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Acid-base and electrolyte abnormalities in patients with congestive heart failure Elsaf M and Siamopoulos K, Exp Clin Cardiology Clinic, 1997 Electrolyte.

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Presentation on theme: "Acid-base and electrolyte abnormalities in patients with congestive heart failure Elsaf M and Siamopoulos K, Exp Clin Cardiology Clinic, 1997 Electrolyte."— Presentation transcript:

1 Acid-base and electrolyte abnormalities in patients with congestive heart failure Elsaf M and Siamopoulos K, Exp Clin Cardiology Clinic, 1997 Electrolyte abnormalities in 62 study patients with congestive heart failure

2 Υπονατριαιμία Υποτονική Υπερτονική (υπεργλυκαιμία) Ισοτονική (υπερλιπιδαιμία) Υποογκαιμική (έλλειψη H 2 0-Na + ) Υπερογκαιμική (  H 2 0 >Na + ) KA – κίρρωση Νορμοογκαιμική (SIADH)

3 Bettari L et al, Heart Fail Rev (2012) 17:17–26 Mechanisms leading to hypotonic hypervolemic hyponatremia in heart failure

4 The Challenge of Hyponatremia Adrogué H and Madias N, J Am Soc Nephrol, 2012 Pathogenesis of hypotonic hyponatremia as derived from the Edelman equation

5 The electrolyte-free water clearance: C e H 2 O = V ( 1 - urine K + + urine Na + serum Na + )

6 The Challenge of Hyponatremia Adrogué H and Madias N, J Am Soc Nephrol, 2012 Effect of urine electrolyte concentration on serum sodium level in hypotonic hyponatremia

7 Ανταγωνιστές των υποδοχέων της AVP (……..vaptanes) Tolvaptan (Samsca, tbl 15 mg) Pack 10 tablets = 1243 € (ΕΟΠΥ) Otsuka Pharmaceutical Europe Ltd. Θεραπεία Υπονατριαιμίας

8 Successful treatment of hyponatremia with ACEi in patients with congestive heart failure Cardiology 1995 Clinical and laboratory parameter before and after treatment with captopril

9 Successful treatment of hyponatremia with ACEis in patients with congestive heart failure Cardiology 1995 Correlation between the increase in serum sodium and the increased in C e H 2 O

10 Amlal H and Soleimani M, Cell Physiol Biochem 2011;28: Schematic diagram showing a cell model of the thick ascending limb with its different transport pathways involved in the transcellular reabsorption of NaCl as well as the paracellular transfer of Na + activated by the luminal positive voltage

11 Amlal H and Soleimani M, Cell Physiol Biochem 2011;28: Schematic diagram showing a cell model of the distal convoluted tubule (DCT) with its different transport pathways involved in the transcellular reabsorption of NaCl. Early DCT expresses only NCC whereas late DCT expresses both NCC and ENaC in the apical membrane

12 Amlal H and Soleimani M, Cell Physiol Biochem 2011;28: Schematic diagram showing cell types in both cortical collecting duct (CCD) and connecting tubules (CNT) with different transport pathways involved in transcellular reabsorption of NaCl. ENaC is expressed on the apical membrane of principal cells and pendrin (PDS) is expressed on the apical membrane of B-intercalated cells

13 Amlal H and Soleimani M, Cell Physiol Biochem 2011;28: Schematic diagram of various nephron segments, including TAL and DCT along with transport proteins targeted by furosemide (NKCC2) or thiazides (NCC). G, glomerulus; PCT, proximal convoluted tubule; PST, proximal straight tubule; TAL, thick ascending limb; DCT, distal convoluted tubule; CCD, cortical collecting tubule; OMCD, outer medullary collecting duct; IMCD, inner medullary collecting duct

14 Pendrin as a Novel Target for Diuretic Therapy Amlal H and Soleimani M, Cell Physiol Biochem 2011;28: Schematic diagram of the nephron showing the action sites for thiazides, inhibitors of NCC, and a new diuretic which can inhibit pendrin


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