Journal of the Louisiana State Medical Society
Figure 2: CT of the chest with contrast showing abnormal appearing adenopathy seen within the bilateral axillary regions in coronal cuts (A&B) and a sagittal view (C). Arrows measure the short axis of the lymph nodes.
is sufficient to correct hyponatremia. When life threaten- ing conditions such as seizures, cerebral edema, or coma are present, treatment with hypertonic saline is indicated. When administering 3% saline, serum sodium levels must be monitored closely, and the correction should be gradual (<10 mEq/day) due to the risk of osmotic demyelination. 8,14 If sodium levels are resistant to the above measures, dem- eclocycline is a therapeutic option. This medication inter- feres with the anti-diuretic hormone effects on the kidney; however, its effects are sometimes unpredictable and it has
numerous side effects. Newer pharmacologic agents of inter- est that have been studied in euvolemic and hypervolemic hyponatremia are vasopressin-2 receptor blockers, referred to as aquaretics. 14 These drugs are competitive inhibitors of vasopressin, with the effective dose dependent on vasopres- sin serum levels. Vasopressin levels are often unknown and not constant. With the potential for overdiuresis or inadequate diuresis, serum sodium must be monitored closely in this setting.
270 J La State Med Soc VOL 166 November/December 2014
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