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Sertraline hydrochloride belongs to the selective serotonin reuptake inhibitor class of antidepressants, which can cause respiratory depression, hypotension, malignant vomiting, liver function impairment, and other symptoms when taken in excess. To our knowledge, reports of sertraline hydrochloride overdose causing diabetes insipidus in patients are rare. This report describes a unique case of a 17-year-old female patient who developed diabetes insipidus after a one-time oral intake of 20 sertraline hydrochloride tablets (50 mg/tablet) during the later course of treatment. Her symptoms were effectively relieved after treatment with pituitrin.

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BACKGROUND: This study aimed to determine the median effective dose (ED50) and 95% effective dose (ED95) of nicardipine for treating pituitrin-induced hypertension during laparoscopic myomectomy, providing guidance for the management of intraoperative blood pressure in such patients. METHODS: Among the initial 40 participants assessed, 24 underwent elective laparoscopic myomectomy. A sequential up-and-down method was employed to ascertain the ED50 of nicardipine based on its antihypertensive efficacy. Nicardipine was initially administered at 6 µg/kg following the diagnosis of pituitrin-induced hypertension in the first patient. Dosing adjustments were made to achieve the desired antihypertensive effect, restoring systolic blood pressure and heart rate to within ± 20% of baseline within 120 s. The dosing increment or reduction was set at 0.5 µg/kg for effective or ineffective responses, respectively. The ED50 and ED95 of nicardipine were calculated using Probit regression by Maximum Likelihood Estimation (MLE) to establish dose-response curves and confidence intervals. RESULTS: 24 patients were included for analysis finally. The ED50 and ED95 of nicardipine for blood pressure control after pituitrin injection were determined. The study found that the ED50 of nicardipine for treating pituitrin-induced hypertension was 4.839 µg/kg (95% CI: 4.569-5.099 µg/kg), and the ED95 was estimated at 5.308 µg/kg (95% CI: 5.065-6.496 µg/kg). Nicardipine effectively mitigated the hypertensive response caused by pituitrin without inducing significant tachycardia or hypotension. CONCLUSIONS: Nicardipine effectively controlled blood pressure after pituitrin injection during laparoscopic myomectomy, with ED50 and ED95 values established. This research highlights the potential utility of nicardipine in addressing hypertensive responses induced by pituitrin, particularly in clinical settings where pituitrin is routinely administered.

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Objective: To determine the dose-response of nitroglycerin in preventing pituitrin-induced hypertension in patients undergoing laparoscopic myomectomy. Methods: Hundred patients scheduled for elective laparoscopic myomectomy were randomly allocated into one of five groups (n = 20) to receive intravenous bolus of prophylactic nitroglycerin at 0, 50, 75, 100, and 125 µg one minute following administration of 3 IU of pituitrin into the myometrium. The patients were monitored for pituitrin-induced hypertension with the primary outcome to determine the effective dose of prophylactic nitroglycerin, defined as complete prevention of pituitrin-induced hypertension during the study period. Probit analysis was used to calculate the median effective dose (ED50) and 95% effective dose (ED95) of prophylactic nitroglycerin. Results: Hypertension occurred in 19/20, 10/20, 8/20, 2/20, and 1/20 in patients who received 0, 50, 75, 100, and 125 ug of prophylactic nitroglycerin, respectively. The calculated ED50 and ED95 of nitroglycerin for preventing hypertension were 54 µg (95%CI: 35~66 µg) and 136 µg (95%CI: 105~289 µg). Conclusion: A prophylactic bolus of nitroglycerin administered immediately following injection of pituitrin into the myometrium during laparoscopic myomectomy effectively prevented pituitrin-induced hypertension, with the ED50 and ED95 of 54 µg and 136 µg, respectively. This information would be useful for clinical practice. Clinical trial registration: www.chictr.org.cn, Identifier ChiCTR2200062282.

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Background: The effectiveness and safety of pituitrin injection coupled with hysteroscopy and suction curettage as treatment for type I cesarean scar pregnancy (CSP) have not been studied enough in the literature, by comparing it to uterine artery embolization (UAE) followed by suction curettage we aim to determine its efficacy. Materials and Methods: Data of 53 patients (the PIT group) with type I CSP treated with pituitrin injection combined with hysteroscopic suction curettage and 137 patients (the UAE group) with type I CSP treated with UAE followed by suction curettage were collected in retrospect. The clinical data were analyzed statistically to compare the efficacy and safety between the two groups. Results: The PIT group had a shorter duration of postoperative vaginal bleeding, postoperative hospitalization, and overall hospitalization length (P < 0.05). The PIT group had lower overall hospitalization costs and a lower rate of adverse events than the UAE group (P < 0.05). There was no significant difference between the two groups in terms of treatment success rate, the average length of operation, blood loss during the procedure, time when serum ß-hCG returned to normal range, and menstrual recovery time after hospital release (P > 0.05). Conclusion: UAE and pituitrin injection followed by hysteroscopic suction curettage are good choices for type I CSP treatment. However, pituitrin injection with hysteroscopic suction curettage outperforms UAE followed by suction curettage. Thus, pituitrin injection may be an option of high priority for type I CSP.

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BACKGROUND: Pituitrin injection solution is an indispensable hemostatic utilized in clinical practice and is widely used in myomectomy. However, there have been reports of adverse reactions leading to gastrointestinal injury, hyponatremia and hypokalemia, anaphylaxis, cardiac arrest, etc. Thus, the safety of pituitrin should be taken seriously. CASE PRESENTATION: In the present study, three cases of cardiac arrest caused by pituitrin injection during laparoscopic myomectomy, who were successfully resuscitated in our hospital, are reported. CONCLUSION: The clinical data and surgical procedures in the patient should be analyzed to find the causes of cardiac arrest. Medication and resuscitation should be summarized to ensure the safety of the patient.

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OBJECTIVE: The objective of the study was to compare and observe the therapeutic effect of octreotide and pituitrin in upper gastrointestinal hemorrhage caused by cirrhosis. MATERIALS AND METHODS: In this prospective, randomized, open, single-blind, controlled, and single-center study, patients with upper gastrointestinal hemorrhage induced by cirrhosis were divided into control group (treated with pituitrin) and experimental group (treated with octreotide). The effective time, hemostasis time, and average bleeding volume of the two groups were observed and recorded, and the incidence of adverse reactions, rebleeding rate, and total effective rate of the two groups were compared. RESULTS: One hundred and thirty-two patients with upper gastrointestinal hemorrhage caused by cirrhosis were included from March 2017 to September 2018. By a single-blind method, the patients were randomly divided into control group (n = 66) and experimental group (n = 66). Compared with the control group, the effective time and hemostasis time of the drug were significantly shorter in the experimental group, whereas the average bleeding volume of patients was lower (average P < 0.05). Compare with the control group, the total effective rate was higher in the experimental group, whereas the incidence of adverse reactions was lower (average P < 0.05). During 1-year follow-up, early and late rebleeding rates and hemorrhage-related mortality between the two groups have no difference (average P > 0.05). CONCLUSION: In the treatment of upper gastrointestinal hemorrhage in cirrhosis, octreotide is superior to pituitrin, with advantages of quick onset, short hemostasis time, and less adverse reactions, which is helpful to control the rebleeding rate and bleeding-related mortality.

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Arrhythmias are perceived as a complication of pituitrin. However, injecting a standard dose of pituitrin via vein causes different arrhythmias. In our case, a 35-year-old female patient was admitted to the hospital due to a productive cough with sputum for 5 days and two occasions of massive hemoptysis. After 1 day of treatment using 500 ml normal saline with 10u pituitrin, the sputum was filled with small amounts of kermesinus bloodstains. When pituitrin was stopped without any other treatment, all presenting symptoms gradually subsided after half an hour, and the ECG returned to normal. Therefore, when treating massive hemoptysis by administering pituitrin intravenously, it is necessary to exercise great precaution and therapeutic measures.

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Background: The vasoplegic syndrome is one of the major consequences of cardiac surgery. If pulmonary hypertension is additionally involved with vasoplegic syndrome, circulation management becomes much more complicated. According to previous studies, pituitrin (a substitute for vasopressin, which contains vasopressin and oxytocin) not only constricts systemic circulation vessels and increases systemic circulation pressure but also likely decreases pulmonary artery pressure and pulmonary vascular resistance. The aim of this study is to investigate whether pituitrin is beneficial for the postoperative outcomes in patients with pulmonary hypertension undergoing cardiac surgery. Methods and analysis: The randomized controlled trial will include an intervention group continuously infused with 0.04 U/(kg h) of pituitrin and a control group. Adult patients with pulmonary hypertension undergoing elective cardiac surgery will be included in this study. Patients who meet the conditions and give their consent will be randomly assigned to the intervention group or the control group. The primary outcome is the composite endpoint of all-cause mortality within 30 days after surgery or common complications after cardiac surgery. Secondary outcomes include the incidence of other postoperative complications, length of hospital stay, and so on. Discussion: Pituitrin constricts systemic circulation vessels, increases systemic circulation pressure, and may reduce pulmonary artery pressure and pulmonary vascular resistance, which makes it a potentially promising vasopressor during the perioperative period in patients with pulmonary hypertension. Therefore, evidence from randomized controlled trials is necessary to elucidate whether pituitrin influences outcomes in patients with pulmonary hypertension following cardiac surgery.

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To compare the efficacies between ultrasound-guided curettage combined with hysteroscopic electro-resection after injection of pituitrin and hysteroscopic electro-resection after methotrexate chemotherapy in the treatment of caesarean scar pregnancy (CSP). 60 patients with CSP admitted to our hospital were selected as the study subjects, and divided into observation group (n = 35) and control group (n = 25) in accordance with the therapeutic options. The observation group was treated with ultrasound-guided curettage combined with hysteroscopic electro-resection after injection of pituitrin, while the control group was treated with hysteroscopic electro-resection after methotrexate chemotherapy. The observation group was superior to the control group in the amount of intraoperative haemorrhage, in-hospital costs, and postoperative time to control vaginal haemorrhage, time to return to a normal serum human chorionic gonadotropin (HCG) level. The observation group had a lower incidence rate of adverse reactions (5.71% vs. 28.00%, p < .05) and a higher first-attempt success rate for treatment (85.71% vs. 84.00%, p > .05) compared with the control group. Ultrasound-guided curettage combined with hysteroscopic electro-resection after injection of pituitrin, exhibiting a higher efficacy, can more effectively shorten the postoperative recovery, reduce adverse reactions, and improve the postoperative quality of life in patients with CSP. IMPACT STATEMENTWhat is already known on this subject? Caesarean scar pregnancy (CSP), a rare form of ectopic pregnancy where the fertilised egg is implanted in the muscle or fibrous tissue of the scar after a previous caesarean section (CS), is a long-term complication of CS that may be life-threatening for parturients. Some therapies have been used to treat CSP, such as uterine artery embolisation and uterine artery embolisation chemotherapy combined with curettage, but the potential adverse effects may affect the ovarian reserve and even affecting the fertility of patients.What do the results of this study add? This study showed that ultrasound-guided curettage combined with hysteroscopic electro-resection after injection of pituitrin, exhibiting a higher efficacy, can more effectively shorten the postoperative recovery, reduce adverse reactions, and improve the postoperative quality of life in patients with CSP.What are the implications of these findings for clinical practice and/or further research? The findings of this study may provide some references for the clinical practitioners and further research and may contribute to the treatment of CSP.

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STUDY OBJECTIVE: To determine the optimal effective dose of pituitrin in laparoscopic myomectomy for uterine leiomyoma. DESIGN: Double-blinded, randomized controlled trial. SETTING: Tertiary women's hospital in China. PATIENTS: Total of 118 patients who underwent laparoscopic myomectomy. INTERVENTIONS: Patients randomly received 0, 2, 4, or 6 units of pituitrin injected into the myometrium surrounding the myoma. MEASUREMENTS AND MAIN RESULTS: Rate of satisfactory surgical condition, hemodynamic changes, total surgical time, and blood loss were recorded. The rates of satisfactory surgical conditions were 6.7%, 72.4%, 89.7%, and 93.3% in groups 0U, 2U, 4U, and 6U, respectively; they were higher in groups 2U, 4U, and 6U than those in group 0U, but there were no significant differences among the groups 2U, 4U, and 6U. The blood loss was higher in group 0U than that in groups 2U, 4U, and 6U (p < .01). Pituitrin was associated with a transient decrease in blood pressures and an increase in heart rate in a dose-dependent fashion, with more pronounced changes in groups 4U and 6U, and these groups also required a higher amount of vasoactive drug to correct hemodynamic changes (p < .05). CONCLUSION: Two units of pituitrin could provide a satisfactory surgical field with minimal hemodynamic changes for laparoscopic uterine myomectomy.

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AIM: To compare the effect of pituitrin local injection (PIT) and uterine artery embolization (UAE) as pretreatment before surgery during the management of cesarean scar pregnancy (CSP). METHODS: Forty-nine CSP patients diagnosed in our department of Suzhou Ninth People's Hospital from October 2017 to October 2019. All patients underwent hysteroscopy and negative pressure aspiration (for type I CSP) or laparoscopic wedge-resection (for type II and III CSP) following one of the preoperative treatments: PIT group (n = 26) and UAE group (n = 23). The baseline clinical data, intraoperative blood loss, blood transfusion rate, postoperative hospital stay, hospitalization expenses, postoperative pain, postoperative fever, postoperative serum ß-human chorionic gonadotropin (ß-hCG) level, and pregnancy outcome were reviewed and analyzed. RESULTS: There was no significant difference (p ≥ 0.05) between two groups in baseline characteristics including age, gravidity, previous cesarean section times, interval since last cesarean delivery, menolipsis time, maximum diameter of gestational sac or mass under ultrasound, fetal cardiac activity and preoperative ß-hCG level. There was no significant difference in blood loss, transfusion rate, and postoperative ß-hCG reduction percentage (p ≥ 0.05) either. The postoperative hospital stay, hospitalization expenses, postoperative pain, and postoperative fever rate in PIT group were significantly lower than those in UAE group (p < 0.05). Moreover, ß-hCG level of all patients turned negative 1 month after surgery successfully. CONCLUSIONS: PIT pretreatment seems to be a same effective, more economical, and with fewer side effects pretreatment method compared to traditional UAE pretreatment in the management of CSP.

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BACKGROUND: Norepinephrine (NE) has currently been the first-choice vasopressor in treating septic shock despite generally insufficient for patients with refractory septic shock. The aim of this update meta-analysis was to assess the safety and efficacy of a combination of non-catecholamine vasopressors (vasopressin/pituitrin/terlipressin/selepressin/angiotensin II) and NE versus NE in managing adult septic shock patients. METHODS: We conducted this study of literatures published from the inception to April 30, 2020, using PubMed, Embase, and the Cochrane Library databases without language restriction. Randomized controlled trials comparing NE with non-catecholamine vasopressors among adult septic shock patients were included in this meta-analysis. Pooled effects of relative risk (RR) or standard mean difference (SMD) and corresponding 95% confidence interval (CI) were calculated using a random-effects model. RESULTS: Twenty-three studies covering 4380 participants were finally enrolled. The combined analysis of non-catecholamine vasopressors resulted in a nonsignificant reduction in 90-day/ICU/hospital mortality except for a decreased in 28-day mortality (n = 4217; RR, 0.92; 95% CI 0.86-0.99; P = 0.02). This favorable result was subsequently verified by the subgroup analyses of low risk of bias studies (RR = 0.91, 95% CI = 0.84 to 0.98; P = 0.02) and catecholamine-resistant refractory shock patients group (RR, 0.84; 95% CI = 0.70-1.00; P = 0.048). The pooled analysis of non-catecholamine vasopressors showed a 14% higher success rate of shock reversal at 6 h, a 29% decreased risk of continuous renal replacement therapy, but a 51% increased risk of hyponatremia and a 2.43 times higher risk of digital ischemia. Besides, the pooled data showed that non-catecholamine vasopressors decreased heart rate (HR) (SMD, - 0.43; 95% CI - 0.66 - - 0.19; P < 0.001), serum creatinine (- 0.15; 95% CI - 0.29 - - 0.01; P = 0.04), and the length of mechanical ventilation (MV) (- 0.19; 95% CI - 0.31 - - 0.07; P < 0.01, but there was no significant difference in other parameters. CONCLUSIONS: Current pooled results suggest that the addition of NE to non-catecholamine vasopressors was associated with a marginally significant reduction in 28-day mortality. Moreover, they were able to shorten the length of MV, improved renal function, decreased HR, and increased the 6-h shock reversal success rate at the expense of increased the risk of hyponatremia and digital ischemia.

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BACKGROUND: Severe hyponatremia is considered a rare complication of pituitrin, which is widely used for the treatment of pulmonary hemorrhage. However, the management of pituitrin-associated hyponatremia can be challenging because a rapid correction of hyponatremia may cause the development of osmotic demyelination syndrome, resulting in life-threatening neurological injuries. CASE SUMMARY: A 20-year-old Chinese man with massive hemoptysis developed symptomatic hyponatremia (116 mmol/L) after therapy by a continuous intravenous drip of pituitrin. To normalize his serum sodium, a hypertonic saline infusion was applied for 3 d, and the pituitrin administration was stopped concurrently. Then, an overly rapid increase in serum sodium level (18 mmol/L in 24 h) was detected after treatment. One day later, the patient experienced a sudden onset of generalized tonic-clonic seizures, as well as subsequent dysarthria and dystonia. Magnetic resonance imaging revealed increased signal intensity in the bilateral symmetric basal ganglia on the T2-weighted images, compatible with a diagnosis of extrapontine myelinolysis. The patient received an intravenous administration of high-dose corticosteroids, rehabilitation, and neurotrophic therapy. Finally, his clinical abnormalities were vastly improved, and he was discharged with few residual symptoms. CONCLUSION: Physicians should be fully aware that pituitrin can cause profound hyponatremia and its correction must be performed at a controlled rate to prevent the development of osmotic demyelination syndrome.

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OBJECTIVES: The aim of this study is to evaluate the efficacy of prophylactic internal iliac artery balloon occlusion combined with Pituitrin intra-arterial infusion in the control of postpartum hemorrhage in women with placenta accreta spectrum (PAS). METHODS: This is a prospective and non-randomized controlled study. The participants were assigned into three groups: without balloon catheterization (non-BC) group, balloon catheterization (BC) group, and Pituitrin combined with balloon catheterization (PBC) group. The primary outcomes were estimated blood loss (EBL) and the units of transfused packed red blood cells (PRBC). The secondary outcome was the incidence of hysterectomy. RESULTS: A total of 100 participants were recruited between August 2013 and November 2018 and assigned into the respective groups as follows: 27 in the non-BC group, 22 in the BC group, and 51 in the PBC group. No statistical differences were found in demographic characteristics among the three groups. There was a trend of lower EBL, PRBC, and hysterectomy rate in the BC group than those in the non-BC group, while all values showed no significant differences (all p > 0.05). Patients in the PBC group had significantly lower EBL, PRBC, and hysterectomy rate compared with those in the non-BC group (all p < 0.05). Linear regression analysis revealed that the PBC (vs. others) was negatively correlated with EBL and the non-BC (vs. others) independently predicted more EBL. CONCLUSIONS: Balloon occlusion combined with Pituitrin infusion is an effective treatment method which significantly reduced EBL, PRBC, and hysterectomy rate in patients with PAS. KEY POINTS: • Internal iliac artery balloon occlusion combined with Pituitrin intra-arterial infusion can significantly decrease EBL, PRBC, and hysterectomy rate during cesarean section in patients with PAS. • Cesarean section without balloon occlusion and placenta accreta depth are two independent risk factors for EBL in patients with PAS.

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ETHNOPHARMACOLOGICAL RELEVANCE: Zi-Yin-Tiao-Jing granule (ZG) is a traditional Chinese medicine compound preparation for perimenopausal dysfunctional uterine bleeding. It is made from 9 Chinese crude drugs based on a modified traditional Chinese prescription recorded in Fu Qingzhu Nvke as Guben Zhibeng Tang. AIM OF THE STUDY: This study aimed to investigate the hemostasis and uterine contraction promoting effect of quality controlled ZG extract on animals as a preclinical study. MATERIALS AND METHODS: ZG extract was quality controlled by determining the contents of asperosaponin Ⅵ and tetrahydroxystilbene glucoside (TSG) with high-performance liquid chromatography (HPLC) and the contents of total tannins, total saponins and total flavonoids with ultraviolet spectrophotometry (UV). Bleeding time, clotting time, prothrombin time (PT), activated partial thromboplastin time (APTT) and fibrinogen (FIB) content were assayed to test the hemostasis effect of ZG extract on sixty healthy female Kunming mice. In addition, ten healthy female Sprague-Dawley rats were used to test the effect of ZG extract on uterine contractions in vitro with the BL-420 Biological Function Experiment System. RESULTS: The ZG extract contained 0.81mgg-1 asperosaponin Ⅵ, 0.15mgg-1 TSG, 1.98mgg-1 total tannins, 1.83mgg-1 total saponins, and 4.09mgg-1 total flavonoids. Compared with placebo, the ZG extract shortened the bleeding time at a dosage of 1.2gkg-1 and 2.4gkg-1, and shortened the clotting time at 0.6gkg-1, 1.2gkg-1 and 2.4gkg-1 in mice (P < 0.01). It also decurtated the APTT at a dosage of 0.6gkg-1 (P < 0.05) and raised the content of FIB in the plasma at a dosage of 2.4gkg-1 (P < 0.05). However, the PT showed no changes after the administration of ZG extract (P > 0.05). In addition, ZG extract at the doses of 1.8mgmL-1, 3.6mgmL-1, and 5.4mgmL-1 increased the amplitude and motoricity of uterine contractions of rats (P < 0.05 or P < 0.01) but maintained the frequency as unchanged. CONCLUSIONS: The ZG extract was quality controllable by assaying for asperosaponin Ⅵ, TSG, total tannins, total saponins and total flavonoids. It could promote the hemostasis of mice in vivo, as well as the uterine contractions of rats in vitro. Therefore, it may be a promising preparation for clinical treatment of perimenopausal dysfunctional uterine bleeding.

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Objective To explore the clinical effect of pituitrin and oxytocin in laparoscopy myomectomy of intramural fibroids.Methods Sixty patients received laparoscopy myomectomy of intramural fibroids during October 2015-December 2016 were selected and divided into two groups with 30 cases in each.We applied injections of pituitrin 6IU + 10ml normal saline to treatment group while 20U oxytocin + 10ml normal saline to control group so as to compare their blood pressure change and other situations based on medication.Results Compared with control group,the time of operation and amount of bleeding during operation in treatment group reduced obviously(98.13 ± 5.07min vs 110.83 ± 8.03min,t =-7.324,P =0.000).The hemoglobin changed before and after operation (67.50 ±10.24ml vs 97.83 ± 16.10ml,t =-8.705,P =0.000).15min after medication during operation,the systolic pressure in treatment group increased obviously,which was higher than that in control group(150.77 ±:5.57mmHg vs 142.03 ± 5.21mmHg,t =6.273,P =0.000).Conclusion The application of pituitrin to laparoscopy myomeetomy of intramural fibroids was better hemostatic effect than oxytoein,but it may geuerate temporary elevation of blood pressure,so the clinical application should combine with patients' individual situation.

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Aim To observe the preventive protection of Yingxindan on acute myocardial ischemia induced by sublingual injection of pituitrin ( pit) in rats.Methods Sixty rats were randomly divided into saline group , model group, nifedipine 12.6 mg · kg -1 group, and Yingxindan 25.2, 12.6, 6.3 mg · kg -1 groups.The saline group and model group were given the same vol-ume of water.After administration for 7 d, an acute myocardial ischemia model was induced by sublingual intravenous injection of pit 1 U · kg -1 in the rats 1 h after last administration .The changes of the II electro-cardiogram(ECG) ST segment at different time points , as well as the positive rate of myocardial ischemia and arrhythmia were observed .Meanwhile , the levels of serum creatine kinase ( CK ) , creatine kinase isoenzyme ( CK-MB ) , glycogen phosphorylase isoenzyme BB ( GPBB ) , cardiac troponin I ( cTnI ) and cardiac troponin T ( cTnT ) were observed .Re-sults Yingxindan could suppress the changes of ST segment of electrocardiogram in rats with acute myocar-dial ischemia induced by pit and reduce the positive rate of myocardial ischemia and arrhythmia .The con-tents of myocardial injury markers CK , CK-MB, GPBB, cTnI and cTnT in serum significantly de-creased, and the corresponding relationship existed . The greater the dose of Yingxindan , the smaller the content of myocardial injuried markers in serum .Con-clusion Yingxindan has significant preventive protec-tion effect on acute myocardial ischemia by pit .