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