[Water intoxication in a schizophrenic patient under treatment with thioridazine: study of the physiopathological mechanisms involved].
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We have described two infants with profound hyponatremia and seizures due to metabolic derangements resulting from inappropriate feeding of large volumes of solute-poor liquids. All of the 23 similar cases in the current literature described children with normal renal and neurologic function before and after the episode of hyponatremia. The chronic feeding of solute-poor fluids in these infants impaired their ability to excrete free water, and continued feeding of solute-poor fluids resulted in progressive hyponatremia and convulsions. Upon reinstitution of normal sodium intake, all metabolic abnormalities disappeared.
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We present a case of well documented multiple sclerosis which presented with the syndrome of inappropriate antidiuretic hormone secretion, following an exacerbation of the disease. This is a poorly documented association.
A mentally retarded patient who developed polydipsia and hyponatremia following the long-term use of neuroleptics is described. Before the investigation, he was treated with a combination of five drugs: diazepam, propericiazine, carbamazepine, lithium carbonate and trihexyphenidyl. The treatment was switched to diazepam alone; to propericiazine, trihexyphenidyl and diazepam; to carbamazepine and diazepam; and finally to lithium carbonate with diazepam. Under the five drug treatment protocols, his weight gains during the day were monitored, every day as an index of the water he drank in the day time. The combination of the five drugs caused the greatest weight differences per day and the other drug regimens, except diazepam alone, seemed to increase the weight differences to some extent. These findings indicate that a drug combination such as the neuroleptics, lithium and carbamazepine used for emotional stabilization must be carefully monitored to avoid the induction of compulsive drinking.
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In this case report the electroencephalograph remained abnormal even when the sodium had returned to normal. Although it was not possible to monitor intracranial pressure in this patient, it is the presumption that the cerebral oedema was the cause of both the seizures and the electroencephalographic abnormalities.
Plasma sodium and osmolality were determined in 80 adult epileptic patients receiving chronic treatment with carbamazepine and in 50 control patients treated with other anticonvulsant drugs. Mean plasma osmolality was significantly lower in the carbamazepine-treated patients but mean plasma sodium did not differ in the two groups. Hyponatraemia was found in five of the carbamazine-treated patients and hypo-osmolality in six. None of the control patients had hyponatraemia and only one had a borderline low osmolality. Three of the 13 patients receiving carbamazepine alone were hyponatraemic. Plasma sodium concentration correlated negatively with both daily carbamazepine dose and serum carbamazepine level. Free water clearance after an oral water load was determined in six patients on carbamazepine alone and in six normal subjects not receiving drug therapy. The capacity of some of the patients to excrete the water load was found to be grossly impaired.
We describe a 71 year old man with a neurodegenerative condition who developed chronic inappropriate antidiuretic hormone secretion and hypothermia resulting in recurrent episodes of impaired consciousness. This combination of abnormalities is attributable to hypothalamic disease and has not to our knowledge been previously reported with clearly documented antidiuretic hormone excess.
Two cases of rheumatoid arthritis, who developed severe hyponatremia after treatment with non-steroidal anti-inflammatory drugs (NSAID) are presented. Early diagnosis was followed by rapid correction with hypertonic saline. It is suggested that NSAIDs, like piroxicam, diclofenac and indomethacin, may be added to the list of drugs which can induce syndrome of inappropriate antidiuretic hormone (SIADH).
The authors conducted a controlled, prospective 4-month study of 10 male inpatients with chronic schizophrenia and polydipsia. The five men who were treated with group psychotherapy drank significantly less fluid than the five men not given this therapy. The effect of group psychotherapy quickly dissipated in the follow-up period, indicating the need for ongoing treatment.