sheenan syndrome presentation
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Sheehans SyndromeSheehans Syndrome
Laura Laureano
Tanya Carl
Heemesh Seth
Na+ and Cl- levels are lowNa+ = 108 mEq/L (135-145 mEq/L)Cl- = 81 mEq/L (100-108 mEq/L)
Hyponatremia = Low Sodium Levels
Electrolyte Abnormalities:
Why Were NaWhy Were Na++ Levels Slow to Levels Slow to Correct?Correct?
•Hyponatremia rapidly corrected to 119 mEq/L
–Active Hydration (normal saline sol–Followed by Furosemide Diuresis
–fluids were restricted•Na+ was slow to correct (135-145
mEq/L)??…
Slow to CorrectSlow to Correct
•Saline solution administered needs to be adjusted to the Patients amount of solutes lost ( Na+)
•Sodium Conc = Total body salt / Total body Volume
(.60*body weight in Kg)
What would be the causes of Hyponatrenmia in our patient ?
The hyponatremia in Sheehans syndrome is not clearly pathologically understood
Possible Hypothesis ?
Hormones Secreted by Anterior Pituitary and it’s effects on
Water.
Thyroid our pt: <.4ng/dl
•TSH → .20 uU//ml
•decrease Water Clearance (i.e Fluid retention)
• ↑Activation of Vasopressin
Adrenal Medulla
• Glucocorticoid deficiency → non osmotic stimulus
• ↑Activation of Vasopressin
Blood Loss; → ↑Activation of Vasopressin
Maintenance of Normal levels:
• After Hormone therapy; Hydrocortisone, Levothyroxine
What complications can/will a patient with hyponatremia experience?
Complications
• Related to the central nervous systemEarly manifestation
anorexia, nausea, lethargy, and apathy • Advanced symptoms
disorientation, agitation, seizures, depressed reflexes, focal neurologic deficits and, eventually, Cheyne-Stokes respiration
• Other symptomsWeight gain, loss of appetite, vomiting, headache, muscle spasms, restlessness, fatigue,
ComplicationsComplications
• Development of Central Pontine Myelinolysis
caused by aggressive therapy
• Features: disorders of upper motor neurons, spastic quadriparesis and pseudobulbar palsy, and mental disorders ranging from mild confusion to coma
Death may occur
Complications
• Complications correlate with how rapidly condition developed • Acute Hyponatremia (within 24-48hrs)
SeizuresComasNo mortality from aggressive treatment
• Chronic Hyponatremia (within ~3 days)No Seizures or ComasDemyelination lesions in the brain (from aggressive therapy)High Mortality rate
REFERENCES
http://www.gv.edu/library/e-reserves/teamnursing/rnsg1443-SP04
http://ndt.oupjournals.org/cgi/content/full/16/9/1799#R15#R15
Nephrol Dial Transplant (2001) 16: 1708-1710
http://ndt.oupjournals.org/cgi/content/full/16/8/1708
Pham, TC. Pham, PM. Pham, HV. Treatment of Chronic Hyponatremia. UCLA. Mar, 29, 2005
Questions and AnswersQuestions and Answers
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