The treatment of HELLP Syndrome is primarily based on the gestation of the pregnancy, but delivery of the baby is the best way to stop this condition from causing any serious complications for mom and baby. If the pregnancy is less than 34 weeks gestation, doctors usually try to evaluate the lung function of the baby to see how well delivery would be handled. Bed rest and admission into a medical facility to be monitored closely Corticosteroid to help babies lungs develop more rapidly Magnesium Sulfate to help prevent seizures Blood transfusion if platelet count gets too low Blood pressure medication Fetal monitoring and tests including biophysical tests, sonogramsnon stress tests and fetal movement evaluation If the pregnancy is more than 34 weeks gestation or the symptoms of HELLP begin to worsen, delivery is the recommended course of treatment. In the past, Cesarean delivery was the most common way for delivery of babies whose moms were dealing with HELLP syndrome.
Dipsogenic[ edit ] Dipsogenic DI or primary polydipsia results from excessive intake of fluids as opposed to deficiency of arginine vasopressin. It may be due to a defect or damage to the thirst mechanism, located in the hypothalamus;  or due to mental illness.
Gestational[ edit ] Gestational DI occurs only during pregnancy and the postpartum period. During pregnancy, women produce vasopressinase in the placentawhich breaks down antidiuretic hormone ADH. In rare cases, however, an abnormality in the thirst mechanism causes gestational DI, and desmopressin should not be used.
Diabetes insipidus is also associated with some serious diseases of pregnancy, including pre-eclampsiaHELLP syndrome and acute fatty liver of pregnancy.
These cause DI by impairing hepatic clearance of circulating vasopressinase. It is important to consider these diseases if a woman presents with diabetes insipidus in pregnancy, because their treatments require delivery of the baby before the disease will improve.
Failure to treat these diseases promptly can lead to maternal or perinatal mortality. In general, electrolyte regulation precedes volume regulation.
When the volume is severely depleted, however, the body will retain water at the expense of deranging electrolyte levels. The regulation of urine production occurs in the hypothalamuswhich produces ADH in the supraoptic and paraventricular nuclei. After synthesis, the hormone is transported in neurosecretory granules down the axon of the hypothalamic neuron to the posterior lobe of the pituitary glandwhere it is stored for later release.
In addition, the hypothalamus regulates the sensation of thirst in the ventromedial nucleus by sensing increases in serum osmolarity and relaying this information to the cortex.
It is encountered as a result of hypoxic encephalopathy, neurosurgery, autoimmunity or cancer, or sometimes without an underlying cause idiopathic. The main effector organ for fluid homeostasis is the kidney.
ADH acts by increasing water permeability in the collecting ducts and distal convoluted tubules; specifically, it acts on proteins called aquaporins and more specifically aquaporin 2 in the following cascade. When released, ADH binds to V2 G-protein coupled receptors within the distal convoluted tubules, increasing cyclic AMPwhich couples with protein kinase Astimulating translocation of the aquaporin 2 channel stored in the cytoplasm of the distal convoluted tubules and collecting ducts into the apical membrane.
These transcribed channels allow water into the collecting duct cells. The increase in permeability allows for reabsorption of water into the bloodstream, thus concentrating the urine.
Nephrogenic DI results from lack of aquaporin channels in the distal collecting duct decreased surface expression and transcription. It is seen in lithium toxicityhypercalcemia, hypokalemia, or release of ureteral obstruction.
Therefore, a lack of ADH prevents water reabsorption and the osmolarity of the blood increases.A complete list of sessions from the Education Program at the ASH annual meeting.
Chapters based on these sessions are published in Hematology, the ASH Education Program. HELLP syndrome is a very traumatic and scary disease process for the patient.
Without thorough evaluation and assessment of the patient and her fetus, both she and her baby could have been subjected to a very different outcome. Maternal physiological changes occur in order to meet the increasing metabolic demands of the foetus and prepare the mother for delivery. Cardiac output increases by up to 50% by the third trimester.
Stroke volume increases by 35% predominately because of the increased blood volume. The increase in. Diabetes insipidus (DI) is a condition characterized by large amounts of dilute urine and increased thirst. The amount of urine produced can be nearly 20 liters per day.
Reduction of fluid has little effect on the concentration of the urine. Complications may include dehydration or seizures.. There are four types of DI, each with a different set of causes. Pathology is one of the most essential fields in USMLE Step 1!
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Save time . Anterior pituitary insufficiency is an uncommon disease. The etiology includes destruction of the anterior pituitary gland by tumors, infarction (postpartum necrosis or Sheehan's syndrome), idiopathic disease (Simmonds' disease), surgery, and .