Severe hyponatraemia with cerebral oedema after Pfizer BNT162b2 mRNA vaccination against COVID-19

Dharma, JFM; Montalto, S.; Johnson, Doug; Chiang, Cherie; Fourlanos, Spiros

doi:10.1016/j.idcr.2023.e01688

Cited by 3 publications

(1 citation statement)

References 13 publications

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“…The literature review methods, including search strategy, selection criteria, study selection, and data extraction, were provided in Additional le 1. A total of 13 studies consisting of 21 patients were reviewed (Table 1) [4][5][6][7][8][9][10][11][12][13][14][15][16].…”

Section: Literature Reviewmentioning

confidence: 99%

Postoperative urinary retention induced hyponatremic seizure following total knee arthroplasty with an enhanced recovery after surgery protocol: a case report and literature review

Lee,

Tsai

2024

Preprint

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Background: Although the enhanced recovery after surgery (ERAS) protocol in total knee arthroplasty (TKA) aimed at facilitating overall outcomes and reducing complication rates, the incidence of postoperative urinary retention (POUR) is still of concern. Case presentation: A 70-year-old woman underwent TKA with an ERAS protocol for severe osteoarthritis of right knee. She developed generalized tonic-clonic seizure on post-operative day 1. The occurrence of altered consciousness initiated further investigation, revealing hyponatremia of 117 mEq/L and significant urinary retention. Following urinary catheterization, during which 1350 mL of urine was immediately drained and an additional 2550 mL over the next 8 hours, her sodium level improved to 130 mEq/L under regular saline solution supply, accompanied by a marked improvement in consciousness. Subsequently, she was discharged with a normal sodium level and complete recovery of the conscious level. The prompt resolution of neurological symptoms highlights the correlation between hyponatremia-induced seizures and POUR. Conclusions: Hyponatremic seizure related to POUR after TKA with an ERAS protocol represents an uncommon yet potentially lethal complication. This case emphasized the importance of recognizing and addressing hyponatremic seizure as well as considering POUR as a potential cause despite the implementation of ERAS protocol. Urinary catheterization and early removal are suggested in elderly patients scheduled for TKA under spinal anesthesia.

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Section: Literature Reviewmentioning

confidence: 99%

Postoperative urinary retention induced hyponatremic seizure following total knee arthroplasty with an enhanced recovery after surgery protocol: a case report and literature review

Lee,

Tsai

2024

Preprint

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Pituitary and COVID-19 vaccination: a systematic review

Verrienti,

Marino Picciola,

Ambrosio

et al. 2024

Pituitary

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Purpose This systematic review aims to examine the latest research findings and assess the impact of COVID-19 vaccination on the pituitary gland. Method PubMed and Tripdatabase were searched from January 1st, 2020 to February 12th, 2024. Case reports, case series and reviews related to post COVID-19 vaccination pituitary disease were included. Eligible articles were tabulated and analysed in the attempt to provide an overview on the epidemiology, clinical presentation, imaging, treatment, outcomes and pathophysiological background of post COVID-19 vaccination pituitary disease. Results Among the 23 case reports included in this review, post COVID-19 vaccination hypophysitis was reported in 9 patients, pituitary apoplexy (PA) in 6 cases, SIADH in 5 cases and Isolated ACTH deficiency in 2 cases. Additionally, precipitating adrenal crisis was registered in 7 patients and pituitary tumor enlargement in 1 patient after receiving COVID-19 vaccination. Conclusion Despite the rarity of these events, our research findings suggest an association between COVID-19 vaccination and the subsequent development of pituitary diseases. The most common manifestations include hypophysitis with ADH deficiency, PA and SIADH, with symptoms typically emerging shortly after vaccine administration. Potential pathogenetic mechanisms include molecular mimicry, vaccine adjuvants and vaccine-induced thrombotic thrombocytopenia (VITT), with the presence of ACE2 receptors in the hypothalamus-pituitary system contributing to the process. These findings can aid in diagnostic and treatment decisions for patients presenting with these syndromes. Nevertheless, given the rarity of these events, safety and efficacy of the currently available COVID-19 vaccines remain robust and we strongly advocate continuing pursuing vaccination efforts.

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Tozinameran

2023

Reactions Weekly

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Severe hyponatraemia with cerebral oedema after Pfizer BNT162b2 mRNA vaccination against COVID-19

Cited by 3 publications

References 13 publications

Postoperative urinary retention induced hyponatremic seizure following total knee arthroplasty with an enhanced recovery after surgery protocol: a case report and literature review

Postoperative urinary retention induced hyponatremic seizure following total knee arthroplasty with an enhanced recovery after surgery protocol: a case report and literature review

Pituitary and COVID-19 vaccination: a systematic review

Tozinameran

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