Hyponatremia, a serum sodium of less than 135 mmol l-1 for more than 2 days, is seen in 10-34% of individuals and, if left untreated, has high associated morbidity and mortality. Cerebral salt-wasting and syndrome of inappropriate anti-diuretic hormone (SIADH) are the two commonest causes, occasionally coexisting. Their distinction is important, as cerebral salt-wasting has an associated depleted circulating volume, making the patient at higher risk for vasospasm.
Cerebral salt wasting is the most common cause of primary natriuresis, negative sodium balance and concurrent diuresis, resulting in hyponatremia and hypovolemia. Natriuresis is stimulated by the release of Atrial Natriuretic Factor (ANF) from the hypothalamus or a digoxin-like substance, which is thought to be released in response to sympathetic nervous system activation or ventricular distension and normally lasts for 4-5 days. These patients should not be fluid restricted. They usually need treatment with intravenous fluid and sodium
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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.