pituitrin and Spinal-Fractures

BACKGROUND The etiology of syndrome of inappropriate antidiuretic hormone secretion (SIADH) is highly variable. With little evidence, much of the guidance and recommendations available for management are based on clinical judgement. Although percutaneous balloon kyphoplasty can effectively relieve the severe pain associated with osteoporotic vertebral compression fractures that do not respond to conventional treatments, the effect of balloon kyphoplasty on SIADH associated with vertebral compression fracture remains unknown. CASE REPORT A 72-year-old woman was admitted to our hospital due to severe pain associated with lumbar compression fracture and pain-related SIADH. Since her pain could not be relieved by analgesics, she underwent percutaneous balloon kyphoplasty, a minimally invasive procedure intended to relieve pain. After the surgery, the patient's pain almost completely disappeared and her sodium level was gradually corrected within 3 days without any adverse events. CONCLUSIONS Percutaneous balloon kyphoplasty is a novel treatment option for SIADH associated with vertebral compression fracture. In the case presented here, it rapidly reduced pain and disability and also improved severe pain-associated SIADH without adverse effects. It may offer an alternative to pain regimens consisting of drugs, such as duloxetine, pregabalin, and opioids, that may exacerbate SIADH and hyponatremia. This case suggests treatment for new-onset or worsening hyponatremia in patients with vertebral compression fracture.

Topics: Aged; Female; Fractures, Compression; Humans; Kyphoplasty; Osteoporotic Fractures; Spinal Fractures; Treatment Outcome; Vasopressins

Blindness caused by ischemic optic neuropathy in the hospital setting occurs perioperatively and in critically ill patients, but its etiology remains ill defined. We describe four critically ill patients who developed blindness within 1 mo of one another. Three cases occurred outside of the operative arena. Potential risk factors for the development of ischemic optic neuropathy, such as use of vasopressors, venous congestion, and hypotension, are described.

Topics: Accidents, Traffic; Blindness; Diabetes Mellitus, Type 1; Diabetic Ketoacidosis; Diverticulitis; Female; Flail Chest; Hemothorax; Humans; Intensive Care Units; Lung Injury; Male; Middle Aged; Myasthenia Gravis; Myocardial Infarction; Optic Nerve Injuries; Optic Neuropathy, Ischemic; Pancreatitis; Pelvic Bones; Prone Position; Risk Factors; Sepsis; Spinal Fractures; Vasopressins