÿ/ïðèòóïëÿåòñÿ îùóùåíèå æàæäû. Ýòî ñîîòâåòñòâóåò ñèíäðîìó Ìàõà?
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#20
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Öèòàòà:
Ïðîáëåìà â òîì, ÷òî êîððåêöèÿ ãèïåðòîíè÷åñêèìè ðàñòâîðàìè íàòðèÿ â ñëó÷àå õðîíè÷åñêîé ãèïîíàòðèåìèè äîñòàòî÷íî îïàñíà - âûñîê ðèñê ïîíòèííîãî ìèåëîëèçà. Òàê ÷òî âûøåóïîìÿíóòûé ïðåïàðàò (èíòåðåñíî, äîñòóïåí ëè îí â Ðîññèè ?) áûë áû âåñüìà ïîëåçåí. |
#21
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Òîëâàïòàí íå çàðåãèñòðèðîâàí
Íå íàøëè áåññïîðíî ïî âèíå èñêàâøèõ Ñ-ì Ìàõà îäèí èç ñàìûõ íåëþáèìûé ìíîþ äèàãíîçîðâ Ëþáîïûòíî , ÷òî âî âðåìåíà ìîåé þíîñòè ÈÝÝèÕà ( íûíå ÝÍÖ ) áûë ïååðïîëíåí ýòèìè ïàöèåíòêàìè - ñåé÷àñ ýòî êàçóèñòèêà äëÿ íàøåãî ïðèåìà
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Ã.À. Ìåëüíè÷åíêî |
#22
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...à ñâÿçàíî åòî ñ òåì, ÷òî íàòðèé ñìîòðÿò, ñêàæåì òàê, íå ïîâñåìåñòíî. Áîëüíîé ñ SIADH- åòî, îáû÷íî íå óõîæåííûé ïàöèåíò àêàäåìè÷åñêîé êëèíèêè, à òÿæåëî áîëüíîé ïîæèëîé, èñòîøåííûé ÷åëîâåê. Åñëè "èíñóëüò â êîìå- ñòàðøå 80" ñêîðàÿ îñòàâëÿåò íà äîìó, è îïåðàöèè ïîæèëûì ëåãêè/ redki, òî áÎëüøàÿ ÷àñòü åòèõ áîëüíûõ âîîáøå îñòàíóòñÿ âíå ñôåðû âíèìàíèÿ.
...ñèòóàöèÿ, ãäå ìîæíî íàáëþäàòü SIADH ó áîëåå ìîëîäûõ- åòî ïàöèåíòû ïîñëå õèðóðãè÷åñêèõ âìåøàòåëüñòâ, ñ ïëîõèì êîíòðîëåì áîëè è ïîñëå ìàññèâíîé áåçäóìíîé â-â òåðàïèè . òàêèå áîëüíûå ëåæàò â ðà¸ííûõ áîëüíèöàõ, è íàòðèé èì òîæå íå ñìîòðèòñÿ, à åñëè ñìîòðèòñÿ, òî- çà÷àñòóþ èãíîðèðóåòñÿ êàê "îøèáêà" . Ñòàòèñòèêè ïî íèì íåò, òÿæåëûå ïðÿ÷óòñÿ ãäå-òî ñðåäè âíîâü âîçíèêøèõ ñóäîðîã â ïîñëåîïåðàöèîííîì ïåðèîäå, ñêîðåå âñåãî òåõ, ÷òî âûæèâàþò- íåêîòîðîå âðåìÿ âåäóò êàê âïåðâûå âûÿâëåííóþ åïèëåïñèþ. Íàñ÷åò Òîëâàïòàíà íàñêîëüêî ÿ ïîìíþ, è Êàìåë, è Ãàëüïåðí ãîâîðèëè î íåì áåç îñîáîãî åíòóçèàçìà, â ñâÿçè ñ òðóäíîñòüþ òèòðîâàíèÿ/ íå-ñòàíäàðòèçèðóåìîé ñèëîé è âðåìåíåì äåéñòâèÿ. åñëè ó Âàñ åñòü âîçìîæíîñòü ïîñûëàòü íàòðèé êðîâè, ìî÷è è îñìîëÿðíîñòü ìî÷è ïî öèòî, åñòü ñåñòðû , êîòîðûå äåëàþò, ÷òî èì âåëåíî, åñòü ÄÄÀÂÏ è æåëàíèå èì âîñïîëüçîâàòüñÿ, òî âåäåíèå SIADH ñðàâíèòåëüíî íåñëîæíî. |
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#23
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Åñòü íåïëîõîé îáçîð ïî ìåõàíèçìàì SIADH: Inappropriate antidiuresis is usually due to administration or endogenous production of arginine vasopressin (AVP) or another vasopressin receptor agonist such as desmopressin. Endogenous production can be either ectopic (from a tumor) or eutopic (from the neurohypophysis). The latter apparently is induced by a wide variety of diseases, drugs, or injuries and is divisible into 3 different types of abnormal AVP release during hypertonic saline infusion: high, erratic fluctuations unrelated to increases in plasma sodium (type A); a slow constant “leak” that is also unaffected by increases in plasma sodium (type B); and rapid progressive increases in plasma AVP that correlate closely with plasma sodium as it rises toward the normal range (type C or “reset osmostat”). In 5% to 10% of patients, there is no demonstrable abnormality in the osmoregulation of AVP (type D) and the cause of inappropriate antidiuresis is unclear. In some children it appears to be due to an activating mutation of the V2 receptor (V2R). In other patients, it may be due to abnormal control of aquaporin-2 water channels in renal collecting tubules or production of an antidiuretic principle other than AVP. --- Regulation of arginine vasopressin in the syndrome of inappropriate antidiuresis. Robertson GL. Am J Med. 2006 Jul;119(7 Suppl 1):S36-42.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#24
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Òàêæå ôðàãìåíò êåéñà, ãäå ãîâîðèòñÿ î âåðîÿòíûõ ìåõàíèçìàõ SIADH ïðè íåîïóõîëåâîé ëåãî÷íîé íåäîñòàòî÷íîñòè:
Several investigators have shown that hypoxaemia or hypercapnic acidosis results in an elevation of plasma ADH levels in man,6 sheep,10 and dog.11 Rosenow et al.6 reported that inadequate filling of the left atrium due to decreased blood flow through the pulmonary vascular bed could be the cause of the elevated blood ADH levels in the patients who have pneumonia and SIADH. There have also been several reports that the plasma ADH level was significantly higher in mechanically ventilated patients of diverse causes with hypoxaemic and/or hypercapnic respiratory failure. It has been assumed this was secondary to intermittent positive pressure ventilation, causing an increase in intrathoracic pressure, impeding the filling of the left atrium, and thus stimulating ADH release.12,13 In our case, the diagnosis of SIADH was made before mechanical ventilation was started, and the hyponatraemia and high level of plasma ADH returned to normal ranges when PaO2 and PaCO2 were normalized by mechanical ventilation, so that such therapy was not causative. Thus, it seems quite reasonable to speculate that hypoxaemia and hypercapnaemia due to respiratory muscle weakness may be responsible for the occurrence of SIADH in this patient. The precise mechanism for the association of SIADH and respiratory failure is still unclear, but clinicians should be aware that acute respiratory failure should be included in the differential diagnosis of SIADH. Respirology. 1999 Jun;4(2):185-7.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#25
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Íå ñîâñåì ïîíÿòíà ðîëü ÄÄÀÂÏ â âåäåíèè SIADH. Ïîÿñíèòå, ïîæàëóéñòà, Âû èìåëè â âèäó èñïîëüçîâàíèå ÄÄÀÂÏ ïðè ïåðåäîçèðîâêå Òîëâàïòàíà èëè äðóãóþ ñèòóàöèþ?
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#26
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Íåò, ÿ èìåþ â âèäó èñïîëüçîâàíèå ÄÄÀÂÏ ÷òîáû "çàïåðåòü ïî÷êó íà çàìîê" , è íå äîïóñòèòü ðåçêîãî ïîâûøåíèÿ íàòðèÿ, êîãäà ïðè÷èíà, âûçûâàþøàÿ SIADH óæå ëèêâèäèðîâàíà, à òåðàïèÿ ïîêà ïðîäîëæàåòñÿ.
Âíå âûøåóïîìÿíóòûõ óñëîâèé ñàìîìó ïðîáîâàòü íå ðåêîìåíäóþ. |
#27
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Öèòàòà:
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#28
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BTW recent editorial re- DDAVP
Öèòàòà:
is a medical emergency Richard H. Sterns 1 , 2 and John K. Hix 1 , 2 Overcorrection of hyponatremia is a medical emergency. Excessive correction usually results from the unexpected emergence of a water diuresis after resolution of the cause of water retention. The concurrent administration of desmopressin and 5 % dextrose in water can be given to cautiously re-lower the serum sodium concentration when therapeutic limits have been exceeded. Nephrologists should be equally aggressive in correcting hyponatremia and in un-correcting it when their patients get too much of a good thing. Kidney International (2009) 76, 587 – 589. doi: 10.1038/ki.2009.251 |
#29
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Öèòàòà:
Âîò ññûëêà íà ïîëíûé òåêñò (íå óâåðåí, î òîì ëè èññëåäîâàíèè èäåò ðå÷ü) - [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] ×òî êàñàåòñÿ SIADH, òî àâòîðû ðàññìàòðèâàþò ýòî ñîñòîÿíèå êàê ïðèìåð íåîáðàòèìîé ïðè÷èíû ãèïîíàòðèåìèè, ïðè êîòîðîì äåñìîïðåññèí âîîáùå íèêàê íå ïîäåéñòâóåò: Öèòàòà:
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