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PubMed2004

Transient reduction in the posterior pituitary bright signal preceding water intoxication in a malnourished child.

We describe a 4 year-old boy with hypothalamic dysfunction and weight loss, attributed to psychosocial deprivation. Reduced intensity of the posterior pituitary bright signal (PPBS) on MRI, associated with a normal urinary concentrating ability, was documented in the 24 hours prior to the development of the syndrome of inappropriate secretion of antidiuretic hormone (ADH) and severe hyponatraemia. The PPBS was normal on MRI 2 months later, following weight gain and resolution of the other hypothalamic abnormalities. This report shows that the abnormalities of ADH associated with decreased intensity of the PPBS include increased secretion and abnormal regulation as well as ADH deficiency. The association of osmotically unregulated ADH secretion with undernutrition and stress suggests that particuar caution should be used when fluid intake in such children is not driven by thirst.

Child, Preschool↗
PubMed1992

Naloxone attenuates drinking behavior in a schizophrenic patient displaying self-induced water intoxication.

This study was performed to examine the effect of naloxone on drinking behavior in a schizophrenic inpatient with psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome). His body weight was checked five times daily, and the maximum and minimum weight gains during a day were chosen as an index of polydipsia. Both daily (0.6 mg) and repeated (0.6 mg for 6 days) injections of naloxone suppressed his weight gain significantly for 2 weeks. Withdrawal of the drug for 4 weeks resulted in weight gain recovering to control level. Thereafter, a second trial was performed to examine the long-term effect of this treatment. A daily naloxone (0.6 mg) injection series was performed once every 2 weeks for six series (12 weeks). This drug regimen also suppressed his weight gain in a continuous fashion. The study showed that naloxone seems to be a potential treatment for PIP syndrome and that endogenous opioid systems play a part in the compulsive drinking behavior of the PIP syndrome.

Drinking Behavior↗
PubMed2006

Successful switch to olanzapine after rhabdomyolysis caused by water intoxication and clozapine use.

We report on a case of rhabdomyolysis induced by the correction of hyponatremia after psychogenic polydipsia and clozapine use, where the switch to a high dose of olanzapine resulted in the non-recurrence of rhabdomyolysis. The 46-year-old patient with the diagnosis of schizophrenia paranoid type, who had been on clozapine treatment for the previous 4 years, was admitted with the symptoms of generalized seizure and vomiting, and as severe hyponatremia was proved, its correction with the parallel use of clozapine treatment was done. CK concentrations increased to 48 120 U/L without any symptom of neuroleptic malignant syndrome. To prevent acute renal insufficiency, high-volume alkaline diuresis was initiated and clozapine was tapered and stopped. On the day 12 of treatment, olanzapine was started and was elevated to 30 mg/day. CK concentration began to fall returning to the normal concentration on day 20. Six months after the switch to olanzapine no recurrence of rhabdomyolysis was detected; clinical and laboratory findings were normal. We suggest that after a benzodiazepine-type antipychotic-induced rhabdomyolysis, a switch to another atypical antipsychotic can be a cautious clinical strategy.

Antipsychotic Agents↗
PubMed1996

Involvement of the endogenous opioid system in the drinking behavior of schizophrenic patients displaying self-induced water intoxication: a double-blind controlled study with naloxone.

Previously we found significant suppression of polydipsia in a schizophrenic patient with PIP syndrome (psychosis, intermittent hyponatremia, and polydipsia). Suppression was obtained with a small dose of naloxone injected once every 2 weeks in long-term repeated studies. We attempted to confirm the effect of naloxone on PIP syndrome by using a double-blind controlled study. The body weights of eight schizophrenic inpatients with PIP syndrome were checked five times daily, and the maximum weight gain during 1 day was chosen as an index of their polydipsia. Naloxone (0.6 mg in three divided doses) or placebo (saline) injection was given once every 2 weeks three times. Assignment to either the naloxone or placebo series was done randomly in a double-blind, crossover design. Naloxone decreased the maximum weight gain per day significantly in five cases. However, naloxone also increased weight gain significantly in three cases. There was no correlation of the weight-increasing effect of naloxone with the duration and intensity of excessive drinking. Our findings showed that the endogenous opioid system might be related to compulsive drinking behavior in the PIP syndrome and that opioid antagonists such as naloxone or naltrexone could be useful in the therapy of PIP syndrome.

Adult↗
PubMed1991

A review of disorders of water homeostasis in psychiatric patients.

Disorders of water homeostasis are common in psychiatric patients and include compulsive water drinking, the syndrome of inappropriate antidiuretic hormone secretion (SIADH), and the syndrome of self-induced water intoxication (SIWI). Although water intoxication was recognized nearly 70 years ago, the physiological basis of these disorders of water metabolism still remains elusive. This review will provide a historical overview, critique current studies on compulsive water drinking and SIWI, discuss possible etiologies, and present current approaches to treatment of these disorders. Because of the complexity of the subject, a review of normal water homeostasis and the SIADH will be included.

Drinking↗
PubMedDate not supplied

[Polydipsia: review of the literature].

Polydipsia, unrelated to organic polyuria is present in 20% of the patients hospitalised in psychiatry on a long term basis. It seems that about a third of them have presented at some point an episode of water intoxication. Most patients with psychogenic polydipsia excrete all the water they absorb. In a subgroup of them, at risk for water intoxication, the capacity to excrete water is deficient. This is usually due to an inappropriate secretion of antidiuretic hormone. The first two steps in the treatment of patients with psychogenic polydipsia consist in making the diagnosis and in evaluating the risk of water intoxication. To do this, one must monitor throughout the day their weight and the serum sodium plasma level if necessary, then reduce the risk factors and prescribe water restriction during the high risk periods. Behavioural therapy is sometimes used; prospects for chemotherapy are being studied. It is probable that there is not a single type of patient with psychogenic polydipsia but several subtypes, the etiology being multifactorial.

Drinking↗
PubMed2006

Desmopressin toxicity due to prolonged half-life in 18 patients with nocturnal enuresis.

PURPOSE: Desmopressin has been used extensively for primary nocturnal enuresis and it is associated with a low incidence of adverse effects. The only reported serious side effect is seizure or altered levels of consciousness resulting from water intoxication, which has been reported for the nasal spray. We describe 18 children with clinical symptoms of water intoxication due to the prolonged bioactivity of desmopressin nasal spray. MATERIALS AND METHODS: We evaluated 18 patients with clinical suspicion of prolonged desmopressin bioactivity during treatment with intranasal desmopressin for primary nocturnal enuresis. The control group consisted of 50 children with primary nocturnal enuresis and proven nocturnal polyuria who were treated with the same desmopressin regimen. RESULTS: All patients had prolonged maximal urinary concentration capacity and delayed restoration of daytime diluting capacity (p <0.01). Of the patients 15 had the characteristic clinical symptoms of water intoxication with vomiting, headache, decreased consciousness and hyponatremia. We suspect that these symptoms are secondary to prolonged desmopressin bioactivity. CONCLUSIONS: Prolonged desmopressin bioactivity may increase the risk of water intoxication.

Adolescent↗
PubMed2002

Effect of alcoholic intoxication on water content and activity of Na,K-ATPase and Ca-ATPase in rat brain.

We studied the effect of 2-week alcohol intoxication on water exchange and activity of Na,K-ATPase and Ca-ATPase in rat brain. Alcohol intoxication increased water content in the brain due to cell hyperhydration. It is assumed that hyperhydration results from increased Na+ content in cells due to inhibition Na,K-ATPase activity, which in turn is caused by activation of lipid peroxidation under the effect of ethanol. A possible mechanism of Na,K-ATPase inhibition.

Alcoholic Intoxication↗
PubMed2005

Noninvasive early detection of brain edema in mice by near-infrared light scattering.

Brain edema accounts for significant morbidity and mortality in many neurologic conditions such as head trauma, stroke, meningitis, and brain tumor. The water channel aquaporin-4 (AQP4) has been found to be an important determinant of brain water accumulation and clearance of excess brain water. We report the development of a noninvasive near-infrared (NIR) light-scattering method to compare the early kinetics of brain swelling in normal and AQP4-deficient mice. Brain tissue was illuminated through the intact skull with NIR light at 850 nm, and steady-state scattered light intensity was monitored at an angle of 90 degrees at a position on the skull approximately 10 mm from the illuminated site. NIR light scattering reversibly increased with brain swelling (DeltaI/Io approximately 25% per 1% increase in brain water content), but was insensitive to changes in cerebral blood flow, blood oxygenation, or blood flow-related changes in intracranial pressure (ICP). DeltaI/Io increased approximately linearly with brain water content as measured by wet-to-dry weight ratios. Acute water intoxication (intraperitoneal water, 20% body weight) produced a gradual increase in DeltaI/Io of 12 +/- 4% in wild-type mice at 5 min, much greater than that of 2 +/- 1% in AQP4-null mice. Correlation of the NIR signal with ICP showed that increased DeltaI/Io preceded measurable increases in ICP, indicating the ability of the NIR method to detect early brain edema before ICP elevation. NIR light scattering provides a simple noninvasive method to monitor brain edema in mice, with potential clinical applications.

Animals↗
PubMed1996

Screening patients with mental retardation for polydipsia.

OBJECTIVES: To determine whether caregiver responses to a screening question are a reliable method of identifying polydipsia (excessive water drinking) in institutionalized residents with mental retardation. To review the etiology, acute and chronic clinical manifestations, and care of polydipsia and water intoxication. METHOD: This paper presents an assessment of interrater reliability for a screening question for polydipsia using responses of primary caregivers of preidentified polydipsia cases (n = 32) and matched controls (n = 33) in a large Canadian institution for developmentally handicapped adults. A chart review of all cases of identified water intoxication is also provided. The behavioural outcomes of preventive measures for water intoxication are described. RESULTS: The screening instrument was reliable, having a kappa (interrater reliability) of 0.73. Several case descriptions illustrate typical presentations of water intoxication in this population. CONCLUSIONS: Polydipsia is reliably identified by caregiver responses to a screening question. It should be screened for regularly to ensure appropriate care to prevent important acute and chronic complications.

Adult↗
PubMed1994

High incidence of neurologic complications following rapid correction of severe hyponatremia in polydipsic patients.

BACKGROUND: Patients with self-induced water intoxication usually tolerate a large, rapid increase in plasma sodium without developing osmotically induced central pontine myelinolysis. However, we have previously reported a case of clinically suspected pontine myelinolysis in a patient with self-induced water intoxication. The purpose of our study was to investigate if a subgroup of these patients may also be vulnerable to neurologic complications of hyponatremia therapy. METHOD: Over a 10-year period, we identified retrospectively 12 polydipsic patients having a total of 24 episodes of symptomatic hyponatremia with plasma sodium < or = 115 mmol/L. The mode of treatment, the kinetics of correction, and the neurologic outcome were recorded. The presence of alcoholism was noted. RESULTS: Seven patients recovered uneventfully from 19 episodes of symptomatic hyponatremia. Five patients had delayed neurologic complications. Late therapy and/or respiratory arrest might have been associated with the complications for 2 patients. The other 3 patients experienced clinical features of central pontine myelinolysis leading to death in 1. Patients with neurologic complications had a higher maximal 24-hour increase in plasma sodium concentration (21.8 +/- 3.9 vs. 15.5 +/- 5.1 mmol/L, p < .02), and a higher incidence of both overcorrection to hypernatremia and chronic alcoholism, often associated with poor nutrition. All 5 patients became water intoxicated at home, and 2 patients with pontine dysfunction had subacute rather than acute hyponatremia. CONCLUSION: A large rapid increase in plasma sodium may also be detrimental in patients with self-induced water intoxication when they are alcoholic, malnourished, and have nonacute hyponatremia.

Adult↗
PubMed2005

Desmopressin associated symptomatic hyponatremic hypervolemia in children. Are there predictive factors?

PURPOSE: Desmopressin is widely used in primary nocturnal enuresis, bleeding disorders, central diabetes insipidus and diagnostic urine concentration testing. Hyponatremic hypervolemia leading to seizures has been reported as a rare but potentially life threatening side effect of desmopressin therapy. We sought to identify factors that predispose patients to hyponatremia and to find predictive factors associated with increased risk of water intoxication. MATERIALS AND METHODS: We report 13 novel cases of desmopressin associated water intoxication and review the literature. A total of 93 instances of symptomatic hyponatremia during desmopressin treatment in children were identified. Specific data were reported in 58 of 93 cases. These 58 cases, in addition to our 13 novel cases, were further analyzed. RESULTS: All children were treated with intranasal or intravenous desmopressin. No patient received oral desmopressin. Younger children are at greater risk for water intoxication than older children. The risk is particularly high at the beginning of desmopressin therapy. A total of 45 patients (63%) had prodromal symptoms, eg nausea, vomiting and headache. In 10 cases (14%) desmopressin was prescribed without an evident need. CONCLUSIONS: Based on this analysis, we conclude that the use of desmopressin should be cautiously considered, careful monitoring should be performed during the initiation of therapy, and particular care should be taken when treating young children and when prodromal symptoms such as nausea, vomiting and headaches occur.

Adolescent↗
PubMed2003

Influence of hypoosmolality on the blood-brain barrier permeability during epileptic seizures.

Changes in the blood-brain barrier permeability to macromolecules were investigated during pentylenetetrazol-induced seizures, using Evans-blue as an indicator, in water-intoxicated and nonintoxicated Wistar albino (210-250 g) adult rats of both sexes. Evans-blue albumin extravasation was judged visually and estimated quantitatively with a spectrophotometer using homogenized brain to release the dye. Hypoosmolar treatment (water intoxication) was performed by the intraperitoneal administration of distilled water to a volume of 10% of the body weight; Six groups of rats were studied. Group I: female control (n=10), Group II: male control (n=10), Group III: nonwater-intoxicated female+seizure (n=15), Group IV: nonwater-intoxicated male+seizure (n=15), Group V: water-intoxicated female+seizure (n=15), Group VI: water-intoxicated male+seizure (n=15). Approximately 2 h after the injection of water, the plasma osmolarity had decreased by 25-30 mosm. Our results revealed that in female rats, the extravasation of Evans-blue albumin was greater in the brains of water-intoxicated rats compared to nonwater-intoxicated rats after pentylenetetrazol-induced seizures. In addition, hypoosmotic female rats were shown to have a larger increase in blood-brain barrier permeability than hypoosmotic male rats after pentylenetetrazol-induced seizures. This difference between male and female rats was found to be significant (P=.005).

Animals↗
PubMed1989

Water excretion and plasma vasopressin in psychotic disorders.

To investigate the pathogenesis of water intoxication in psychotic disorders, a standard water load test was given to 23 unmedicated patients with schizophrenic or schizoaffective disorders. Levels of plasma arginine vasopressin were measured concurrently. Compared with 28 healthy volunteers, the psychotic patients had significantly smaller cumulative urine output and higher minimum urine osmolalities. Patients whose current illness had lasted less than 24 weeks exhibited the most severe antidiuretic state and also had the highest plasma arginine vasopressin levels. Water intoxication in acute exacerbations of psychosis may develop as a result of impaired excretory mechanisms.

Adolescent↗
PubMed1985

Hyponatremia and seizures presenting in the first two years of life.

During a three-month period, 15 patients under two years of age presented with serum sodium concentrations less than 127 mEq/L. Seven (47%) of these patients presented with seizures. Hyponatremia accounted for a majority (58%) of the afebrile seizures in children under two years during this period. Of the eight patients without seizures, four later proved to have cystic fibrosis. Most of the patients with seizures appear to represent the syndrome of infant water intoxication. Hyponatremia may account for more seizures in early life than has been appreciated. Physicians and parents should avoid dietary practices which promote water intoxication. The etiology, diagnosis, and management of water intoxication and hyponatremic seizures are discussed.

Cystic Fibrosis↗