digoxin and Hyponatremia

Topics: Benzothiadiazines; Diagnosis, Differential; Digoxin; Diuretics; Heart Failure; Humans; Hyponatremia; Lung Diseases; Sodium Chloride Symporter Inhibitors; Vascular Resistance; Vasodilator Agents

Subarachnoid haemorrhage is commonly associated with natriuresis and hyponatraemia. One possible explanation for these features is a defect in the central regulation of renal sodium reabsorption with increased secretion of a natriuretic factor. We investigated whether excess sodium secretion in patients with subarachnoid haemorrhage is related to increased secretion of natriuretic peptides or to the presence of digoxin-like immunoreactive substances.. We measured the plasma concentrations of digoxin-like immunoreactive substances (by a fluorescence polarisation immunoassay) and natriuretic peptides, aldosterone, renin, and antidiuretic hormone (by radioimmunoassay) in ten patients with aneurysmal subarachnoid haemorrhage, ten patients undergoing elective craniotomy for cerebral tumours, and 40 healthy controls of similar age and sex distribution. Samples were collected before surgery, 1 h, 4 h, and 12 h after surgery, then daily until 7 days postoperatively in the two groups of patients.. All patients with subarachnoid haemorrhage, but none of the tumour patients, showed increased urine output and urinary excretion of sodium (p = 0.018 for comparison of means of curves to 7 days). The patients with subarachnoid haemorrhage had much higher plasma concentrations of brain natriuretic peptide (BNP) than controls, on admission (mean 15.1 [SE 3.8] vs 1.6 [1.0] pmol/L, p < 0.001) and throughout the study period, accompanied by lower than normal aldosterone concentrations and normal plasma concentrations of atrial and C-type natriuretic peptides (ANP, CNP). The patients with tumours had similar plasma concentrations of ANP, BNP, and CNP to the controls. We did not detect digoxin-like immunoreactive substances in either group of patients.. Salt-wasting of central origin may induce hyponatraemia in patients with aneurysmal subarachnoid haemorrhage, possibly as a result of increased secretion of BNP with subsequent suppression of aldosterone synthesis.

Topics: Brain Neoplasms; Cardenolides; Digoxin; Enzyme Inhibitors; Female; Fluorescence Polarization Immunoassay; Humans; Hyponatremia; Intracranial Aneurysm; Male; Middle Aged; Natriuretic Agents; Natriuretic Peptide, Brain; Nerve Tissue Proteins; Saponins; Sodium; Sodium-Potassium-Exchanging ATPase; Subarachnoid Hemorrhage

Topics: Blood Proteins; Cardenolides; Digoxin; Humans; Hyponatremia; Intracranial Aneurysm; Plasma Volume; Renin; Saponins; Sodium-Potassium-Exchanging ATPase; Subarachnoid Hemorrhage; Vasopressins

Because the syndrome of inappropriate antidiuretic hormone (SIADH) is a state of disturbed body fluid volume regulation and altered sodium balance we sought to determine if recently described volume regulatory factors were stimulated in SIADH. We measured atrial natriuretic peptide (ANP), endogenous digitalis-like natriuretic factor (EDNF) and urinary free dopamine in SIADH (n = 27). We also determined fractional clearance of lithium (FCLi). The data obtained in SIADH were compared with similar measurements performed in sodium retaining hyponatremias, such as those of heart failure (n = 26), liver cirrhosis (n = 19) and volume contraction (n = 28). We observed: ANP was 19.5 +/- 2.7 fM/ml in SIADH; it was significantly lower than ANP in cardiac failure, but no different from ANP in volume contraction. Urinary free dopamine was 2.2 +/- 0.8 microM/24 h in SIADH; this was significantly higher than in volume contraction and liver cirrhosis. EDNF (259 +/- 42 nM/24 h) and FCLi (21.4 +/- 2%) were both numerically higher in SIADH than in other hyponatremic disorders; however, the differences did not achieve significance. In conclusion, our observations did not establish a specific role of ANP in chronic stable SIADH. As to the importance of EDNF, dopamine and proximal tubular fluid reabsorption (FCLi) additional work using acute volume changes may demonstrate their participation in the renal sodium handling of SIADH more clearly than our study did.

Topics: Aged; Arginine Vasopressin; Atrial Natriuretic Factor; Blood Proteins; Cardenolides; Digoxin; Dopamine; Female; Heart Failure; Humans; Hyponatremia; Inappropriate ADH Syndrome; Lithium; Liver Cirrhosis; Male; Middle Aged; Plasma Volume; Saponins

Topics: Blood Proteins; Cardenolides; Digoxin; Humans; Hyponatremia; Infant, Newborn; Infant, Premature; Saponins

Topics: Blood Proteins; Cardenolides; Digoxin; Humans; Hyponatremia; Infant, Newborn; Infant, Premature; Saponins

We examined the frequency of hypokalemia and hypomagnesemia in patients receiving digitalis. Serum sodium, magnesium, and potassium levels were determined in 136 serum samples sent to the laboratory for digoxin assay. Hyponatremia (less than or equal to 130 mEq/L) occurred most frequently (21%), followed by hypomagnesemia (less than or equal to 1.25 mEq/L) in 19%, hypokalemia (less than or equal to 3.5 mEq/L) in 9%, and hypermagnesemia (greater than or equal to 2.25 mEq/L) in 7%. The twofold frequency of hypomagnesemia (19%) contrasted with hypokalemia (9%) indicates that clinicians are more attuned to avoiding hypokalemia than hypomagnesemia in patients receiving digitalis. Because hypokalemia and/or hypomagnesemia may contribute to the toxic effects of digitalis, our observation suggests that hypomagnesemia may be a more frequent contributor than hypokalemia to induction of toxic reactions to digitalis. Routine serum magnesium determination in patients receiving digitalis, who often are also receiving potent diuretics, may assist in identifying additional patients at risk for the toxic effects of digitalis.

Topics: Digitalis Glycosides; Digitoxin; Digoxin; Hospitalization; Humans; Hypokalemia; Hyponatremia; Magnesium

Topics: Digoxin; Diuretics; Heart Failure; Humans; Hypoglycemia; Hypokalemia; Hyponatremia; Hypothermia; Magnesium; Protein-Energy Malnutrition

Topics: Aminophylline; Digitalis Glycosides; Digoxin; Diuretics; Heart Failure; Heart Rate; Humans; Hypokalemia; Hyponatremia; Intermittent Positive-Pressure Breathing; Mineralocorticoid Receptor Antagonists; Oxygen; Potassium Deficiency; Pulmonary Edema; Tachycardia; Thyroid Diseases

Topics: Diet Therapy; Digitalis Glycosides; Digoxin; Diuretics; Heart Failure; Humans; Hypokalemia; Hyponatremia; Morphine; Pulmonary Edema; Rest; Water-Electrolyte Balance

Topics: Digoxin; Edema; Heart Failure; Humans; Hypocalcemia; Hyponatremia; Infant, Newborn; Infant, Newborn, Diseases; Magnesium

A daily infusion of 500-1,000 ml of 50% glucose containing 100-120 units of soluble insulin and 100-120 mEq of potassium chloride per litre was given to six patients suffering from hyponatraemia and congestive cardiac failure resistant to digoxin and diuretic therapy. In two patients there was no response, but four showed a striking improvement with a sodium and water diuresis, a rise in plasma sodium level, and in two cases a reversion from atrial fibrillation to sinus rhythm. It is suggested that insulin, glucose, and potassium given by the intravenous route in adequate dosage forms a useful adjunct to the management of severe congestive heart failure.

Topics: Adult; Aged; Atrial Fibrillation; Blood Pressure; Body Weight; Digoxin; Diuresis; Diuretics; Female; Glucose; Heart Failure; Humans; Hyponatremia; Injections, Intravenous; Insulin; Male; Middle Aged; Natriuresis; Potassium; Potassium Chloride; Sodium

Topics: Animals; Bicarbonates; Blood Pressure; Cardiac Output; Chlorides; Chromatography, Thin Layer; Digoxin; Dogs; Hydrogen-Ion Concentration; Hyponatremia; Myocardium; Osmolar Concentration; Potassium; Radionuclide Imaging; Renal Dialysis; Sodium; Tritium