Guy Decaux

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Christopher Anzalone

Marine Corps University

Don Ross

University College Cork

Armando Marques-Guedes

UNL - New University of Lisbon

Jan Slaby

Freie Universität Berlin

Nicholas V Cozzi, Ph.D.

University of Wisconsin-Madison

Mercedes Tubino-Blanco

Western Michigan University

Revista Innovación Educativa, Instituto Politécnico Nacional

Instituto Politécnico Nacional

Karolina M Gilas

Universidad Nacional Autónoma de México

George Panagis

University of Crete

Thereza Christina Monteiro Lima

Universidade Federal de Santa Catarina - UFSC (Federal University of Santa Catarina)

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Papers by Guy Decaux

Management of Hypotonic Hyponatremia

Springer eBooks, 1988

Iconography : SIADH et traitement par vaptans

Psychosis, central hyperventilation and inappropriate secretion of antidiuretic hormone in systemic lupus erythematosus

Postgraduate Medical Journal, Nov 1, 1981

A case of systemic lupus erythematosus with reversible psychosis and hyperventilation related to ... more

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Hyperglycemia induces attention and gait deficits in diabetic mellitus patients

Acta Diabetologica, Aug 23, 2017

Results During transient hyperglycemia, the mean response time (ms) and the TDT were significantl... more Results During transient hyperglycemia, the mean response time (ms) and the TDT were significantly longer. The mean response time for the four tests increased by 53, 5 ms (P < 0.001). There was no increase in the number of errors. The TDT of the center of pressure increased significantly by 102 mm (P < 0.001). Conclusions Transient hyperglycemia alters attention and gait in patients with diabetes mellitus.

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Inappropriate secretion of antidiuretic hormone treated with frusemide

BMJ, Jul 10, 1982

These findings add further weight to evidence that frusemide is a good alternative for the treatm... more

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Rapid (24-Hour) Reaccumulation of Brain Organic Osmolytes (Particularly myo-Inositol) in Azotemic Rats after Correction of Chronic Hyponatremia

Journal of The American Society of Nephrology, Jun 1, 2002

It was recently demonstrated that renal failure and exogenous urea prevent myelinolysis induced b... more It was recently demonstrated that renal failure and exogenous urea prevent myelinolysis induced by rapid correction of experimental hyponatremia. To determine why elevated blood urea levels favorably affect brain tolerance to osmotic stress, the changes in brain solute composition that occur when chronic hyponatremia is rapidly corrected were studied in rats with or without mercuric chloride-induced renal failure. After 48 h of hyponatremia, the brains of azotemic and nonazotemic animals became depleted of sodium, potassium, and organic osmolytes. Twenty-four hours after rapid correction of hyponatremia, the brains of animals without azotemia remained depleted of organic osmolytes, with little increase in myoinositol or taurine contents above those observed in animals with uncorrected hyponatremia; brain electrolytes were rapidly reaccumulated, increasing the brain sodium content to a level 17% higher than values for normonatremic control animals. In contrast, within 2 h after correction of hyponatremia, brain myo-inositol contents in azotemic rats returned to control levels and brain taurine levels were significantly higher than those in azotemic animals with uncorrected hyponatremia (16.5 versus 9 mol/g dry weight). There was no "overshooting" of brain sodium and water contents after rapid correction in the azotemic animals. Rapid reaccumulation of brain organic osmolytes after correction of hyponatremia could explain why azotemia protects against myelinolysis.

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Nephrogenic Syndrome of Inappropriate Antidiuresis in Adults

Journal of The American Society of Nephrology, Feb 1, 2007

Nephrogenic syndrome of inappropriate antidiuresis (NSIAD) is a recently described genetic cause ... more Nephrogenic syndrome of inappropriate antidiuresis (NSIAD) is a recently described genetic cause of hyponatremia in male infants. Whether this X-linked condition could be detected in the adult or also could affect women is unknown. A large five-generation family was identified in which the recently described arginine-vasopressin receptor type 2 (AVPR2) mutation that is responsible for NSIAD was segregated. The proband was a 74-yr-old patient who had a syndrome of inappropriate antidiuresis and whose hyponatremia resisted administration of two AVPR2 antagonists. The phenotype of family members who carry the mutation was investigated. Patients with normal serum sodium were subjected to a water-load test. The previously reported activating missense R137C mutation in the AVPR2 gene in three hemizygous male and four heterozygous female individuals was identified. Except in one woman, spontaneous episodes of hyponatremia or abnormal water-load test were identified in all patients with the mutation, whether male or female. Skewed X inactivation was evidenced in the blood of the asymptomatic woman, which is compatible with preferential inactivation of her mutated allele. NSIAD is not limited to male infants. The diagnosis also should be considered in both male and female adults.

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Lack of elevation of urinary albumin excretion among patients with chronic syndromes of inappropriate antidiuresis

Nephrology Dialysis Transplantation, May 25, 2008

Background. A recent study has revealed that acute and chronic administration of the vasopressin ... more Background. A recent study has revealed that acute and chronic administration of the vasopressin V2 receptor (V2R) agonist dDAVP induced a marked increase of urinary albumin excretion (UAE) in healthy rats and humans (Bardoux P et al. Nephrol Dial Transplant 2003; 18: 497-506). The occurrence of an elevation of UAE among patients with chronic syndromes of inappropriate antidiuresis has not been reported. Methods. We looked for the elevation of UAE in 24-h urine samples of the following patients: nine chronic SIADH patients, two patients with acute post-operative SIADH, three patients of the same family with nephrogenic syndrome of inappropriate antidiuresis (NSAID) and two patients with hyponatraemia due to surdosage of dDAVP in the setting of central diabetes insipidus. Results. There was no elevation of UAE in our patients (whether they presented with hyponatraemia or not), apart from a patient treated with supra-physiological doses of dDAVP. When she received 80 µg/day of dDAVP, her UAE was 42 mg/day. In this patient, UAE returned to the normal range (21 mg/day) when doses of dDAVP were tapered (20 µg/day). Conclusion. The present study shows that chronic V2R stimulation generally does not result in a rise in UAE. The discrepancy between our results and those of the abovementioned study could be explained by a dose-dependent effect of V2R stimulation on UAE.

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Osmotic Stress–Induced Defective Glial Proteostasis Contributes to Brain Demyelination after Hyponatremia Treatment

Journal of The American Society of Nephrology, Jan 25, 2017

Adequate protein folding is necessary for normal cell function and a tightly regulated process th... more Adequate protein folding is necessary for normal cell function and a tightly regulated process that requires proper intracellular ionic strength. In many cell types, imbalance between protein synthesis and degradation can induce endoplasmic reticulum (ER) stress, which if sustained, can in turn lead to cell death. In nematodes, osmotic stress induces massive protein aggregation coupled with unfolded protein response and ER stress. In clinical practice, patients sustaining rapid correction of chronic hyponatremia are at risk of osmotic demyelination syndrome. The intense osmotic stress sustained by brain cells is believed to be the major risk factor for demyelination resulting from astrocyte death, which leads to microglial activation, blood-brain barrier opening, and later, myelin damage. Here, using a rat model of osmotic demyelination, we showed that rapid correction of chronic hyponatremia induces severe alterations in proteostasis characterized by diffuse protein aggregation and ubiquitination. Abrupt correction of hyponatremia resulted in vigorous activation of both the unfolded protein response and ER stress accompanied by increased autophagic activity and apoptosis. Immunofluorescence revealed that most of these processes occurred in astrocytes within regions previously shown to be demyelinated in later stages of this syndrome. These results identify osmotic stress as a potent protein aggregation stimuli in mammalian brain and further suggest that osmotic demyelination might be a consequence of proteostasis failure on severe osmotic stress.

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Vaptans are not the mainstay of treatment in hyponatremia: perhaps not yet

Kidney International, Sep 1, 2011

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Urea for long-term treatment of syndrome of inappropriate secretion of antidiuretic hormone

BMJ, Oct 24, 1981

The efficacy of oral urea in producing a sufficiently high osmotic diuresis was tested in seven p... more The efficacy of oral urea in producing a sufficiently high osmotic diuresis was tested in seven patients with the syndrome of inappropriate secretion of antidiuretic hormone. In all patients urea corrected the hyponatraemia despite a normal fluid intake. Five patients were controlled (serum sodium concentration v 128 mmol(mEq)/l) with a dose of 30 g urea daily, and two with 60 g daily. The patients who needed 30 g drank 1-2 1 of fluid daily, while those who needed 60 g drank up to 31 per day. No major side effects were noted, even after treatment periods of up to 270 days. These findings suggest that urea is a safe and efficacious treatment of the syndrome of inappropriate secretion of antidiuretic hormone.

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Treatment of euvolemic hyponatremia in the intensive care unit by urea

Critical Care, 2010

Introduction: Hyponatremia in the intensive care unit (ICU) is most commonly related to inappropr... more Introduction: Hyponatremia in the intensive care unit (ICU) is most commonly related to inappropriate secretion of antidiuretic hormone (SIADH). Fluid restriction is difficult to apply in these patients. We wanted to report the treatment of hyponatremia with urea in these patients. Methods: Two groups of patients are reported. The first one is represented by a retrospective study of 50 consecutive patients with mild hyponatremia treated with urea. The second group is presented by a series of 35 consecutive patients with severe hyponatremia acquired outside the hospital (≤ 115 mEq/L) who where treated by isotonic saline and urea (0.5 to 1 g/kg/day), administered usually by gastric tube. Results: In the first group with mild hyponatremia (128 ± 4 mEq/L) the serum sodium (SNa) increased to a mean value of 135 ± 4 mEq/L (P < 0.001) after two days of urea therapy (46 ± 25 g/day), despite a large fluid intake (> 2 L/day). The mean duration of urea therapy was six days (from 2 to 42 days). Six patients developed hyponatremia again once the urea was stopped, which necessitated its reintroduction. Six patients developed hypernatremia (maximum value 155 mEq/L). In the second group, SNa increased from 111 ± 3 mEq/L to 122 ± 4 mEq/L in one day (P < 0.001). All the patients with neurological symptoms made a rapid recovery. No side effects were observed. Conclusions: These data show that urea is a simple and inexpensive therapy to treat euvolemic hyponatremia in the ICU.

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La Maladie De Behcet

Revue Médicale de Bruxelles, 1991

SCOPUS: sh.jinfo:eu-repo/semantics/publishe

Syphilis méningo-vasculaire avec manifestations épileptiques

Dermatology, 1982

SCOPUS: NotDefined.jinfo:eu-repo/semantics/publishe

Hyponatremic Encephalopathy

Critical Care Medicine, 2018

SCOPUS: le.jinfo:eu-repo/semantics/publishe

Tetracycline-Induced Renal Hypophosphatemia in a Patient with a Syndrome of Inappropriate Secretion of Antidiuretic Hormone

Nephron, 1988

A third case of acquired phosphate diabetes associated with a syndrome of inappropriate secretion... more A third case of acquired phosphate diabetes associated with a syndrome of inappropriate secretion of antidiuretic hormone (SIADH), related to a pulmonary tuberculosis, is reported. Renal hypophosphatemia in this patient was caused by the erroneous intake of 1 g doxycycline. It is likely that the selective nephrotoxicity in these 3 patients with SIADH was induced by tetracycline.

Hypertonic saline, isotonic saline, water restriction, long loops diuretics, urea or vaptans to treat hyponatremia

Expert Review of Endocrinology & Metabolism, May 3, 2020

Introduction: Hyponatremia is the most common fluid and electrolyte abnormality. It is associated... more Introduction: Hyponatremia is the most common fluid and electrolyte abnormality. It is associated with much higher morbidity and mortality rates than found in non hyponatremic patients. Areas covered: When the physician is faced to a hyponatremic patient he first has to confirm that hyponatremia is associated with hypoosmolality. Then he must answer to a series of questions: What is its origin? Is it acute or chronic? Which treatment is the most appropriate? We will discuss the various options for the treatment of hypotonic hyponatremia. For a better comprehensive approach of the treatment we will also discuss some pathophysiological data. The use of urea in euvolemic and hypervolemic hyponatremia will be particularly discussed. Literature was reviewed from Jan 1970 to Dec 2019. Expert opinion: Prospective studies showing the benefit in decreasing morbidity by increasing SNa in patients with chronic hyponatremia should be done. These studies should also compare the efficacy and side effects of urea therapy compare to vaptans.

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Syndrome d’immunodéficience acquise (AIDS) révélé par un herpes génital sévère

Dermatology, 1984

The authors present 2 cases of AIDS revealed by severe recurrent genital herpes simplex. The pati... more The authors present 2 cases of AIDS revealed by severe recurrent genital herpes simplex. The patients are 2 young, previously healthy, African women without histories of homosexuality or drug abuse. The first patient died after 5 months of follow-up (post mortem findings: viral bronchopneumonia with positive cultures for herpes and cytomegalovirus (CMV), viral colitis due to CMV). The second patient survived. She has been treated, during the last 11 months, for filariasis, buccal and vaginal candidiasis and cerebral toxoplasmosis.

Urea Treatment for Exercise-associated Hyponatremia

Clinical Journal of Sport Medicine, May 1, 2006

To the Editor: We read with interest the recent ‘‘Consensus Statement of the First International ... more To the Editor: We read with interest the recent ‘‘Consensus Statement of the First International Exercise-associated Hyponatremia Consensus Development Conference’’ (Clin J Sport Med. 2005; 15:208–213). The morbidity and mortality in acute hyponatremia are related to brain edema and decreasing as rapidly as possible brain edema by removing water could be life saving. The recommendations of consensus conference consist in the administration of a 100mL 3% NaCl solution, in 10 minutes that is expected to increase serum Na values by 2 to 3mmol/L. The authors of the consensus also suggest the study of the role of oral hypertonic NaCl solution onsite (especially when intravenous solutions are not available). It should, however, be noted that large amounts of fluid could still be reabsorbed later from the bowel, with subsequent lower than expected correction of serum Na value. We rather suggest the oral or intravenous administration of urea at doses 0.5 to 1 g/kg of body weight; this scheme will increase the osmotic gradient for the brain by 15 to 30mmol/L in 30 to 60 minutes. When use in hyponatremic patients with noncardiac acute pulmonary edema administration of urea will not be associated with volume expansion, unlike hypertonic saline. Urea is usually dissolved in 150mL of water with a fruit syrup or with an antacid (Maalox) and the obtained solution can be given orally, or by nasogastric tube if the patient is unconscious or nauseating. The oral route will allow administration of a larger dose and a more rapid increase of brain osmotic gradient. However, intravenous route (Ureaphil) is still an alternative in the unconscious patient when nasogastric tube cannot be placed. Urea has been used to treat brain edema for decades as it diffuses rapidly in all tissues except in the brain where equilibration with intracellular water takes longer (4 to 10 h). The use of urea in symptomatic exercise-associated hyponatremia should be confirmed by a prospective study.

Cerebral ventricular volume during hyponatraemia

Journal of Neurology, Neurosurgery, and Psychiatry, May 1, 1983

In order to determine if the neurologic manifestations in chronic hyponatraemia result partly fro... more In order to determine if the neurologic manifestations in chronic hyponatraemia result partly from brain oedema, we measured the cerebral ventricular volume before ano after correction of hyponatraemia in eight patients with central nervous system manifestations. Only the three patients with seizures showed a clear change in the ventricular size and probably had brain oedema.

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Management of Hypotonic Hyponatremia

Springer eBooks, 1988

Iconography : SIADH et traitement par vaptans

Psychosis, central hyperventilation and inappropriate secretion of antidiuretic hormone in systemic lupus erythematosus

Postgraduate Medical Journal, Nov 1, 1981

A case of systemic lupus erythematosus with reversible psychosis and hyperventilation related to ... more

Download

Hyperglycemia induces attention and gait deficits in diabetic mellitus patients

Acta Diabetologica, Aug 23, 2017

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Inappropriate secretion of antidiuretic hormone treated with frusemide