demeclocycline and Chronic-Disease

Hyponatremia is the most common electrolyte disorder. With the aging of the population and the greater propensity of the elderly to develop hyponatremia, this electrolyte disorder is of increasing importance to the practicing nephrologist. In this Attending Rounds, an illustrative patient with hyponatremia is presented. The reasons for the increased incidence and prevalence of hyponatremia in the elderly are discussed, with emphasis on the effects of aging on urinary dilution, the frequently multifactorial nature of hyponatremia in this population, and the absence of a definite cause for inappropriate and persistent vasopressin release in many such patients. The rationale for treating the hyponatremia, even when apparently asymptomatic, is discussed, with attention to cognitive function, gait, and bone structure disturbances that increase the risk for fractures. The various available treatment approaches, including water restriction, demeclocycline, loop diuretics with NaCl supplementation, urea, and vasopressin antagonists are summarized, with emphasis on the efficacy and limitations of each of these therapies.

Topics: Age Factors; Aged; Antidiuretic Hormone Receptor Antagonists; Biomarkers; Chronic Disease; Demeclocycline; Drinking; Female; Hormone Antagonists; Humans; Hyponatremia; Predictive Value of Tests; Risk Factors; Sodium; Sodium Chloride; Sodium Potassium Chloride Symporter Inhibitors; Treatment Outcome; Urea; Urination; Water-Electrolyte Balance

Etiopathogenesis, diagnostics and therapy of hyponatremias are summarized for clinicians. Hyponatremia is the most common electrolyte abnormality. Mild to moderate hyponatremia and severe hyponatremia are found in 15-30% and 1-4% of hospitalized patients, respectively. Pathophysiologically, hyponatremias are classified into two groups: hyponatremia due to non-osmotic hypersecretion of vasopressin (hypovolemic, hypervolemic, euvolemic) and hyponatremia of non-hypervasopressinemic origin (pseudohyponatremia, water intoxication, cerebral salt wasting syndrome). Patients with mild hyponatremia are almost always asymptomatic. Severe hyponatremia is usually associated with central nervous system symptoms and can be life-threatening. Diagnostic evaluation of patients with hyponatremia is directed toward identifying the extracellular fluid volume status, the neurological symptoms and signs, the severity and duration of hyponatremia, the rate at which hyponatremia developed. The first step to determine the probable cause of hyponatremia is the differentiation of the hypervasopressinemic and non-hypervasopressinemic hyponatremias with measurement of plasma osmolality, glucose, lipids and proteins. For further differential diagnosis of hyponatremia, the determination of urine osmolality, the clinical assessment of extracellular fluid volume status and the measurement of urine sodium concentration provide important information. The most important representative of euvolemic hyponatremias is SIADH. The diagnosis of SIADH is based on the exclusion of other hyponatremic conditions; low plasma osmolality (<275 mosmol/kg) and inappropriate urine concentration (urine osmolality >100 mosmol/kg) are of pathognomic value. Acute (<48 hrs) severe hyponatremia (<120 mmol/l) necessitates emergency care with rapid restoration of normal osmotic milieu (1 mmol/l/hr increase rate of serum sodium). Patients with chronic symptomatic hyponatremia have a high risk of osmotic demyelination syndrome in brain if rapid correction of the plasma sodium occurs (maximal rate of correction of serum sodium should be 0.5 mmol/l/hr or less). The conventional treatments for chronic asymptomatic hyponatremia (except hypovolemic patients) include water restriction and/or the use of demeclocycline or lithium or furosemide and salt supplementation. Vasopressin receptor antagonists have opened a new forthcoming therapeutic era. V2 receptor antagonists, such as lixivaptan, tolvaptan, satavaptan and the V2+

Topics: Antidiuretic Hormone Receptor Antagonists; Azepines; Benzamides; Benzazepines; Blood Volume; Brain Diseases; Central Nervous System; Chronic Disease; Demeclocycline; Demyelinating Diseases; Diagnosis, Differential; Diuretics; Extracellular Fluid; Furosemide; Humans; Hyponatremia; Inappropriate ADH Syndrome; Lithium Compounds; Morpholines; Osmolar Concentration; Osmosis; Pyrroles; Severity of Illness Index; Sodium; Spiro Compounds; Time Factors; Tolvaptan; Vasopressins

Topics: Absenteeism; Adult; Ampicillin; Chronic Disease; Clinical Trials as Topic; Common Cold; Demeclocycline; Drug Synergism; Humans; Information Systems; Male; Middle Aged; Nasal Mucosa; Placebos; Punched-Card Systems; Respiratory Tract Infections; Smoking; Sputum; Surveys and Questionnaires; Time Factors

Mucosal changes have been well described in chronic sinusitis, yet little is known about the underlying bone, despite clinical and experimental evidence suggesting that bone may be involved in chronic sinusitis. Techniques of undecalcified bone analysis were used for detailed histologic examination of ethmoid bone in chronic sinusitis compared with controls. Bone synthesis, resorption, and inflammatory cell presence were specifically assessed. Additionally, histomorphometry techniques were used to determine ethmoid bone physiology in individuals undergoing surgery for chronic sinusitis. Overall, individuals undergoing surgery for chronic sinusitis were found to have evidence of marked acceleration in bone physiology with histologic changes including new bone formation, fibrosis, and presence of inflammatory cells. These findings are compared with osteomyelitis in long bone and the jaw. The suggestion that underlying bone may serve as a catalyst for chronic sinusitis is supported and implications for therapy are discussed.

Topics: Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Bone Remodeling; Bone Resorption; Chronic Disease; Coloring Agents; Demeclocycline; Edema; Endoscopy; Ethmoid Bone; Ethmoid Sinusitis; Female; Fibrosis; Humans; Male; Mandibular Diseases; Mucous Membrane; Osteitis; Osteogenesis; Osteomyelitis; Prospective Studies; Rhinitis; Single-Blind Method; Tetracycline; Turbinates

Topics: Acute Disease; Butorphanol; Chronic Disease; Demeclocycline; Drinking Behavior; Furosemide; Humans; Inappropriate ADH Syndrome; Lithium Carbonate; Saline Solution, Hypertonic; Sodium

Chronic syndrome of inappropriate secretion of antidiuretic hormone (chronic SIADH) has been reported in adults after traumatic brain injury (TBI) but few similar cases have been reported in the pediatric population. We present a case of a 14-year-old boy who developed chronic SIADH after TBI in which caloric needs could not be adequately provided, with concomitant fluid restriction as the first line of treatment. Demeclocycline was ultimately used, which allowed for increased fluid liberalization and for provision of adequate calories. This form of therapy should be considered early in a child's course to prevent nutritional decline. Demeclocycline may be used for prolonged periods until the child's clinical condition permits fluid restriction to be effective therapy.

Topics: Adolescent; Brain Injuries; Chronic Disease; Demeclocycline; Energy Intake; Humans; Inappropriate ADH Syndrome; Male

Serum sodium concentration increased significantly in eight hyponatremic schizophrenic subjects treated with demeclocycline. The incidence of severe hyponatremic episodes was significantly reduced. The authors argue that mild impairments in urinary dilution contribute to water intoxication in most chronic psychotics who develop this syndrome. Demeclocycline may help these patients.

Topics: Adult; Chronic Disease; Compulsive Behavior; Demeclocycline; Drinking Behavior; Female; Humans; Hyponatremia; Inappropriate ADH Syndrome; Male; Middle Aged; Schizophrenia

Topics: Chronic Disease; Demeclocycline; Drug Therapy, Combination; Genital Diseases, Male; Humans; Inflammation; Male; Streptokinase

Topics: Bacterial Infections; Chronic Disease; Demeclocycline; Drug Therapy, Combination; Genital Diseases, Male; Humans; Inflammation; Male; Streptodornase and Streptokinase

We evaluated demeclocycline and lithium therapy in 10 patients with the syndrome of inappropriate secretion of antidiuretic hormone. Despite severe water restriction, all patients had hyponatremia (mean +/- S.E.M. serum sodium of 122 +/- 1.1 meq per liter) and elevated urine osmolality (744 +/- 59 mOsm per kilogram) before treatment. Demeclocycline (600 to 1200 mg daily) restored serum sodium concentration to 139 +/- 1.1 meq per liter within five to 14 days, permitting unrestricted water intake in all patients. In three patients given lithium carbonate (900 mg daily) the serum sodium concentration, urine osmolality and urine volume were unchanged; since two patients had adverse central-nervous-system symptoms during lithium therapy, further study of this agent was abandoned. A patient with an unusual 22-year history of the syndrome was unresponsive to lithium, whereas long-term treatment with demeclocyline was markedly effective. Demeclocycline is superior to lithium in the treatment of the syndrome and may obviate the need for severe water restriction.

Topics: Adult; Aged; Child; Chronic Disease; Demeclocycline; Drug Evaluation; Female; Humans; Hyponatremia; Lithium; Male; Middle Aged; Osmolar Concentration; Sodium; Syndrome; Vasopressins

The efficacy of demeclocycline hydrochloride in suppressing the tubular action of tumoral antidiuretic products was tested in seven patients with the syndrome of inappropriate antidiuretic hormone secretion. In all patients, demeclocycline hydrochloride (1,200 mg/day) induced production of hypotonic urine and corrected hyponatremia despite large fluid intakes. Comparison of the response to a standard water load before and during treatment showed a notable improvement in the response to water ingestion. Even though demeclocycline moderately impairs renal function, it appears to be the treatment of choice in the chronic form of the syndrome.

Topics: Administration, Oral; Aged; Carcinoma, Small Cell; Chronic Disease; Demeclocycline; Depression, Chemical; Dose-Response Relationship, Drug; Humans; Hyponatremia; Kidney Concentrating Ability; Lung Neoplasms; Male; Middle Aged; Syndrome; Vasopressins

Topics: Acute Disease; Adolescent; Bacteria; Child; Child, Preschool; Chronic Disease; Demeclocycline; Drug Resistance, Microbial; Female; Haemophilus Infections; Humans; Infant; Lymphadenitis; Male; Otitis Media; Parotitis; Pseudomonas Infections; Sinusitis; Staphylococcal Infections; Streptococcal Infections

Topics: Acute Disease; Adult; Aged; Bronchitis; Chlortetracycline; Cholecystitis; Chronic Disease; Cystitis; Demeclocycline; Female; Humans; Male; Middle Aged; Pyelitis; Tablets; Tetracycline; Tuberculosis, Pulmonary; Vibrio Infections

Topics: Acute Disease; Adult; Bacteria; Chloramphenicol; Chlortetracycline; Chronic Disease; Cystitis; Demeclocycline; Epididymitis; Female; Humans; Male; Middle Aged; Penicillin G; Pyelonephritis; Streptomycin; Tablets; Tetracycline; Urinary Tract Infections

Topics: Anti-Bacterial Agents; Bronchitis; Chloramphenicol; Chronic Disease; Demeclocycline; Humans; Methacycline; Oxytetracycline; Tetracycline

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Antigens; Antigens, Bacterial; Asthma; Bronchitis; Chloramphenicol; Chronic Disease; Chymotrypsin; Demeclocycline; Drug Resistance, Microbial; Enterobacter aerogenes; Erythromycin; Humans; Isoproterenol; Penicillin Resistance; Penicillins; Sputum; Staphylococcus; Streptomycin; Sulfisoxazole; Tetracycline