Chinese rapid growth in the economy is compelling its investment in enhancing and expanding military modernization. Defensive compulsions amplify Chinese gradual tilt towards complementing technological advancements in the military sphere. For this purpose, China is undergoing a process of robust military modernization. This paper aims to dissect China’s military modernization under the leadership of President Xi. It comprises of three portions. The first part theorizes the process of Chinese Military Modernization. Structural Anarchy in International Politics and Security Dilemma helps us in understanding the process of Chinese Military Modernization. The second part of this study explains the process of military modernization of China under the leadership of President Xi. This part explains three dimensions of Chinese military modernization under President Xi; Evolution of Chinese Military Doctrine, Reorganization of People Liberation Army (PLA), and technological advancements in Chinese weaponry. The final part of this study explains the rising challenges to the existing international order in face of the Chinese rise.
We report a 67-year-old female who presented with progressively symptomatic hyponatremia due to the SIADH secretion complicating TBI and neurosurgical intervention. She responded initially to fluid restriction, 3% NaCl infusion and oral NaCl tablets. Nevertheless, by hospital day 8, she had quickly developed polyuria, dumping over 3 liters of urine in the first 4-6 hours of that morning with rapid recurrence of hyponatremia, again. She was, this time, diagnosed with CSW and was managed differently with 0.9% NaCl volume expansion. To our knowledge, this is the first case of the sequential development of symptomatic hyponatremia from SIADH followed by the development of hyponatremia from CSW in the same patient during the same admission. Furthermore, our case further highlighted the contrarian observation that with a high index of suspicion for CSW and its early diagnosis, volume depletion and hypovolemia from polyuria may not be a distinguishing presenting factor, when contrasted with SIADH.Please cite this paper as: Onuigbo MAC, Agbasi N, Amadi EJ, Okeke UC, Khan A. Sequential cerebral salt wasting complicating SIADH in a patient following head trauma. J Renal Inj Prev. 2018;7(1):49-52. DOI: 10.15171/jrip.2018.12. Hyponatremia is the most commonly encountered dyselectrolytemia following head trauma. The two main mechanisms responsible for non-iatrogenic hyponatremia are cerebral salt wasting (CSW) syndrome and the syndrome of inappropriate antidiuretic hormone secretion (SIADH). SIADH is the commonest dyselectrolytemia cause of hyponatremia following traumatic brain injury (TBI) whereas CSW is the most elusive and challenging diagnosis of the causes of hyponatremia from intracranial causes. The need to distinguish between CSW and SIADH is critical because the management of CSW is volume restitution and sodium restoration whereas for SIADH, the management is exact opposite -water restriction. Our recent experience with a 67-year old Caucasian female post-TBI illustrated very interesting observations. To our knowledge, this is the first case of the sequential development of symptomatic hyponatremia from SIADH followed by the development of hyponatremia from CSW in the same patient during the same admission. Furthermore, our case further highlighted the contrarian observation that with a high index of suspicion for CSW and its early diagnosis, volume depletion and hypovolemia from polyuria may not be a distinguishing presenting factor, when contrasted with SIADH.
We report a 62-year-old obese hypertensive Caucasian male patient with advanced COPD, pulmonary hypertension and acutely decompensating diastolic heart failure who presented with severe symptomatic life-threatening hyponatremia. Hypertonic 3% saline infusion did not improve hyponatremia even at 40 cc/h infusion rate and the patient was quickly experiencing worsening pulmonary edema with respiratory distress and imminent need for ventilatory support. The swift use of intravenous conivaptan, a vasopressin antagonist, with close 4-hourly monitoring of the serum sodium levels resulted in a prompt aquaresis with resolution of symptoms of pulmonary edema, fluid retention and simultaneous correction of life-threatening symptomatic hyponatremia. Vasopressin antagonists can be a life-saving therapeutic option in such critical clinical circumstances.
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