The document discusses the hypothalamus and pituitary gland. It notes that the hypothalamus secretes hormones that regulate the anterior pituitary, while the posterior pituitary is an extension of the hypothalamus and stores hormones. The anterior pituitary develops from Rathke's pouch and the posterior pituitary develops from the infundibulum. The hypothalamus regulates water balance and vasopressin secretion through the posterior pituitary. Diabetes insipidus occurs when there is a deficiency of vasopressin, and can be central or nephrogenic in origin. Post-operative diabetes insipidus is a common complication of pituitary surgery.
Slideshow is from the University of Michigan Medical School's M2 Endocrine sequence
View additional course materials on Open.Michigan:
openmi.ch/med-M2Endo
DEFINITION
• Myxedema coma is a rare life-threatening condition.It is the decompensated state of severe hypothyroidism in whichthe patient is hypothermic and unconscious.The condition occurs most often among elderly women in the winter months and appears to be precipitated by cold.
• Myxedema coma, occasionally called myxedema crisis, is a rare life- threatening clinical condition that represents severe hypothyroidism with physiological decompensation. The condition usually occurs in patients with long-standing, undiagnosed hypothyroidism and is usually precipitated by infection, cerebrovascular disease, heart failure, trauma, or drug therapy.
• Myxedema is also used to describe the dermatologic changes that occur in hypothyroidism which refers to deposition of mucopolysaccharides in the dermis, which results in swelling of the affected area.
Slideshow is from the University of Michigan Medical School's M2 Endocrine sequence
View additional course materials on Open.Michigan:
openmi.ch/med-M2Endo
DEFINITION
• Myxedema coma is a rare life-threatening condition.It is the decompensated state of severe hypothyroidism in whichthe patient is hypothermic and unconscious.The condition occurs most often among elderly women in the winter months and appears to be precipitated by cold.
• Myxedema coma, occasionally called myxedema crisis, is a rare life- threatening clinical condition that represents severe hypothyroidism with physiological decompensation. The condition usually occurs in patients with long-standing, undiagnosed hypothyroidism and is usually precipitated by infection, cerebrovascular disease, heart failure, trauma, or drug therapy.
• Myxedema is also used to describe the dermatologic changes that occur in hypothyroidism which refers to deposition of mucopolysaccharides in the dermis, which results in swelling of the affected area.
About the newer drugs in anaesthesia. What are the problems with the existing drugs? Which all drugs failed commercially? And why? Which are the newer drugs in anaesthesia?
important points regarding ICU psychosis, role of dexmedetomidine in it's treatment, mortality associated with delirium, symptomatic and definitive management
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
Diabetes insipidus
1.
2. Hypothalamus…proud mother; has two
daughters
Anterior pituitary [adenohypophysis]…is a
gland..having vascular connections with the
hypothalamus
Posterior pituitary [neurohypophysis]…is not a
gland but an extension of the
3. The adenohypophysis develops from
Rathke’s pouch, which is an upward
invagination of oral ectoderm from the roof of
the stomodeum
neurohypophysis develops from the
infundibulum, which is a downward extension
of neural ectoderm from the floor of the
6. the supraoptic and paraventricular nuclei of
the hypothalamus (cell bodies of the
magnocellular, neurosecretory neurons)
the supraoptico-hypophyseal tract
the posterior pituitary
7. Situated in the pituitary fossa limited
anteriorly, posteriorly and inferiorly by bony
constituents of the sella turcica [a depression
in the body of the sphenoid bone]
Demarcated laterally and superiorly by
reflections of dura and elsewhere by the sella
turcica
9. arterial blood supply from the inferior
hypophyseal artery [arises from the
meningohypophyseal trunk, a branch of the
cavernous segment of the ICA]
SON and PVN: from the
suprahypophyseal, ACOM, PCOM, anterior
cerebral and posterior cerebral arteries, all
derived from the circle of Willis.
Venous drainage via the dural, cavernous and
10.
11. Synthesis of the VP and OT precursors
occurs in the cell bodies of magnocellular
neurosecretory neurons within the SON &
PVN of the hypothalamus
They migrate along the axons & get stored in
secretory granules within the terminals of the
magnocellular neurons in the posterior
13. The osmoregulatory systems for thirst and VP
secretion, and the actions of VP on renal
water excretion, maintain plasma osmolality
within narrow limits: 284 to 295 mOsmol/kg
the mean plasma osmolality above which
plasma VP increases in response to
increases in plasma osmolality ['osmotic
threshold' for VP] is 284 mOsmol/kg ; relation
14. Reductions in circulating volume and
hypotension stimulate VP release
[baroregulation]
Nausea and emesis.
Manipulation of abdominal contents.
osmoreceptors are situated in anterior
circumventricular structures: the subfornicular organ
16. vasopressin exerts its antidiuretic effect via V2
receptors and involves insertion of protein
water channels called Aquaporins [13
variants]
vasopressin-responsive water channel in the
collecting ducts is aquaporin-2
• NB:AQP1: in apical and basolateral membranes of the PCT
17. Significant changes in secretion occur when
osmolality is changed as little as 1%
Maximum diuresis at plasma VP conc of 0.5
pmol/L or less.
Maximum urine concentration achieved at
plasma VP concentrations of 3-4 pmol/L
18. VP stimulates the expression of aquaporin on
the luminal surface of the interstitial cells
lining the CD.
Presence of aquaporin (AQP) in the wall of
the distal nephron allows resorption of water
from the duct lumen along an osmotic
gradient, and excretion of concentrated urine.
19. decrease medullary blood flow
stimulate active urea transport in the distal CD
stimulate active Na transport into the renal interstitium
All these contribute to the generation and
maintenance of a hypertonic medullary
interstitium, and this augment VP-dependent
water resorption.
20. Diabetes [Greek] = to go through
[describing excessive urination]
Insipidus [Latin] = without taste
Mellitus = sweet urine
Diabetes insipidus (DI) involves the
passing of urine that is tasteless
because of its relatively low sodium
content.
21. Central --impaired AVP production
Nephrogenic --due to refractoriness of the
distal nephron to the effects of AVP.
24. DI complicates the postoperative course occurs
in ̴ 30% of patients undergoing pituitary surgery,
transient and relatively benign in the majority of
cases
Chronic postoperative DI : incidence ̴ 0.5% to
15% in neurosurgical reviews.
This is relatively uncommon because >90% of
the magnocellular AVP neurons in the SON &
PVN must degenerate bilaterally before
25. Pre-operative central diabetes insipidus has
been reported in 8-35% of patients affected
with craniopharyngioma, and in 70-90% after
surgery.
26. Unusual for pituitary adenomas to present
with DI
They are slow growing also…
the site of AVP release shifts from the
posterior pituitary to the median eminence
Seen as an upward migration of the posterior
bright spot by MRI
27. Clinical signs and symptoms
Polyuria, high volumes (>2.5 -3.0 mL/kg/hr or 4–18 L/day), with abrupt
onset, typically within 24–48 hours postoperatively
• Polydipsia, with craving for cold fluids which better quenches osmotically-
stimulated thirst
• With/without hypovolemia, depending on whether the patient has an intact
thirst mechanism
Laboratory data
Dilute urine (specific gravity less than1.005, urine osmolality less than 200
mOsm/kg H2O)
• Normal to increased serum osmolality >295 mOsm/L
• S[Na+] greater or equal to 145 milliequivalent/L with continued diuresis of
hypotonic urine
• Irritability or mental status changes, dehydration, shock
28. osmotic diuresis from glucosuria
Is he getting stress doses of steroids?
Excessive fluids intraoperatively
• If this large postoperative diuresis is matched with continued
intravenous fluid infusions, an incorrect diagnosis of DI may be
made based on the resulting hypotonic polyuria; medullary
washout phenomenon
diuretic use (including mannitol)
the recovery phase of acute renal failure
primary polydipsia, and
after relief of obstructive uropathy.
29. Therefore, if the serum [Na+] is not elevated
concomitantly with the polyuria, the rate of
parenterally administered fluid should be slowed
with careful monitoring of the serum [Na+] and urine
output until a diagnosis of DI can be confirmed by
continued hypotonic polyuria in the presence of
hypernatremia or hyperosmolality
30. .
withhold water: stimulates AVP
rise in plasma Na
Mild dehydration production
urine output, should
↓, and urine
water conservation
osmolality, which
should ↑
31. dangerous in ICU patients
can induce hypovolemia and hemodynamic instability.
Further, ICU patients with DI often have already developed at least mild
hypernatremia spontaneously, which obviates the rationale
‘inappropriately low urine osmolality in the face of even very mild
hypernatremia’: means at least
partial DI is
there
32. Normal response to hypernatremia: Urine osmolality
>800 mOsmol/kg H2O
.
Response in partial DI: Urine osmolality 300–700
g mOsmol/kg H2O
Response in complete DI: urine osmolality <300
mOsmol/kg H2O
33. can be made by measuring plasma AVP levels after water
deprivation or spontaneous development of mild
hypernatremia
34. .
Normal response to hypernatremia:Plasma AVP
concentration >2 pg/mL
Response in partial DI: Plasma AVP concentration
may reach 1.5 pg/mL
Response in complete DI: Plasma AVP concentration
undetectable
Response in nephrogenic DI: Plasma AVP concentration
can exceed 5 pg/mL
35. More commonly achieved by assessing urine
osmolality before and after a single dose of
aqueous AVP (5 units subcutaneously) or the
AVP analog desmopressin (1 or 2 μg
subcutaneously or IV)
The response in central DI may be blunted if there has been
down-regulation of aquaporin channels or a significant
degree of medullary washout
36. .
Normal response: No more than a 5% increase in
urine osmolality
Response in partial central DI: 10–50% increase in
urine osmolality
Response in complete central DI: At least a 50%
increase in urine osmolality
Response in nephrogenic DI: No change in urine
osmolality is expected
37. Bright spot in the sella can be visualized on
T1-weighted images when stored vasopressin
and oxytocin are present in neurosecretory
granules of the posterior pituitary.Absence of
this bright spot is characteristic of DI
Not very reliable
38.
39. classic studies of pituitary stalk transection
describes three types: transient, permanent,
or triphasic
Transient DI :begins within 24 to 48 hours of
surgery and usually abates within several
days
Permanent
40. . severing of the neuronal connections
or axonal shock from perturbations in
the vascular supply to the pituitary
stalk
temporary dysfunction of AVP
producing neurons
resolves as the vasopressinergic
neurons regain full function.
41. Rarely persistent DI may follow as preformed
stores of AVP are depleted and no additional
AVP is synthesized.
42. In a series of 24 patients*…
80% to 100% DI with
higher stalk injury
low pituitary stalk section at the
level of the diaphragm
sella, only 62% developed
permanent DI
*
*Sharkey PC, Perry JH, Ehni G. Maclean JP, West CD, et al
43. First phase of DI typically lasts 5 to 7 days
transitions into a second antidiuretic phase of
SIADH
caused by the uncontrolled release of AVP
from degenerating posterior pituitary tissue, or
from the remaining magnocellular neurons
whose axons have been severed
44. Urine quickly becomes concentrated in
response to the elevated plasma AVP levels
and urine output markedly decreases.
Continued administration of excess water
during this period can quickly lead to
hyponatremia and hypoosmolality. can last
from 2 to 14 days .
45. After the AVP stores are depleted from the
degenerating posterior pituitary, the third
phase of chronic DI then typically
ensues, although not always
In this phase, there are insufficient remaining
AVP neurons capable of synthesizing
additional AVP, thereby resulting in permanent
47. a
profound hypernatremia,hyperosmolality, and dehydration, If
sufficient water intake or hypotonic IV fluid is not provided
• unlikely if the total body water deficit is entirely due to electrolyte free
water loss; very likely with even small degrees of co-existing total body
sodium depletion
Hypokalemia, hypomagnesemia, and hypophosphatemia
• Also should be anticipated
49. . Close monitoring of water balance (fluid intake
and output) Urine osmolality or specific gravity
every 4 to 6 hrs, until resolution or stabilization
Frequent serial measurements of serum
Na,K,Mg, and P concentration. Serum [Na+]
every 4 to 6 hours, until resolution or stabilization
Appropriate titration of IV fluids to prevent or
correct volume depletion and hypernatremia
50. Avoid other causes of polyuria
DI = continued hypotonic polyuria despite
hyperosmolality.
criteria for subsequent redosing of ADH
analogues need not be as stringent, and can
be based simply on the redevelopment of
polyuria
51. Allow patient to drink according to thirst
Supplement hypotonic intravenous fluids
(D5W to D5 1/2NSS) if patient is unable to
maintain a normal plasma osmolality and
serum [Na+] through drinking
52. The established water deficit = 0.6 X
premorbid weight X [1-140/serum Na
(mmol/L)]
Ongoing losses decrease the efficacy of this
formula
53. • NS or other isotonic
In patients crystalloid given initially.
. with severe • even if the patient is
hypernatremic
fluid depletion
Then • more gradually to avoid
intracellular inducing cerebral edema
volume • particularly if significant
hypernatremia has been
depletion is + for >24 hrs
corrected
54. even slow correction of the volume deficit may
necessitate a high rate of hypotonic fluid
administration if there is ongoing polyuria.
Overhydration water diuresis medullary
washoutsustaining the polyuria even if the DI
resolves.
55. Positive daily fluid balance >2 L suggests
possibility of inappropriate antidiuresis
If so antidiuretic hormone therapy should be
held and fluids restricted to maintain serum
[Na+] within normal ranges
56. Any patient with postoperative DI, and
particularly those manifesting a triphasic
response, should be assumed to have
anterior pituitary insufficiency
Cover with stress dose corticosteroids
(hydrocortisone 100 mg iv every 8
hours, tapered to 15mg to 30mg by mouth
58. Aqueous AVP has a half-life of 2–4 hours and
can be given s/c, im,IV bolus, or by continuous
IV infusion. It is a potent vasoconstrictor,owing to
its effect on vascular V1 receptors
Dose 4-10 units s/c or i.m. repeated every 4 to 6
hours
recommended only for diagnostic purposes or in
acute conditions (e.g., trauma) in which the DI
59. Preparations
PITRESSIN • 5u / mL im
TANNATE • Q4-8H
SYNTHETIC
• 50 u / mL in isotonic saline
LYSINE • DRODID nasal spray
VASOPRESSIN
• 1-2µg bd iv or s/c
DESMOPRESSIN • 10-20 µg bd/tid nasal spray
• 200-600 µg bd / tid orally
60. 1-deamino-8-D-arginine-vasopressin
Desmopressin, initial dose of 1 μg to 2 μg i.v.
or s/c dosed at 1–2 μg every 8–12 hours; half-
life 8–20 hrs SPRAY
INTRANASAL SOLUTION 100 UG/ML
INTRANASAL 10 UG/SPRAY
IM 4 UG/ML
ORAL 200UG TAB
<2 yr: 2-5ug intranasal; >2 y:5-10 ugrams/day
61. Parenteral routes are preferable, because this
obviates any concern about absorption, causes
no significant pressor effects, and has the same
total duration of action as the other routes
Redose when urine output 200 mL to 250 mL per
hour for greater than or equal to 2 hours, with
urine specific gravity less than 1.005 or urine
osmolality less than 200 mOsm/kg H2O
62. Prompt reduction in urine output and the
duration of antidiuresis is approximately 6 to
12 hours.
Each dose of desmopressin should be given
after the recurrence of polyuria, but before the
patient actually becomes hyperosmolar to
avoid fluid retention and hyponatremia
63. Excretion of 200 mL to 250 mL per hour of
urine with an osmolality less than 200
mOsm/kg H2O or specific gravity less than
1.005 affirms the need for retreatment with
desmopressin
64. Dosing desmopressin on an as needed
basis, also has the benefit of
allowing the detection of return of endogenous
AVP secretion
or the start of the second phase of a triphasic
response,
by a lack of return of polyuria after the effects of
the previous desmopressin dose have dissipated
65. intranasal or oral desmopressin.
The nasal spray delivers metered single doses of
0.1 mL (10 micrograms).The reliability diminished
in patients with mucosal atrophy, nasal
congestion, scarring, or nasal discharge
So wait until several days postoperatively before
using intranasal desmopressin, especially in
patients who have nasal packing in place.
66. Duration 6 to12 hours: most patients require
twice daily dosing.
It is often useful to permit intermittent polyuric
episodes every 1 to 2 weeks by delaying a
dose of desmopressin, thereby verifying
continued presence of DI and allowing any
retained excess water to be excreted so that
67. Patients with chronic rhinitis or mucosal scarring:
oral preparations more viable option
available in 0.1 mg to 0.2 mg dosing options
20 times higher dose than intranasal spray as
>99% of the oral dose is destroyed by
gastrointestinal peptidases.
central DI : on average 200 mg to 600 mg of oral
desmopressin two times per day to control
polyuria
68. headache, nausea, nasal congestion,flushing
and abdominal cramping
no pressor effects because it selectively binds
to the AVP V2 receptors
safe in patients with coronary or hypertensive
cardiovascular disease
69. Patient with DI coming for
surgery dose intra
just before surgeryusual
nasally or aq.vasopressin 100 mu iv bolus
f/b constant infusion of 100-200 mu/hr
[0.1mU/kg/hr]
isotonic ivfs
p.osmolarity hourly..closely monitor Na
if >290 mosm/l hypotonic ivfs & increase
vasopressin infusion >200 mu/ hr
70. .
Stopping any causative drugs
Monitoring fluid balance and
electrolyte levels, Supplying IVFs
restricting Na intake
71. . Na restriction and thiazides
mild volume contraction
stimulates sodium and
water reabsorption in the
PCT
decreases water delivery
to the distal nephron
limit polyuria
72. • Especially when Li
. Amiloride exposure is the cause
+/- • amiloride limits lithium
entry into tubular cells
thiazide
• Indomethacin and
ibuprofen
Others • Desmopressin;in those
with receptor mutations
high doses may be useful
73. Neurocritical Care ;Michel T. Torbey
Disorders of Water and Salt Metabolism Associated with
Pituitary Disease Jennifer A. Loh, MD, Joseph G.
Verbalis, MD ; Endocrinology and Metabolism Clinics of North
America
Endotext.org; Stephen G Ball, Peter H Bayliss
Diabetes insipidus in Craniopharyngoma; postoperative
management of water and electrolytes; Stefano
Ghiradello,Neil Hopper
Bope and Kellerman: Conn's Current Therapy 2012, 1st ed.
74. 'We'll just mill around
. till he's asleep, and then
send him back up.
This operation is
actually for a placebo effect.'