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In vivo measurement of brain extracellular space diffusion by cortical surface photobleaching.

Molecular diffusion in the brain extracellular space (ECS) is an important determinant of neural function. We developed a brain surface photobleaching method to measure the diffusion of fluorescently labeled macromolecules in the ECS of the cerebral cortex. The ECS in mouse brain was labeled by exposure of the intact dura to fluorescein-dextrans (M(r) 4, 70, and 500 kDa). Fluorescein-dextran diffusion, detected by fluorescence recovery after laser-induced cortical photobleaching using confocal optics, was slowed approximately threefold in the brain ECS relative to solution. Cytotoxic brain edema (produced by water intoxication) or seizure activity (produced by convulsants) slowed diffusion by >10-fold and created dead-space microdomains in which free diffusion was prevented. The hindrance to diffusion was greater for the larger fluorescein-dextrans. Interestingly, slowed ECS diffusion preceded electroencephalographic seizure activity. In contrast to the slowed diffusion produced by brain edema and seizure activity, diffusion in the ECS was faster in mice lacking aquaporin-4 (AQP4), an astroglial water channel that facilitates fluid movement between cells and the ECS. Our results establish a minimally invasive method to quantify diffusion in the brain ECS in vivo, revealing stimulus-induced changes in molecular diffusion in the ECS with unprecedented spatial and temporal resolution. The in vivo mouse data provide evidence for: (1) dead-space ECS microdomains after brain swelling; (2) slowed molecular diffusion in the ECS as an early predictor of impending seizure activity; and (3) a novel role for AQP4 as a regulator of brain ECS.

Animals↗

Absence of antidiuresis during administration of prostaglandin F2 alpha.

Water diuresis was induced in six patients in mid-pregnancy. Three were then given oxytocin and the remainder prostaglandin F(2)alpha (PGF(2)alpha), both drugs being infused intravenously in doses used to induce labour at term. Pronounced antidiuresis occurred with oxytocin, whereas PGF(2)alpha showed no such effect. The probable absence of any risk of water intoxication when using PGF(2)alpha in inducing labour may be of particular value when maternal pre-eclampsia or renal disease is present.

Abortion, Legal↗

5-year treatment of the chronic syndrome of inappropriate secretion of ADH with oral urea.

We report the case of a patient with an idiopathic syndrome of inappropriate secretion of ADH for more than 6 years. Water restriction was effective only during hospital care but was socially difficult to maintain at home, so that the patient presented frequent symptoms of water intoxication. Normal natremia was also obtained with a high salt intake (9 g/day) but this induced leg edema mild dyspnea and gastric intolerance. The patient was however successfully treated for more than 5 years without any side effects with oral urea (30 g/day) allowing her a normal fluid intake (1-1.5 liters/day). Oral urea, even during long periods, is a safe and effective therapeutic approach for patients with chronic SIADH which is not controlled by water restriction alone.

Administration, Oral↗

[Sudden bradycardia and hypotension in five patients under spinal anesthesia during transurethral resection of the prostate].

We reported five patients had developed sudden bradycardia and hypotension under spinal anesthesia during transurethral resection of the prostate. The symptoms occurred not only just after the induction of spinal anesthesia, but also at the end of operation. It seems that these symptoms are caused from water intoxication, myocardial ischemia or vagal reflex. This emphasizes the importance of rigorous vigilance on patients until the end of operation.

Aged↗

Differential effects of neuroleptic and clozapine on polydipsia and intermittent hyponatremia.

Recent reports indicate that clozapine may dramatically decrease both polydipsia and intermittent hyponatremia associated with chronic psychosis. In contrast, there are conflicting reports regarding the impact of standard neuroleptic treatment in this syndrome. We review the relevant literature examining the effects of antipsychotics on the excessive thirst drive and inordinate arginine vasopressin activity observed in patients with water intoxication. Confounding interpretation of the current literature are inconsistent use of diagnostic criteria and treatment outcome measures. If results of preliminary trials is substantiated, clozapine treatment may provide an opportunity to correct methodological problems and provide greater insight into the syndrome of polydipsia and intermittent hyponatremia.

Antipsychotic Agents↗

Changes in amino acids, ammonium, and coagulation factors after transcervical resection of the endometrium with a glycine solution used for uterine irrigation.

OBJECTIVE: Transcervical resection of the endometrium with the use of 1.5% glycine for irrigation is associated with postoperative nausea in some patients. This could be because of hyponatremia or toxic effects of glycine and its metabolites. Moreover, 1.5% glycine is hypoosmolar, and hemolysis and fibrinolysis are possible. Changes in plasma factors related to these potential complications of transcervical resection of the endometrium were measured. STUDY DESIGN: In 101 patients undergoing transcervical resection of the endometrium sodium, ammonium, and coagulation factors were measured preoperatively and postoperatively at intervals. In the initial 30 patients glycine and 28 other amino acids were measured at the same intervals. The results were correlated with the patients' clinical status and operative parameters. RESULTS: Glycine and nine other amino acids and ammonia showed increased postoperative plasma levels; these changes were correlated with the absorption of the irrigating glycine solution and the development of hyponatremia. Minor activation of fibrinolysis and hemolysis was also seen. CONCLUSION: Nausea after transcervical resection of the endometrium with 1.5% glycine for irrigation may be partly explained by toxic effects of glycine and its secondary metabolites in addition to the effects of water intoxication and hyponatremia. Minor, clinically insignificant changes in the coagulation system may also occur. Studies on alternatives to glycine for creation of near-isotonic irrigating solutions are encouraged.

Adult↗

Fatal compulsive water drinking.

In two cases of psychogenic polydipsia, water intoxication developed and contributed to the patient's death. The treatment of the patient with psychogenic polydipsia has been based on the presumed reversibility of the condition. Treatment of such patients must be reconsidered in light of these deaths.

Adult↗

'And not a drop to drink'--why water is harmful for newborns.

Breastmilk is a species-specific food, that is, milk made by human mothers for human infants, and thus is the only natural fluid appropriate for the newborn human. There is a plethora of information available discussing the dangers of water supplementation to babies. This article aims to collate the more recent research papers. Fully breastfed babies do not require water, even in the hottest weather. The dangers of newborn water intoxication, risk of reduction in breastmilk supply and early weaning as well as not following the Ten Steps to Successful Breastfeeding's step six, are discussed. The impact of the attitude of and information from influential persons in the mother's life is also noted.

Breast Feeding↗

Symptomatic hyponatremia associated with psychosis, medications, and smoking.

Over a 3-year period, 15 patients with severe hyponatremia were referred to our emergency room from a nearby psychiatric institution. This article reports on 36 episodes of symptomatic hyponatremia in those 15 patients. All but two of the patients were receiving antipsychotic medications; one patient was taking a nonsteroidal anti-inflammatory drug, and one patient was taking an oral hypoglycemic agent. Thirteen patients were chronic schizophrenics, one had a bipolar depressive disorder with psychotic features, and one patient had no psychiatric disorder. Patients presented with seizures, change in mental status, and vegetative symptoms (nausea, vomiting, and diarrhea) associated with hyponatremia and water intoxication. Exacerbation of the patients' underlying illness, psychogenic polydipsia, compulsive smoking, alcoholic cirrhosis, drug abuse, and neuroleptic and other medications are thought to be the major causes of acute hyponatremia in these patients.

Adult↗

Hyponatraemia and cerebral convulsion due to short term DDAVP therapy for control of enuresis nocturna.

UNLABELLED: Desmopressin (DDAVP) is frequently used in the treatment of primary isolated enuresis nocturna if other approaches have failed. We report a further case of hyponatraemia and cerebral convulsion due to water intoxication after intranasal DDAVP application by a 6 year-old boy with enuresis. CONCLUSION: Although adverse reactions in DDAVP (e.g. hyponatraemia) are rare, it should not be considered as the first choice treatment of enuresis nocturna and only be used with caution.

Child↗

Acute pulmonary oedema following oxytocin administration: a life threatening complication.

Water Intoxication is not a common complication of oxytocin infusion. A 26 years primigravida developed acute onset severe pulmonary oedema in postpartum period to whom oxytocin was infused for the induction of labour and to prevent postpartum haemorrhage. The relative role of oxytocin and of electrolyte-free fluids in the pathogenesis of this problem is discussed.

Acute Disease↗

Side effects and complications of treatment with desmopressin for enuresis.

A literature search revealed 23 studies that have reported on the type or frequency of side effects or complications associated with the use of desmopressin (DDAVP, Rhône-Poulenc Rorer Pharmaceuticals Inc, Collegeville, Pennsylvania) for the treatment of enuresis. Thirty-one (4.3%) side effects were reported in 717 patients. Seizure secondary to water intoxication is a potential complication of treatment with desmopressin and was reported in six patients, usually in association with excess fluid intake during the evening or day preceding the use of desmopressin. Desmopressin appears to have a favorable safety profile. Patients should be specifically instructed not to ingest excess fluids during the evening prior to administration of desmopressin.

Clinical Trials as Topic↗

Polydipsia and schizophrenia in a psychiatric hospital: a replication study.

A prior study in a US state hospital suggested that schizophrenia, smoking and long hospitalization were associated with polydipsia. This study, in another US hospital, attempts to (1) replicate that schizophrenia and smoking are associated with polydipsia, and (2) rule out that this relationship is partly explained by alcohol and drug use. Both studies have similar methodologies. The second sample included 588 inpatients. Models of variables associated with polydipsia were developed using logistic regression. In the second study, after correcting for other factors, the association between polydipsia and schizophrenia showed a borderline significance, while polydipsia and smoking displayed a significant association. Neither organic brain lesions, nor alcohol or drug use, were associated with polydipsia. An analysis combining both samples showed that: (1) schizophrenia, long hospitalization, smoking and heavy smoking were significantly associated with polydipsia, and (2) male gender and Caucasian race (but not smoking) increased the risk of developing water intoxication in polydipsic patients. These two studies in severely mentally ill patients suggest that the association of polydipsia with schizophrenia, smoking and chronicity is consistent and independent from the definition of polydipsia (by staff, a biological method or the combination of both). Psychiatric medications do not appear to explain most cases of polydipsia in these patients.

Analysis of Variance↗

NMDA receptor-antagonistic properties of hyperforin, a constituent of St. John's Wort.

Extracts of the medicinal plant St. John's wort (Hypericum perforatum) are widely used for the treatment of affective disorders. Hyperforin, a constituent of St. John's wort, is known to modulate the release and re-uptake of various neurotransmitters, an action that likely underlies its antidepressive activity. We now report that hyperforin also has N-methyl-D-aspartate (NMDA)-antagonistic effects. Hyperforin (10 microM) was found to inhibit the NMDA-induced calcium influx into cortical neurons. In rat hippocampal slices, hyperforin inhibited the NMDA-receptor-mediated release of choline from phospholipids. Hyperforin also antagonized the increase of water content in freshly isolated hippocampal slices, and it counteracted, at 3 and 10 microM, the increase of water content induced by NMDA. Hyperforin was inactive, however, in two in vivo models of brain edema formation, middle cerebral artery occlusion and water intoxication in mice. In conclusion, hyperforin has NMDA-receptor-antagonistic and potential neuroprotective effects in vitro. This effect may contribute to the therapeutic effectiveness of St. John's wort extracts in some situations, for example, for relapse prevention in alcoholism.

Animals↗

Operative hysteroscopy: American Association of Gynecologic Laparoscopists' 1993 membership survey.

The 1993 American Association of Gynecologic Laparoscopists' membership survey on operative hysteroscopy had 713 respondents reporting 14,707 procedures. Directed biopsy and endometrial ablation were the most commonly reported. The majority of operative hysteroscopies were performed for a complaint of abnormal bleeding (78%). The most frequent reported complication was uterine perforation not requiring transfusion (14.2/1000 procedures). The rates of water intoxication and pulmonary edema stayed essentially unchanged from 1991: 2/1000 in 1993 compared with 1.4/1000 in 1991. No deaths were reported this year. The consistency in rates of procedures performed and complications within the three surveys conducted in 1988, 1991, and 1993 add credibility to the data from these retrospective studies.

Biopsy↗

[Optimization of hydrodynamic conditions in transurethral resection of benign prostatic hyperplasia].

Water intoxication remains a serious complication of transurethral resection (TUR) occurring more frequently in patients with large-size benign prostatic hyperplasia (BPH) and in those who was operated for more than 1 hour. An advanced irrigation system employing mechanical valve "Floval" and active aspiration provides controlled irrigation of the bladder preventing spontaneous rise of intravesical pressure in conducting TUR in BPH patients.

Equipment Design↗

[Schizophreniform psychosis with polydipsia and electrolyte imbalance in multiple sclerosis].

We present the case report of a young woman who suffered from schizophrenia-like psychosis leading to polydipsia and consequent water intoxication. Because of progressive somnolence and epileptic seizures therapy on the intensive care unit became necessary. Findings of MRI and cerebrospinal fluid were consistent with the diagnosis of chronic inflammatory disease of the central nervous system. As other possible causes could be excluded, multiple sclerosis seemed to be most probable. Simultaneous incidence of schizophrenia and multiple sclerosis and the differential diagnosis of central pontine myelinolysis following hyponatremia are discussed.

Adult↗