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Orthostatic Sodium Retention

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101. Depression

is present on more days than not for at least 2 years. In contrast, subsyndromal depression is an acute mood disorder that is less severe (some, but not all, diagnostic symptoms present) than major depression. Possible Medical Causes of Depressive 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

2012 PDQ - NCI's Comprehensive Cancer Database

102. Gastrointestinal Complications

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 laxative. Bulk-producing agents are not recommended in a regimen used to counteract the bowel effects of opioids. Two tablets of a senna preparation twice daily. One bisacodyl tablet at bedtime. Milk of magnesia, 30 to 45 mL, if a bowel movement is not achieved in 24 (...) hours after other methods are instituted. If the amount of stool is still inadequate, increase stool softeners up to six capsules per day or a senna preparation (e.g., Senokot) gradually to a maximum of eight tablets (four tablets twice a day); bisacodyl may be increased gradually to three tablets. If the amount of stool is still inadequate, a glycerin or bisacodyl suppository or enema (phosphate/biphosphate, oil retention, or tap water) is used with caution, especially in patients with neutropenia

2012 PDQ - NCI's Comprehensive Cancer Database

103. Zyprexa Relprevv (olanzapine) for Extended Release Injectable Suspension - medical review

aqueous soluble crystalline salt. This NDA seeks a claim for the use of OP Depot in the short-term and maintenance treatment of patients diagnosed with schizophrenia who are able to tolerate oral olanzapine and tend to be poorly adherent with treatment. DNP met initially with the applicant on 26 AUG 1999 to discuss the required program to support registration of OP Depot and on 22 JUL 2003 as well as 09 SEP 2005 to discuss a number of CMC and clinical pharmacology issues. Eli Lilly and Company (...) specifications as of this date, to be resolved before an expiry period can be assigned by CMC. 1% Sodium Lauryl Sulfate in USP buffer pH 6.8 medium using USP Apparatus 4 ( or Ph.Eur.2.9.3 Flow-Through Apparatus) at 3 ml/min flow rate. 210 mg: %released at 30 min % released at 2 hrs % released at 8 hrs 300 mg: %released at 30 min % released at 2 hrs % released at 8 hrs 405 mg: %released at 30 min % released at 2 hrs % released at 8 hrs Within one year after the date of this letter, Lilly is required

2009 FDA - Drug Approval Package

104. Kombiglyze XR (saxagliptin/metformin extended release) fixed dose combination tablets

Increases insulin sensitivity 0.5-1.4 Lower risk of hypoglycemia Fluid retention Weight gain Expensive Insulin Lispro NPH insulin Glargine Stimulates glucose uptake in muscle and adipose tissue 1.5-2.5 No dose limit Inexpensive Improve lipid profile Injections Frequent monitoring Hypoglycemia Weight gain Alpha-glucosidase inhibitors Acarbose Miglitol Slow GI absorption of carbohydrates 0.5-0.8 Weight neutral Frequent GI side effects TID dosing Expensive Meglitides Repaglinide Nateglinide Insulin (...) , laboratory test results, ECG, and vital signs. Laboratory test included hematology (hemoglobin, hematocrit, RBC, WBC count with differential, and platelet counts), serum chemistry (ALT, AST, alkaline phosphatase, creatine kinase, total bilirubin, BUN, serum creatinine, calculated creatinine clearance, sodium, potassium, chloride, total protein, and albumin), and urinalysis (dipstick evaluation for pH, protein, leukocyte esterase, and blood). Study CV181039 was titled “ A multicenter, randomized, double

2009 FDA - Drug Approval Package

105. Primary Care Corner with Geoffrey Modest MD: Tighter Blood Pressure Control? The SPRINT Trial

% of diabetics have hypertension: hypertension is associated with insulin resistance, and in therefore part of the Metabolic Syndrome; insulin causes renal sodium retention and contributes to hypertension). So, excluding diabetics effectively excludes a very large % of patients with hypertension. Other important exclusions affecting the study’s generalizability include: all participants were >50yo, none had SBP>180 mmHg, none had a prior stroke or had predominantly diastolic hypertension (though they did (...) difference by prior hx of CKD, age < or >75, sex, race, previous hx of cardiac disease, or baseline systolic pressure Rates of serious adverse events were higher in those in the intensive group: hypotension (2.4 vs 1.4%), syncope (2.3 vs 1.7%), electrolyte disturbances (10.1 vs 7.4%), acute kidney injury or failure (4.1 vs 2.5%), but not injurious falls, and orthostatic hypotension more common in standard treatment group (18.3 vs 16.1%) ​Study stopped early, after 3.26 years, because of statistically

2015 Evidence-Based Medicine blog

106. Guidelines on Diagnosis and Management of Syncope

and pathophysiology . . . . . . . . . . . . . . 2635 1.2.1 Placing syncope in the larger framework of transient loss of consciousness (real or apparent) . . . . . . . . 2635 1.2.2 Classi?cation and pathophysiology of syncope . . . . 2636 1.2.2.1 Re?ex syncope (neurally mediated syncope) . . . 2637 1.2.2.2 Orthostatic hypotension and orthostatic intolerance syndromes . . . . . . . . . . . . . . . . . 2637 1.2.2.3 Cardiac syncope (cardiovascular) . . . . . . . . . . 2639 1.3 Epidemiology (...) . . . . . . . . . . . . . . . . . . . . . . . . . . 2645 2.2.1 Carotid sinus massage . . . . . . . . . . . . . . . . . . . 2645 2.2.2 Orthostatic challenge . . . . . . . . . . . . . . . . . . . . 2647 2.2.2.1 Active standing . . . . . . . . . . . . . . . . . . . . . . 2647 2.2.2.2 Tilt testing . . . . . . . . . . . . . . . . . . . . . . . . . 2647 2.2.3 Electrocardiographic monitoring (non-invasive and invasive) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2649 2.2.3.1 In-hospital monitoring . . . . . . . . . . . . . . . . . 2649

2009 European Society of Cardiology

107. Pharmacological treatment of bipolar disorder in primary care Full Text available with Trip Pro

, slowing, dystonia Anticholinergic reactions: constipation, dry mouth, blurred vision, urinary retention Other: sedation, increased appetite, sexual dysfunction, gastrointestinal upset, peripheral oedema, nausea, cerebrovascular events such as stroke and TIA (especially in older patients), orthostatic hypotension, tachycardia Jaundice, neuroleptic malignant syndrome, seizures, tardive dyskinesia, electrocardiogram changes (increased QT interval), SIADH, temperature irregularity, blood dyscrasias (...) -converting enzyme inhibitors, non-steroidal anti-inflammatory drugs) and sodium depletion (eg, gastrointestinal disturbance) There can be a delay of 6–8 weeks for an antidepressant effect Lithium toxicity: signs include loss of balance, increasing diarrhoea, vomiting, anorexia, weakness, ataxia, blurred vision, tinnitus, polyuria, coarse tremor, muscle twitching, irritability and agitation. Drowsiness, psychosis, disorientation, seizures, coma and renal failure may also occur. Valproate GIT: nausea

2010 Clinical Practice Guidelines Portal

108. Toxic Neuropathy (Diagnosis)

and symptoms Patients with neuropathy typically present with symptoms of pain, tingling, or numbness in their feet, consistent with dysfunction affecting the longest and largest fibers of the peripheral nervous system (PNS). Other manifestations of neurologic dysfunction that may be present include the following: Hypohidrosis or hyperhidrosis Diarrhea or constipation Urinary incontinence or retention Gastroparesis Sicca syndrome Blurry vision Facial flushes Orthostatic intolerance Sexual dysfunction (...) of neuropathy, such as sodium channel, neuromuscular transmission, or cranial neuropathies, also have toxic etiologies. In North America, sodium channel dysfunction may be the result of ciguatera toxin from reef fish or saxitoxin from shellfish. This often presents as an acute or subacute illness. Puffer fish may be intoxicated with tetrodotoxin in Japan. Neuromuscular transmission dysfunction is associated most commonly with organophosphate intoxication; however, envenomation from snake bites or botulism

2014 eMedicine.com

109. Multiple System Atrophy (Diagnosis)

Orthostatic Hypotension in MSA Class Drug Description or Mechanism Corticosteroids Fludrocortisone (Florinef) Mineralocorticoid; sodium retention, primarily in extravascular compartment, causes tissue edema to venous capacitance bed in lower extremity. With this edema, venous bed accommodates decreased volume of blood in an upright posture (high doses, late effect); increases sensitivity to norepinephrine (even with small doses) Sympathomimetic amines Midodrine Alpha1-adrenoreceptor agonist acts directly (...) .) Table 5. Clinicopathologic Correlations Clinical Symptom Pathologic Findings and Location of Damage or Cell Loss Orthostatic hypotension Primary preganglionic damage of intermediolateral cell columns Urinary incontinence (not retention) Preganglionic cell loss in spinal cord (intermediolateral cell columns), related to detrusor hyperreflexia caused mainly by loss of inhibitory input to pontine micturition center (rather than to external urethral sphincter denervation alone) Urinary retention caused

2014 eMedicine.com

110. Migraine Headache: Pediatric Perspective (Diagnosis)

Postdrome Premonitory Migraine with aura (previously known as classic migraine) and migraine without aura (previously known as common migraine) each have a premonitory phase, or prodrome, which may precede the headache phase by up to 24 hours. During this phase, the following features may occur: Irritability Elation or sadness Talkativeness or social withdrawal Increased or decreased appetite Food craving or anorexia Water retention Sleep disturbances These premonitions are often more pronounced (...) , nystagmus, gait unsteadiness, limb incoordination, and dysarthria. Genetic abnormalities have been identified; CACNA1A gene mutations (coding for calcium channel) on chromosome 19 in FHM1; mutations in the ATP1A2 gene (coding for a K/Na-ATPase) on chromosome 1 in FHM2; and mutations in the SCN1A gene (coding for a sodium channel) on chromosome 2 in FHM3. [ ] Consider structural lesions, vasculitis, cerebral hemorrhage, brain tumor, mitochondrial myopathy, encephalopathy, and lactic acidosis

2014 eMedicine.com

112. Proteinuria (Diagnosis)

function. Glomerular proteinuria can also be categorized according to whether pathological damage of the glomerulus is present. Types that do not result from pathological damage to the glomerulus include transient and orthostatic proteinuria. Transient proteinuria occurs in persons with normal renal function, bland urine sediment, and normal blood pressure. The quantitative protein excretion is less than 1 g/day. The proteinuria is not indicative of significant underlying renal disease; it may (...) be precipitated by high fever or heavy exercise, and it disappears upon repeat testing. Exercise-induced proteinuria usually resolved wihtin 24 hours. Orthostatic proteinuria is diagnosed if the patient has no proteinuria in early morning samples but has low-grade proteinuria at the end of the day. It usually occurs in tall, thin adolescents or adults younger than 30 years (and may be associated with severe lordosis). Patients have normal renal function and proteinuria is usually < 1 g/day, with no hematuria

2014 eMedicine.com

113. Proteinuria (Overview)

function. Glomerular proteinuria can also be categorized according to whether pathological damage of the glomerulus is present. Types that do not result from pathological damage to the glomerulus include transient and orthostatic proteinuria. Transient proteinuria occurs in persons with normal renal function, bland urine sediment, and normal blood pressure. The quantitative protein excretion is less than 1 g/day. The proteinuria is not indicative of significant underlying renal disease; it may (...) be precipitated by high fever or heavy exercise, and it disappears upon repeat testing. Exercise-induced proteinuria usually resolved wihtin 24 hours. Orthostatic proteinuria is diagnosed if the patient has no proteinuria in early morning samples but has low-grade proteinuria at the end of the day. It usually occurs in tall, thin adolescents or adults younger than 30 years (and may be associated with severe lordosis). Patients have normal renal function and proteinuria is usually < 1 g/day, with no hematuria

2014 eMedicine.com

114. Migraine Headache: Pediatric Perspective (Overview)

Postdrome Premonitory Migraine with aura (previously known as classic migraine) and migraine without aura (previously known as common migraine) each have a premonitory phase, or prodrome, which may precede the headache phase by up to 24 hours. During this phase, the following features may occur: Irritability Elation or sadness Talkativeness or social withdrawal Increased or decreased appetite Food craving or anorexia Water retention Sleep disturbances These premonitions are often more pronounced (...) , nystagmus, gait unsteadiness, limb incoordination, and dysarthria. Genetic abnormalities have been identified; CACNA1A gene mutations (coding for calcium channel) on chromosome 19 in FHM1; mutations in the ATP1A2 gene (coding for a K/Na-ATPase) on chromosome 1 in FHM2; and mutations in the SCN1A gene (coding for a sodium channel) on chromosome 2 in FHM3. [ ] Consider structural lesions, vasculitis, cerebral hemorrhage, brain tumor, mitochondrial myopathy, encephalopathy, and lactic acidosis

2014 eMedicine.com

115. Multiple System Atrophy (Overview)

Orthostatic Hypotension in MSA Class Drug Description or Mechanism Corticosteroids Fludrocortisone (Florinef) Mineralocorticoid; sodium retention, primarily in extravascular compartment, causes tissue edema to venous capacitance bed in lower extremity. With this edema, venous bed accommodates decreased volume of blood in an upright posture (high doses, late effect); increases sensitivity to norepinephrine (even with small doses) Sympathomimetic amines Midodrine Alpha1-adrenoreceptor agonist acts directly (...) .) Table 5. Clinicopathologic Correlations Clinical Symptom Pathologic Findings and Location of Damage or Cell Loss Orthostatic hypotension Primary preganglionic damage of intermediolateral cell columns Urinary incontinence (not retention) Preganglionic cell loss in spinal cord (intermediolateral cell columns), related to detrusor hyperreflexia caused mainly by loss of inhibitory input to pontine micturition center (rather than to external urethral sphincter denervation alone) Urinary retention caused

2014 eMedicine.com

116. Nephrosclerosis (Treatment)

dilation by blocking arterial wall calcium uptake Effective in severe hypertension (minoxidil is better than hydralazine) Minoxidil most potent vasodilator available for oral use No dose adjustment in renal failure Best used in combination with a diuretic plus a beta-blocker Adverse effects are as follows: Reflex activation of sympathetic nervous system (headache, tachycardia) Activation of renin-angiotensin system (sodium retention) Loop diuretic possibly required to control edema Hirsutism (minoxidil (...) ) T-wave inversion in approximately 50% of patients on minoxidil Central-acting alpha-2 agonists Effects and indications are as follows: Methyldopa drug of choice in pregnancy Hypertensive emergency (clonidine) Clonidine useful when patient has migraine in association with hypertension Adverse effects are as follows: Sedation Orthostatic hypotension Dry mouth, skin irritation (clonidine patch) Rebound hypertension upon abrupt discontinuation Possible Coombs-positive hemolytic anemia

2014 eMedicine.com

117. Cardiovascular Concerns in Spinal Cord Injury (Overview)

in the management of orthostatic hypotension Atropine: Drug of choice for bradycardia but rarely used in rehabilitation settings except during emergencies (phenylephrine and dopamine also can be considered) Alpha-adrenergic agonists: Improve the patient's hemodynamic status by increasing myocardial contractility and heart rate Corticosteroids: Cause sodium and fluid retention, resulting in improvements in symptomatic orthostatic hypotension Sympathomimetics: Augment coronary and cerebral blood flow (...) lead to increased blood pressure. Corticosteroids cause sodium and fluid retention to improve symptomatic orthostatic hypotension, and sympathomimetics augment coronary and cerebral blood flow. Anticholinergics are administered to improve conduction through the atrioventricular (AV) node; this is accomplished by a reduction of vagal tone by way of muscarinic receptor blockade. Previous References Partida E, Mironets E, Hou S, Tom VJ. Cardiovascular dysfunction following spinal cord injury. Neural

2014 eMedicine.com

118. Botulism (Overview)

, dysphagia, and/or suppressed gag reflex Additional neurologic manifestations include symmetrical descending paralysis or weakness of motor and autonomic nerves Respiratory muscle weakness may be subtle or progressive, advancing rapidly to respiratory failure The autonomic nervous system is also involved in botulism, with manifestations that include the following: Paralytic ileus advancing to severe constipation Gastric dilatation Bladder distention advancing to urinary retention Orthostatic hypotension (...) no role in foodborne botulism Magnesium salts, citrate, and sulfate should not be administered, because magnesium can potentiate the toxin-induced neuromuscular blockade. Wound botulism requires the following: Incision and thorough debridement of the infected wound Antitoxin therapy High-dose intravenous penicillin therapy Prevention of nosocomial infections Measures to reduce the risk of nosocomial infections include the following: Close observation for hospital-acquired infections - Especially

2014 eMedicine.com

120. Altitude-Related Disorders (Treatment)

to displace the CSF. Conversely, those with lesser CSF to brain volume ratio have limited space for compensation of brain swelling and are prone to AMS. The role of fluid retention in the pathogenesis of AMS remains uncertain. Secretion of antidiuretic hormone and atrial natriuretic factor is altered in AMS and may contribute to vasogenic edema. More recently, hypoxia-induced alterations in oxidative stress and free radical metabolism have been implicated in the pathophysiology of AMS. [ ] Treatment (...) of the pathogenesis of HAPE is shown below. This image shows the pathophysiology of high-altitude pulmonary edema (HAPE) following ascent to high altitude. Factors leading to a low partial pressure of oxygen (PO2), such as exercise, sleep, or a low ventilatory response to hypoxia, increase the likelihood of developing HAPE. Alterations in the sympathetic nervous system are also believed to contribute to the development of HAPE. Recent evidence suggests that a defect in sodium transport across the alveolar

2014 eMedicine.com

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