'Low sodium' diuresis and ileal loss in patients with ileostomies: effect of desmopressin

Article Abstract:

To learn more about the physiology of patients who have undergone ileostomies, a study of eight subjects who had had the procedure several years earlier was carried out. Ileostomy is the surgical creation of a passage from the ileum (the last part of the small intestine) through the abdominal wall so that fecal matter enters a disposable bag fixed with adhesive on the abdomen. Patients with ileostomies are at risk of losing too much sodium and water and may become dehydrated if they fail to include sufficient sodium in their diets. This occurs even though the concentrations of sodium and water in the blood remain normal. The mechanism by which large quantities of water are lost (diuresis) in ileostomy patients is not known, but it may involved decreased secretion of arginine vasopressin, a naturally-occurring antidiuretic (a substance that promotes water retention). To evaluate the role of arginine vasopressin in water balance after ileostomy, the patients received either desmopressin (a synthetic drug analogous to arginine vasopressin) or a placebo (inactive) drug on two separate occasions while eating a low-sodium diet. The concentrations of sodium and potassium in blood, urine, and fecal fluid were measured at regular intervals. Following placebo administration, there was a pronounced diuresis on the first day of the low-sodium diet, which was associated with a decrease in sodium excretion by the kidney and no alteration in the volume or composition of fecal fluid. After desmopressin, most patients experienced a significant decrease in fluid loss, with changes in kidney sodium excretion and fecal fluid output excretion similar to those in the placebo condition. Hence, desmopressin can prevent diuresis in patients on a low sodium diet without effects on sodium excretion by the kidney. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Physiological aspects, Ileostomy, Gastrointestinal system, Desmopressin, Diuresis

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Rhabdomyolysis after intramuscular iron-dextran in malabsorption

Article Abstract:

Iron bound to dextran, a sugar-like polymer, is a common treatment for iron deficiency, and is usually given by intramuscular injection or by infusion. Common local or systemic reactions include joint and muscle pain. A case is reported of a 59-year-old man with chronic malabsorption who developed rhabdomyolysis, muscle destruction, following iron-dextran given intramuscularly. The patient had diarrhea and malabsorption related to partial intestinal atrophy associated with a deficiency in a subtype of antibodies, immunoglobulin A (IgA). Steroid treatment, which can suppress the immune system, led to a decrease in diarrhea, but intestinal atrophy remained. Iron-dextran, used to treat the malabsorption-related iron deficiency, resulted in local and generalized muscle pain, with subsequent muscle weakness and dark urine. The patient was found to be deficient in vitamin E and selenium, molecules that protect against oxygen-mediated cell and molecular damage. A muscle biopsy obtained 19 days after the peak of muscle pain suggested that muscle fibers were regenerating after muscle inflammation and damage. The report suggests that due to the patient's prolonged malabsorption of many nutrients, rhabdomyolysis due to iron-dextran treatment, which otherwise might have gone unnoticed, became evident. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Rhabdomyolysis, Iron-dextran complex

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Improved functional outcome in patients with early rheumatoid arthritis treated with intramuscular gold: results of a five year prospective study

Article Abstract:

Early treatment of rheumatoid arthritis with injections of gold may effectively improve the functional ability of patients. Intramuscular gold injections are generally reserved for more advanced cases of the disease. Researchers treated 440 patients with regular gold injections. In patients with recent-onset disease, gold treatments produced a 30% decrease in disability. Functional ability did not significantly improve in patients with arthritis of longer duration. Initiating treatment within two years of diagnosis may be most beneficial in patients with rheumatoid arthritis.

Health aspects, Evaluation, Drug therapy, Rheumatoid arthritis, Gold, Antirheumatic agents

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