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Orthostatic Sodium Retention

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21. Delirium in Adult Cancer Patients: ESMO Clinical Practice Guidelines

- mary tumour or metastasis) in 36 patients (6%). Study limitations include a low overall incidence of delirium (3.5 per 100 admis- sions) and retrospective design. Other delirium risk factors have been implicated in other studies, including age, dementia, depres- sion, alcohol abuse, poor functional status, organ dysfunction and abnormal levels of serum sodium, potassium or glucose, among others [40–44]. Moreover, many medications are implicated as risk factors for delirium, in particular opioids (...) Continued Table 1. Continued Indirectriskfactorsfordelirium Otherstatusorpredisposingcomorbidities[5,39] Visual impairment Urinary retention or use of urinary catheter Constipation Alcohol or drug abuse, or withdrawal (including nicotine) CNS diseases or trauma; history of stroke or transient ischaemia Liver failure Renal failure End-stage cardiac disease End-stage lung disease Endocrinopathy CNS, central nervous system; NSAID, non-steroidal anti-in?ammatory drug; SIADH, syndrome of inappropriate

2018 European Society for Medical Oncology

22. Drugs That May Cause or Exacerbate Heart Failure

Level of Evidence for HF Induction or Precipitation Possible Mechanism(s) Onset Comments Causes Direct Myocardial Toxicity Exacerbates Underlying Myocardial Dysfunction Analgesics COX, nonselective inhibitors (NSAIDs) x Major B Prostaglandin inhibition leading to sodium and water retention, increased systemic vascular resistance, and blunted response to diuretics Immediate COX, selective inhibitors (COX-2 inhibitors) x Major B Anesthesia medications Inhalation or volatile anesthetics Desflurane x (...) affect platelet aggregation, maintenance of the gastric mucosal barrier, and renal function. NSAIDs have the potential to trigger HF through sodium and water retention, increased systemic vascular resistance, and blunted response to diuretics. Observational studies suggest an association between traditional NSAIDs use and HF precipitation and exacerbation. In an evaluation of 7277 long-term NSAID users over 72 months, the Rotterdam study results found a trend to an increased risk for incident HF

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2016 American Heart Association

23. Chronic kidney disease

or secondary to CKD itself). See the CKS topic on for more information. Palpable bilateral flank masses with possible hepatomegaly (suggests polycystic kidney disease with possible liver cysts). Palpable distended bladder (suggests obstructive uropathy). Peripheral oedema (may be due to renal sodium retention, hypoalbuminaemia, or co-morbid heart failure). See the CKS topic on for more information. Peripheral neuropathy (may present with paraesthesia, sleep disturbance, and restless legs syndrome (...) to possible acute kidney injury [AKI], obstructive uropathy causing urinary retention; or end-stage renal disease). Any potentially , including over-the-counter or herbal medicines. Any known for CKD or previous history of AKI. See the CKS topic on for more information. Any associated co-morbidities or of CKD. Any family history, such as autosomal dominant polycystic kidney disease. Any associated clinical features of anxiety or depression. See the CKS topics on and for more information. Examine for signs

2019 NICE Clinical Knowledge Summaries

24. LUTS in men

about: Storage symptoms, including urgency, daytime urinary frequency, nocturia, urinary incontinence, and feeling the need to urinate again just after passing urine. The man should also be asked about bedwetting, which can be a sign of chronic urinary retention. Voiding symptoms, including hesitancy, weak or intermittent urinary stream sometimes causing splitting or spraying, straining, incomplete emptying, and terminal dribbling. Post-micturition symptoms, including post-micturition dribble (...) care management of men with lower urinary tract symptoms (LUTS) that are not caused by infection, inflammation, neurological disease, drugs, or cancer. It covers the management of voiding symptoms, overactive bladder, nocturnal polyuria, stress urinary incontinence, urinary retention, and post-micturition dribbles. There are separate CKS topics on , , , , , and . The target audience for this CKS topic is healthcare professionals working within the NHS in the UK, and providing first contact

2019 NICE Clinical Knowledge Summaries

25. Gastrointestinal Complications (PDQ®): Health Professional Version

that mineral oil be avoided because it can cause lipid pneumonitis. It can interfere with postoperative healing of anorectal surgery. Avoid giving with docusate sodium. Docusate sodium causes increased systemic absorption of mineral oil. Use: Prophylactically to prevent straining in patients for whom straining would be dangerous. Drugs and dosages: - Mineral oil: 5 to 30 cc at bedtime. Fecal softeners Fecal softeners promote water retention in the fecal mass, thus softening the stool. Up to 3 days may pass (...) of molasses enema with magnesium citrate 8 oz by mouth. Consider bowel management consult. If patient is neutropenic or thrombocytopenic, arrange for bowel management consult. Start one of the following regimens if the patient has not had a stool in 3 days or on the first day that any patient starts taking drugs associated with constipation: - Stool softeners (e.g., docusate sodium, one to two capsules per day). For opioid-related constipation, stool softeners may be used in combination with a stimulant

2018 PDQ - NCI's Comprehensive Cancer Database

26. Therapies Targeting the Nervous System for Chronic Pelvic Pain Relief

to urinary frequency/retention and diarrhoea/constipation, and endocrine dysfunction, particularly alterations in the activity of the hypothalamic–pituitary–adrenal axis, potentially resulting in increased rates of infections and autoimmune conditions. Women with CPP frequently present to gynaecologists, of whom the majority will focus their assessment and treatments on the pelvis. This paper will therefore review the available treatments for CPP that target the nervous system rather than the pelvis (...) sodium and calcium channels and interactions with the ?-aminobutyric acid (GABA) system. 14 Given that women with CPP frequently report feeling that their doctors thought their pain was psychological, these points can be useful in counselling women prior to commencing an antidepressant or anticonvulsant medication. In general, both classes of drugs are well tolerated with relatively minor adverse effects (drowsiness and nausea most commonly), although specific adverse effects vary between drugs

2015 Royal College of Obstetricians and Gynaecologists

27. Acute pain management: scientific evidence (3rd Edition)

is not superior over others but some opioids are better in some patients (U) (Level II).SUMMARY xxii Acute Pain Management: Scientific Evidence 14. The incidence of clinically meaningful adverse effects of opioids is dose-related (U) (Level II). 15. High doses of methadone can lead to prolonged QT interval (N) (Level II). 16. Haloperidol is effective in the prevention of postoperative nausea and vomiting ( N) (Level II). 17. Opioid antagonists are effective treatments for opioid-induced urinary retention ( N

2015 National Health and Medical Research Council

29. Depression (PDQ®): Health Professional Version

Symptoms in People With Cancer Uncontrolled pain.[ ][ ] Metabolic abnormalities: - Hypercalcemia. - Sodium/potassium imbalance. - Anemia. - Vitamin B12 or folate deficiency. - Fever. Endocrine abnormalities: - Hyperthyroidism or hypothyroidism. - Adrenal insufficiency. Medications:[ ][ ][ - ];[ ][ ] - Steroids. - Endogenous and exogenous cytokines, i.e., interferon-alfa and aldesleukin (interleukin-2 [IL-2]).[ ] - Methyldopa. - Reserpine. - Barbiturates. - Propranolol. - Some antibiotics (e.g

2017 PDQ - NCI's Comprehensive Cancer Database

30. Heart Failure Management in Skilled Nursing Facilities

Infective endocarditis Cardiomyopathy Dilated (nonischemic) Alcohol Chemotherapeutic agents Inflammatory myocarditis Idiopathic Hypertrophic Obstructive Nonobstructive Restrictive (especially amyloid) Pericardial disease Constrictive pericarditis High-output syndromes Chronic anemia Hyperthyroidism Arteriovenous shunting HF indicates heart failure. Table 3. Common Factors Contributing to HF Exacerbations in Older Adults Myocardial ischemia or infarction Uncontrolled hypertension Dietary sodium excess (...) to clarify goals for all SNF residents. outlines the application of HF guideline recommendations to the 3 different groups of patients in SNFs. Table 4. Medical Management of HF in Relation to SNF Admission Goals Intervention Rehabilitation Group Uncertain Prognosis Group Long-Term Group Assessment of LVEF Yes Yes Preferable, needs to be individualized Sodium restriction to achieve euvolemia Preferable, needs to be individualized Preferable, needs to be individualized Preferable, needs

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2015 American Heart Association

31. Treatment of Hypertension in Patients With Coronary Artery Disease

hypertension are numerous, including activation of the sympathetic nervous system, sodium retention, activation of the renin-angiotensin-aldosterone system (RAAS), insulin resistance, and altered vascular function, there is no acceptable guideline on the antihypertensive drug of choice for the management of hypertension among obese patients. , Some investigators consider ACE inhibitors the drugs of choice for adequate BP control in obesity-related hypertension because of their capacity to increase insulin (...) pathways interact with genetic, demographic, and environmental factors (such as heightened exposure or response to psychosocial stress, excessive dietary intake of sodium, and inadequate dietary intake of potassium and calcium) to determine whether a person will develop hypertension and related CAD. Concomitant metabolic disorders, for example, diabetes mellitus, insulin resistance, and obesity, also lead to the production of vasoactive adipocytokines that promote vasoconstriction, endothelial

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2015 American Heart Association

35. Clinical practice guideline for the management of patients with Parkinson´s disease

in posture, large meals, hot baths, and vasodilation medication. v Managing orthostatic hypotension in patients with PD is recommended, using non-pharmacological measures before initiating pharmacological treatment. Non- pharmacological measures include avoiding meals that are low in sodium and high in carbohydrates, increasing intake of water (2-2.5 l/d) and salt (>8 g or 150 mmol/d) in the diet, breaking up meals, exercise, elevating the head while sleeping, wearing compression stockings, or carrying (...) . visual alterations; olfactory dysfunction; taste alterations; hypoacousia and other auditory disorders; pain and associated sensitivity symptoms) Autonomic dysfunctions 7. Which treatments are safest and most effective in controlling the autonomic dysfunctions associated with Parkinson’s disease? (e.g. orthostatic hypotension; constipation; fecal incontinence; nausea and vomiting; intolerance to heat; excessive sweating; nocturia; sexual dysfunction; weight loss; difficulty swallowing) Depression

2015 GuiaSalud

36. Male Sexual Dysfunction

conditions may result in orthostatic hypotension.MALE SEXUAL DYSFUNCTION - UPDATE MARCH 2015 17 • Sildenafil labelling advises that 50 or 100 mg sildenafil should be used with caution in patients taking an a-blocker (especially doxazosin). Hypotension is more likely to occur within 4 h following treatment with an a-blocker. A starting dose of 25 mg is recommended [99]. • Concomitant tr eatment with var denafil should only be initiated if the patient has been stabilised on his a-blocker therapy. Co (...) - limited after prolonged use. It can be alleviated with the addition of sodium bicarbonate or local anaesthesia [143, 144, 146]. Cavernosal fibrosis (from a small hematoma) usually clears within a few months after temporary discontinuation of the injection program. However, tunical fibrosis suggests early onset of Peyronie’s disease and may indicate stopping intracavernosal injections indefinitely. Systemic side-effects are uncommon. The most common is mild hypotension, especially when using higher

2015 European Association of Urology

38. Clinical Practice guideline on the diagnosis and treatment of hyponatraemia

of blood may reducetheeffectivearterialbloodvolume.Asinheartfailure,this reduction can lead to neurohumoral activation and water reten- tionduetobaroreceptor-mediatedvasopressinrelease. In addition, mineralocorticoid receptor blockers such as spironolactone, which either alone or in combination with loop diuretics, are frequently used to reduce sodium retention inliverfailure,cancontributetohyponatraemia[59]. 5.9.4. Nephrotic syndrome. In nephrotic syndrome, blood volume may be decreased due (...) to the lower serum oncotic pressure(under-?llhypothesis).Ifthishappens,stimulationof vasopressin secretion can cause patients to develop hypona- traemia. The tendency for water retention is generally ba- lancedbyintensesodiumretention,buttheincreasedrenalre- absorption of sodium usually necessitates a considerable dose of diuretics. The combination of increased vasopressin release and diuretic use may promote moderate hyponatraemia, especiallyinchildrenwithlowbloodpressure[60]. 6. DIAGNOSIS

2014 European Renal Best Practice

39. Type 1 Diabetes Mellitus and Cardiovascular Disease: A Scientific Statement From the American Heart Association and American Diabetes Association

at an early age. Some data suggest that its presence may portend CVD events; however, how these subclinical markers function as end points is not clear. Cardiac Autonomic Neuropathy Neuropathy in T1DM can lead to abnormalities in the response of the coronary vasculature to sympathetic stimulation, which may manifest clinically as resting tachycardia or bradycardia, exercise intolerance, orthostatic hypotension, loss of the nocturnal decline in BP, or silent myocardial ischemia on cardiac testing (...) , age and DM duration also play an important role. In addition, CVD risk brought on by unhealthy behaviors and associated CVD risk factors requires careful consideration. Avoidance of smoking, maintenance of a normal weight, and consumption of a balanced diet replete in fruits and vegetables, low in saturated fat and sodium, and enriched in whole grains are generally recommended. In this section, we will address a variety of risk factors and their relationship to CVD risk management. Table 3

2014 American Heart Association

40. Risperdal (Risperidone) - schizophrenia and bipolar disorders and persistent aggression in conduct disorder in children and ersistent aggression in patients with moderate to severe Alzheimer's dementia

effects, falls, choking on food, excessive sedation, metabolic disorders, orthostatic hypotension, anticholinergic effects (risk of cognitive impairment, constipation and urine retention). Antipsychotics also seemed to be associated, in patients with dementia, with an increased risk of cerebral vascular events and death. The management of aggressive behaviour in Alzheimer's disease is comprehensive. Firstly, it includes care techniques adjusted to the dementia patient. Non-drug interventions (...) the deterioration of cognitive functions is combined with deterioration of functional autonomy. Aggressive behaviours are of multifactorial origin and may reflect: - a defence reaction by the patient in a situation that he cannot control or understand, - a problem specific to the disease (cognitive deficit, delirium, hallucination), - the expression of a somatic problem (urine retention, infection, acute pain, faecal impaction, etc.), - the expression of a psychiatric comorbidity, etc. These behaviour problems

2014 Haute Autorite de sante

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