Endoscopic surveillance for colorectal cancer has been reported to decrease its mortality. The guidelines recommend that colon examinations including colonoscopy be done at regular intervals in individuals over 50 years of age (1). Colonoscopy requires an adequate level of cleansing for effective evaluation of the colonic mucosa (2). The main types of laxatives used for bowel cleansing are oral sodium phosphate (OSP) and polyethylene glycol (PEG). Safety is also very important, as in the case of sodium phosphate, which was rejected by the United States Food and Drug Administration despite its convenience because it gives an increased risk of phosphate nephropathy. Because of such safety concerns, current guidelines suggest use of PEG over OSP (2, 3). PEG is a biologically inactive substance that does not bear an electrical charge and therefore cannot influence the movement of other solutes (4). It is a water-soluble, nontoxic polymer that is minimally absorbed in the gastrointestinal tract (5).
Although PEG is generally considered to be safe for colonic cleansing, it can occasionally induce adverse events such as renal failure, hyponatremia, upper gastrointestinal bleeding or aspiration caused by vomiting, and even death (2, 3, 6). Here, we report a case of hyponatremia in the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) resulting in generalized tonic–clonic seizures after PEG precolonoscopic cleansing. As far as we know, there have been no prior reports describing an association between SIADH and PEG use for colonic cleansing.
Case Report
A 69-year-old woman visited our gastrointestinal clinic for routine colonoscopic checkup. She had a history of diabetes and dyslipidemia, for which she had been taking gl...
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...ng colonoscopy preparation. However, these reports did not confirm SIADH as the cause of hyponatremia, and failed to prove an actual increase in ADH (6, 16). Our case is interesting in that hyponatremic seizures developed despite the patient having normal renal function and no other risk factors except PEG preparation.
Current guidelines recommend that colonoscopic screening be done regularly in patients from age 50 years onwards, which would place many elderly patients at risk of hyponatremia-related SIADH. We conclude that physicians should be thoroughly familiar with a patient’s medical history before prescribing PEG, and that all patients should be well hydrated with electrolyte-containing solutions both during and after PEG ingestion. Also, serum electrolytes should be promptly checked and treatment begun in patients showing symptoms suggesting their imbalance.
Sammy is rating his pain as a 10 out of 10 on a scale where 10 is the highest level of pain and 1 is the lowest. It is evident that some of the choices Sammy made prior to ending up in the emergency room were not beneficial to his health. Sammy has been discarding lunches and drinks as school, is feeling nauseas, having diarrhea, and was playing in 21 degrees Fahrenheit weather without a jacket. Sammy’s diarrhea may be explained by his electrolyte imbalance as a high potassium (K+) level can cause diarrhea. Due to the fact that sickled RBCs are blocking blood flow, oxygen cannot be delivered to the cells. As the cells produce lactic acid, the pH is lowered creating an acidotic environment. With an increase in hydrogen (H+) ions, K+ moves out of the cell into extracellular fluid (ECF) to maintain ionic balance, explaining a K+ level of 6.2 mEq/L (citation). Sammy’s arterial blood gas (ABG) results also play a role in determining Sammy’s condition. With a low pH of 7.28, PCO2 of 32, a PO2 of 64, and a HCO3 21 these results are indicative of metabolic acidosis. Sammy’s increased respiratory rate of 32 breaths per minute is the body’s was of compensating for increased levels of acid. The body increases respirations in order to excrete CO2 at a higher rate and increase the pH level. Unfortunately, the body can only keep this up for so long as this type of buffering system is physically
23 y/o female is post-op day two following a small bowel resection. Her nasogastric (NG) tube is connected to low intermittent wall suction and draining copious amounts of green fluid. Urine output has decreased to 0.3mL/kg/hr despite receiving IV fluids. Labs are as follows:
Hyponatremia treatment that occurs too rapidly is associated with the formation of demyelinating lesions in the pons known as CPM. These lesions lead to permanent neurological damage (Gheorghita et. al 2010). Physicians and patients should not fail to treat severe hyponatremia in an effort to avoid CPM development. Failure to treat hyponatremia may lead to severe brain damage, coma, or even death (Schuster et. al 2009 and Gheorghita et. al 2010). Symptoms of CPM have been seen to improve with time which plays the most critical role. Even treating hyponatremia with a hypertonic saline solution still raises the most important risk of developing CPM but a good neurological outcome has been seen in several cases when enough time and one of the above therapies are done.
Metformin is the generic name of a medication used in the management of diabetes mellitus type 2. Various trade names of this drug include Riomet, Glucophage XR, Carbophage SR, Obimet, Siofor, Fortamet, Glucophage, and Glumetza. The chemical name is 1,1-Dimethylbiguanide monohydrochloride. Doses up to 2000 mg per day may be given twice daily. The circulation of metformin is that the drug’s steady state of concentration within the blood is reached in 24-48 hours and the half life is approximately 6-1/2 hours. The nonabsorbed fraction of the dru...
Bowers, L., Allan, T., Simpson, A., Nijman, H., & Warren, J. (2007). Adverse Incidents, Patient
...e importance of taking nutritious foods and multivitamins, try to stop drinking coffee for two or three days. Eating regular well balanced meals. Avoid fast-food lifestyle that can cause great fluctuation in blood sugar. Lastly, the patient will be able to describe the benefits of regular exercise and how regular exercise can improve blood glucose control. They should know the importance of relaxation and exercises, deep breathing which are popular ways to relieve stress and to avoid strenuous physical activity. Meditations, yoga are good ways of relieving stress.
Evidence of any benefit to the treatment of glucose levels lower than the current criteria for diagnosis are lacking. Studies seen above provide evidence that treatment of even
Seron-Arbeloa, C., Zamora-Elson, M., Labarta-Monzon, L., & Mallor-Bonet, T. (2013). Enteral nutrition in critical care. Journal of Clinical Medicine Research, 5(1), 1-11. doi:10.4021/jocmr1210w
Diabetes Insipidus is the less known form of diabetes. It is often accompanied by excess urine outflow, intake of fluid, and an increased thirst. Bedwetting due to lack of control and frequency, and an unusual concentration of urine is included. There are four types of DI, and each are completely different in treatment and causes. Most commonly, the cause is the lack of vasopressin, which concentrates urine to reduce its output. It is called pituitary DI because it is usually caused by the destruction of the back of the pituitary gland. It cannot be cured, but drugs can help with symptoms. Gestational DI is caused by pregnancy and usually disappears a few weeks after delivery. The placenta uses the vasopressin too fast and causes it. The symptoms are repressed the same way as pituitary DI. The third type of DI is caused by the kidneys inability to respond to the effects of vasopressin, called nephrogenic DI. It is resulted from drugs against kidney diseases, and could (or could not) be cured only by eliminating the drug or disease. Drugs can be prescribed to alleviate some of the symptoms. The fourth, primary polydipsia, is caused by excessive intake of fluids and has two subcategories. Dipsogenic DI is most common and usually associated with an abnormality in the brain that regulates thirst. Psychogenic polydipsia is caused by psychosomatic issues. Neither one can be completely treated.
-The patient was having pitting edema and inspiratory rales because the increase of sodium caused an increase of fluid in the vascular system and lungs.
This can be attributed to excess vomiting, overuse of diuretics, adrenal disease, a large loss of potassium or sodium in a short amount of time, antacids, accidental ingestion of bicarbonate, laxatives, and alcohol abuse (Khan, Cherney, 2017).
Diabetes has been around for 2000 years. Over the years there has been a vast improvement in treatments which are still ongoing to this day. In the 17th century, diagnoses were done through urine tests and one was diagnosed if one’s urine was sweet. In the 20th century, doctors would advise patients to go on radical diets of less than 450 calories per day. In 1921 insulin was finally discovered.
In Type 2 Diabetes, very high blood glucose levels and dehydration can lead to a life-threatening condition called as the "non-ketotic hyperosmolar coma". In this condition, the blood glucose may rise to 6–20 times the normal range and unconsciousness may develop. Urgent medical care and re-hydration are required.
Forsyth, D., Lapid, M., Ellenbecker, S., Smith, L., O'Neil, M., Low, D., Clobes, J., Drier, J., & Seifers, M. (2008). Hydration status of geriatric patients in a psychiatric hospital. Issues in Mental Health Nursing, 29(8), 853-862.
"Symptoms - The American Diabetes Association." American Diabetes Association, 2014. Web. 3 Mar 2014. .