Adh hormone in elderly. Share Link


In tee present study, 11 patients with PDI were investigated from September t o January during twenty-four-h clearance periods.

Foglalkozik az idôskorban megfigyelhetô élettani változásokkal, a táplálkozási szokásokat, az életmódot és az egészségi állapotot tanulmányozó epidemiológiai vizsgálatok eredményeivel.

Data of treatment days were compared with those of 73 control days. The diagnosis was established by the modified Cartter-Robbins test 24,a. Patients received the regular hospital diet and were allowed to drink ad libiturn. During administration of giibenclamide, all patients participating in this study were instructed to have a very high carbohydrate intake to prevent hy; pogiycemia.

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Before tee present studies, previous antidiuretic therapy was witedrawn in a]] but one patient for weeks. The present proIonged study was undertaken to evaluate in a relatively large number of patients with pituitary diabetes insipidus PDI : 1 the diuretic action of glibenclamide; 2 the persisting enhancement of potyuria after withdrawal of the d ~ g ; 3] the 1 GfibencIam~de s~udy - - Aher an aclequate control pericd mean: 7 days, range days glibendamide Daonil ®, Hoechst was given p.

For determination of dose-response relations, glibenelamide was administered in Ke~'-words: Carbam~zepine antidiu:tesis; Clofib~. Received: April 1, i Acts diabee, lat. The daily dose varied between mg 15 mg and 30 mg were given in three, 20 mg in four divided doses between 8 a.

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The average daily dose was As there was no definite relationship bevween the doses and the diuretic effect of gIibendamide, all data ~-ere poo!

The diuretic effect of glibendamide was followed after discontinuation of treatment in six patients tabs 2, 3, 5, 6, 7, 8 for altogether 38 days. Considering the persisting diuretic effect of glibenclamide after discontinuation, the effects of other drugs were studied - - unless otherwise indicated - - before the first administration of glibenclamide DDAVP: tab.

This was repeated on the days of glibenclamide treatment. In studies used for comparison of the effect of carbamazepine done and glibenclamide plus carbamazepine the average daJIy dose of carbamazepine was rag. Different doses rag~die of carbamazepine were administered to 4 patients tabs 2, 5, 7, 8. Carbamazepine was adrpSnistered done in adh hormone in elderly doses to 2 patients tabs 2 and 5whS! Carbamazepine was combined with clofibrate in 3 patients tabs 2, 5 and 7.

Two pat! In each patient daily fasting serum osmolality was measured at 8 a. Intermediate values were obtained by interpolation. Serum and urine osmolalides were determined by an Advanced Osmometer. Osmolal and free water clearances were calculated by standard formulas. Glomerular filtration rate was estimated by endogenous creatinine clearance a.

The resu! The diuretic action of glibenclamide was excessive in p a t i e n t M. G F R increased from 6. Of giibenclamide O. I00 -- 0. I00 mg carbamazepineq mg dofibrare 3. I00 Table 8 - Effects of glibenclamide and glibencIamide plus carbamazepine on specific kidney function parameters in patient B. RADO, L. The diuretic action o~ ghbenc, " ~amzae "' persisted after treatment was discontinued tabs 2 and 3.

In patient M. The mean fasting blood glucose decreased from The decrease of C. In response to 0. A more marked decrease occurred after 0. On the day when 0. There was no consistent change in solute excretion and GFR. Diuretic effect of glibenclamide was inhibited by carbamazepine in al!

Higher doses of carbamazepine induced a greater antidiuretic response even during glibenclamide treatment tab.

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Although the withdrawal of glibenclamide from the combination with carbamazepine resulted in a decrease of the mean value for CH.

Changes induced by ctofibrate and glibenclamide plus clofibrate were qualitatively similar to those occurring after carbamazepine without and with glibencIamide tabs 4 and 5. The antidiuretic effect can be raised by increasing the dosage o. DoublL,ng of the dose of both carhamazepine and clofibrate resulted in a more marked antidiuretic e~ect. Our resuhs also confirmed that: 1 a definite relationship exists between the dose of DDAVP, carbamazepine and clofibrate and the antidiuretic effect z' 2, ~s, aa, a4.

Glibenclamide enhanced free water excretion b our padents with PDI while on ad libka. The diuretic action persisted even after discontinuation of the drug tabs 2 and 3. A marked diuretic action was observed also during simultaneous treatment with carbamazepine, clofibrate or DDAVP. On the other hand, DDAVP, clofibrate and carbamazepine significantly inhibited the enhancement of polyuria induced by g]ibenclamide.

On the basis of the 'antagonistic' effect between glibenclamide and 'vasopressin-like' drugs 2a, aT. RAD6, L. JuHos, I. TAK6 sipidus Brattlehoro rats ~8.

Inhibition of the peripheral action of A D H by glibenclamide is a more complex problem. It was established that during maintained water diuresis the changes in urine flow and osmolality are consequences of the primary changes in free water clearance induced by small doses of vasopressin a. In our preliminary experiments after a single small dose adh hormone in elderly lysine-vasopressin the level of free water clearance was significantly adh hormone in elderly and the level of urinary osmolality was significantly lower during glibendamide treatment than without it.

Idôskorúak táplálkozás-egészségügyi vizsgálatának családorvosi vonatkozásai

However, the decrease in free water clearance induced by iysine-vasopressin agreed closely without and with glibenclamide as. Similar results were obtained during constant infusion of smalt amounts of pitressin 2a. There~ore it was postu! This postulate was, however, weakened in recent studies ~ suggesting that glibenclamide adh hormone in elderly inhibits the peripheral action of DDAVP. This hypothesis is supported also by the findings obtained in the present investigations.

The g! Nov,- it is generally accepted vdth some exceptions s. The duration of action of natural vasopressins arginine-vasopressin, lysine-vasopressin, etc.

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The antidiuretic effect o{ 'vasopressin-like' drugs is also delayed. A definite relationship exists between the dose and the antidiuretic effect of vasopressin and 'vasopressin-like' drugs. Onty small amounts of vasopressin can be effectively inhibited by glibenclamide; if a higher dose of vasopressin is given, the very long-lastLug diuretic effect of glibenclamide is apparent only when the concentration of vasopressin decreases as a result of enzymatic degradation.

The diuretic efEect oE glibenclamide progressively adh hormone in elderly wkh increasing doses of vasopressin cukorbeteg fórum 'vasopressin-like' drugs and can be completely overcome if adequate vasopressin doses are given ~8' aT,48 This explains why the diuretic action of glibenclamide is not evident in dehydrated man and animals.

An ahemative hypothesis woutd be that g[ibenclamige acts aar. In our present and previous studies we did not find any evidence for a GFR increasing effect of glibencIamide.

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On the contrary, Lq 3 patients a significant decrease occurred in GFR during administration of gm~enctamlde. In water diuresis the fluid voltune entering the collect~g tubules is larger and therefore the water loss from the collecting tubules is greater than in antidiuresis in the presence of A D H 8. Assuming that glibenclamide inhibits a water reabsorbing mechanism independent of ADH aa.

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On the other hand, ADH exerts its opposite effect probably both in the distal tubules and collecting system 8. Inhibition of the diuretic action of gtibenclamide by small doses of ADH DDAVP, carbamazepine, dofibrate may represent a summation of diuretic and antidiuretic influences occurring in functionally different nephron segments One may specuIate that A D H acting on the cortical part of the distal nephron reduces the fluid volume entering the collecting tubule, leaving less free water for inhibition to glibenclamide.

An ahernative possibility would be the co-existence of an ADH-dependent and of an ADt{-independent water-reabsorbing mechanisms within the same nephron segment collecting tubuIes.

Further studies are required for elucidating the exact mechanism of the diuretic action of glibenclamide. The diuretic action of glibenclamide may have very important clinical implications in situations associated with life-threatening water retention.

This abnormality occurs in those mainly geriatric patients who are unable to inhibit A D H release in response to hypo-osmolality sa. Cblorpropamide induced water intoxication adh hormone in elderly patients with psychogenic polydipsia a4, It has been stressed that administration of an antidiuretic drug diazoxide in hypertensive emergencies could be detrimental in chlorpropamide-treated patients with diabetes mellitus ~1.

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Water intoxication due to inappropriate secretion of A D H has also been described in patients treated with carbamazepine a4. This syndrome was observed in patient T. We observed fatal water intoxication during an acute illness associated with severe potassium depletion in an otd patient with hypertension and hyperlipidemia treated chronically with the combination of hydrochIorotbiazide and clofibrate unpublished observation.

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In elderly diabetics suffering also from cardiac, hepatic or renal disease with a tendency toward abnormal water retention a8 or who must be treated with antidiuretic drugs listed above because of other illnesses, administration of chlorpropamide should be avoided. Concurrent administration of two or more drugs with antidiuretic properties may be particularly dangerous.

Giibenclamide, for its diuretic action, may be useful in the prevention of the serious clinical hazard of water intoxication 5,; the present study was undertaken to evaluate the diuretic effect of glibenclamide and the influences of some pharmacological agents on it.

TAKO diabetes insipidus while on ad libixum fluid intake.

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Glibenclamide significantly enhanced free water excretion in all patients. The diuretic effect continued for several days after withdrawal of the drug. On the other hand, the antidinretic action of DDAVP, carbamazepine and clofibrate was significandy inhibited by glibenclamide.

Two alternative hypotheses are suggested to account for the diuretic effect of glibenclamide: 1 glibenclamide competitively inhibits the action of vasopressin; 2 glibenclamide inhibits a water reabsorbing mechanism in the collecting tubules independent of ADH. The results of the present study confirmed also the definite relationship between the dose of DDAVP, carbamazepine, clofibrate and carbamazepine plus clofibrate and the antidiuretic effect.

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Combination of carbamazepine and clofibrate revealed an additive antidinretic action. I02, Bgham, Ata. Diabéteszes neuropátiás fájdalomBoa3~2LY L. ItADO, L. ROSI~ E. J~ reed. In i~ress. Hearth J. Paris 49, ,