ascorbic-acid and Hyponatremia

Topics: Anemia; Animal Feed; Animals; Ascorbic Acid; Ascorbic Acid Deficiency; Caniformia; Deficiency Diseases; Dolphins; Fishes, Poisonous; Histamine; Hyponatremia; Lactose Intolerance; Seals, Earless; Thiamine Deficiency; Vitamin E Deficiency

In physically less fit patients and patients requiring repeated exams, adequate bowel preparation for colonoscopy remains problematic, particularly because patients need to drink large volumes of unpleasant-tasting fluids. A further concern is potential unwarranted fluid shifts.. This study aimed to compare the safety and burden of a small-volume sodium picosulphate/magnesium citrate preparation (SPS-MC) with a 2-l ascorbic-acid-enriched polyethylene glycol solution plus bisacodyl pretreatment (PEG-Asc+B).. Patients referred for colonoscopy were randomized to SPS-MC or PEG-Asc+B administered as a split-dose regimen. Patients received advice on the recommended 4-l SPS-MC and 2-l PEG-Asc+B fluid intake. Safety was assessed by blood sampling before and after the preparation and during a 30-day follow-up period. A questionnaire assessed tolerability and perceived burden of the preparation.. A total of 341 patients underwent colonoscopy. Blood sampling showed a slight but significant decrease in sodium, chloride and osmolality and increase in magnesium in the SPS-MC group and a decrease in bicarbonate in the PEG-Asc+B group. Hyponatraemia and hypermagnesaemia without clinical signs were observed in 16 (14 SPS-MC) and 13 SPS-MC patients, respectively. Patients reported significantly fewer physical complaints and a significantly higher completion rate with SPS-MC. Patients receiving SPS-MC rated the intake as being easier and better tasting. In the event of a repeat colonoscopy, 59.7% of patients in the PEG-Asc+B and 93.6% of patients in the SPS-MC group would opt for the same preparation again.. Despite electrolyte shifts, both SPS-MC and PEG-Asc+B appeared clinically safe. From a patient's perspective, a small-volume preparation formula such as SPS-MC is preferred, resulting in fewer physical complaints and greater ease of intake.

Topics: Administration, Oral; Adult; Aged; Ascorbic Acid; Biomarkers; Bisacodyl; Cathartics; Citrates; Citric Acid; Colon; Colonoscopy; Drug Administration Schedule; Drug Combinations; Female; Fluid Shifts; Humans; Hyponatremia; Male; Medication Adherence; Middle Aged; Netherlands; Organometallic Compounds; Patient Satisfaction; Pharmaceutical Solutions; Picolines; Polyethylene Glycols; Therapeutic Irrigation; Time Factors; Treatment Outcome; Water-Electrolyte Balance

Previous reports have shown that bowel preparation can, in extremely rare circumstances, induce severe acute hyponatremia. Polyethylene glycol plus ascorbic acid as a bowel preparation is considered relatively safe with a smaller amount of free water load and a more pleasant taste with additives.We present the case of an 86-year-old man who developed severe acute hyponatremia presenting with tremor and impaired consciousness after colonoscopy, which is life-threatening. The severe hyponatremia in our case was not caused by free water loads from drinking large amounts of water during bowel preparation or hypovolemia due to bowel preparation-induced nausea, vomiting, and diarrhea, but might have been due to non-osmotic stimuli of antidiuretic hormone (ADH) release (i.e., pre-existing nausea, stress, anxiety, pain, stress, or the colonoscopy itself). Our study indicates that it is important to choose safer bowel preparation solutions, to be aware of ingested water volumes, to assess volume status, and also remain aware of other coexisting risk factors for acute hyponatremia, such as medical history, medication, and ADH release, especially in elderly patients.

Topics: Aged; Aged, 80 and over; Ascorbic Acid; Colonoscopy; Humans; Hyponatremia; Male; Nausea; Polyethylene Glycols

Our recent animal and human studies revealed that chronic hyponatremia is a previously unrecognized cause of osteoporosis that is associated with increased osteoclast numbers in a rat model of the human disease of the syndrome of inappropriate antidiuretic hormone secretion (SIADH). We used cellular and molecular approaches to demonstrate that sustained low extracellular sodium ion concentrations ([Na(+)]) directly stimulate osteoclastogenesis and resorptive activity and to explore the mechanisms underlying this effect. Assays on murine preosteoclastic RAW 264.7 cells and on primary bone marrow monocytes both indicated that lowering the medium [Na(+)] dose-dependently increased osteoclast formation and resorptive activity. Low [Na(+)], rather than low osmolality, triggered these effects. Chronic reduction of [Na(+)] dose-dependently decreased intracellular calcium without depleting endoplasmic reticulum calcium stores. Moreover, we found that reduction of [Na(+)] dose-dependently decreased cellular uptake of radiolabeled ascorbic acid, and reduction of ascorbic acid in the culture medium mimicked the osteoclastogenic effect of low [Na(+)]. We also detected downstream effects of reduced ascorbic acid uptake, namely evidence of hyponatremia-induced oxidative stress. This was manifested by increased intracellular free oxygen radical accumulation and proportional changes in protein expression and phosphorylation, as indicated by Western blot analysis from cellular extracts and by increased serum 8-hydroxy-2'-deoxyguanosine levels in vivo in rats. Our results therefore reveal novel sodium signaling mechanisms in osteoclasts that may serve to mobilize sodium from bone stores during prolonged hyponatremia, thereby leading to a resorptive osteoporosis in patients with SIADH.

Topics: 8-Hydroxy-2'-Deoxyguanosine; Animals; Ascorbic Acid; Calcium; Cell Line; Deoxyguanosine; Endoplasmic Reticulum; Humans; Hyponatremia; Inappropriate ADH Syndrome; Mice; Osmosis; Osteoclasts; Osteoporosis; Oxidative Stress; Rats; Rats, Sprague-Dawley; Sodium

Topics: Ascorbic Acid; Bendroflumethiazide; Complementary Therapies; Dietary Supplements; Diuretics; Humans; Hyponatremia; Plant Preparations; Vitamins

Topics: Ascorbic Acid; Complementary Therapies; Dietary Supplements; Humans; Hyponatremia; Plant Preparations; Vitamins

Topics: Ascorbic Acid; Bendroflumethiazide; Complementary Therapies; Dietary Supplements; Diuretics; Humans; Hyponatremia; Plant Preparations; Vitamins