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PubMedDate not supplied

[Effect of diazepam and phenazepam on Leao's depression in brain edema].

Experiments on rats with brain edema under water intoxication were made to examine the effect of the benzodiazepine tranquilizers diazepam and phenazepam on the time course of the recovery of brain electrical activity after passing the spreading Leao's depression wave. It was found that the drugs indicated possess antiedematous properties and improve brain function under these conditions. It is assumed that the drug action on the spreading depression is linked with their effect on metabolic processes in the brain and antiedematous properties.

Animals↗
PubMed1986

Hyponatremia and ultramarathon running.

Two ultramarathon runners were hospitalized with hyponatremic encephalopathy after completing 80 and 100 km (50 and 62 miles), respectively, of the 1983 American Medical Joggers Association ultramarathon race in Chicago. The two runners consumed such large quantities of free water during the race that apparent water intoxication developed. Both recovered satisfactorily after treatment with intravenous saline. The hyponatremia was caused primarily by increased intake and retention of dilute fluids and contributed to by excessive sweat sodium loss. A possible explanation for the postrace onset of symptoms might be the sudden absorption of fluid in the gastrointestinal tract after exercise ceased, with subsequent further dilution of the plasma sodium. Hyponatremia, which has not been commonly associated with exercise, should be considered as a possible consequence of ultraendurance events.

Adult↗
PubMedDate not supplied

Hyponatremic seizures as a presenting symptom of child abuse.

Poisoning is an uncommon manifestation of child abuse. The intentional administration of water to a child as a form of punishment has rarely been reported as the responsible substance among children who have been poisoned. We describe a case of a 5-year-old girl presenting with severe hyponatremia due to acute water intoxication. The patient was brought to the emergency room in status epilepticus. A history was obtained from the child's mother stating that the patient had been playing outside when she collapsed. She had had no known prior illnesses. Laboratory evaluation included a hemoglobin of 10.1 mg%, glucose of 60 mg%, serum sodium of 107 mEq/l, potassium of 3.2 mEq/l and chloride of 71 mEq/l. A CAT scan obtained approximately 1 h after admission revealed generalized cerebral edema. Careful examination of the skin revealed multiple linear ecchymosis of varying ages on the back and thighs and a hand print on the right flank. In addition, the child demonstrated severe failure to thrive with height, weight and bone age compatible with a 2.5-year-old girl. Appropriate therapy for severe hyponatremia was successfully instituted. For the next 12 h she was deeply somnolent, but the following morning was alert and conversant. She stated that she "would be good if she didn't have to drink any more water". The child's mother subsequently admitted that she frequently used water ingestion as a form of punishment. The child stabilized metabolically and demonstrated rapid in-hospital weight gain. She was placed in foster care at discharge and has had no further hyponatremia or seizures.(ABSTRACT TRUNCATED AT 250 WORDS)

Child Abuse↗
PubMed1990

Successful behavioral treatment of polydipsia in a schizophrenic patient.

Behavioral treatment of a 35 year old female with chronic schizophrenia and water intoxication with seizures was conducted on an inpatient psychiatric unit. Treatment included frequent daily weights, restricted fluid intake, positive reinforcement for program compliance, and time-out from reinforcement following significant weight gain or other specified program violations. The final 6 months of the 30 month treatment program were a maintenance phase during which most contingencies were faded and all fluid restrictions were removed. There was no reported recurrence of polydipsia after 18 months of community placement.

Adult↗
PubMed1990

Polydipsia and hyponatremia in psychiatric patients: challenge to creative nursing care.

Among patients with psychiatric disorders, especially schizophrenia, a pattern of extreme polydipsia and polyuria sometimes emerges, usually without readily identifiable medical causes. Hyponatremia may develop and progress to water intoxication, with symptoms including restlessness, confusion, seizures, or even death. We review the clinical features and pathophysiology of this syndrome and discuss nursing roles in identifying and managing patients with polydipsia and hyponatremia. While the causes of polydipsia and hyponatremia are unclear, relevant factors seem to include a possible dysfunction in central nervous system (CNS) thirst and osmoregulatory centers, the inappropriate secretion of or sensitivity to antidiuretic hormone (ADH), and psychoactive drugs. Management techniques for affected patients concentrate on careful observation, fluid restriction, and the minimization of possible exacerbating factors such as high neuroleptic dosage and cigarette consumption.

Humans↗
PubMed1995

Treatment of polydipsia and hyponatremia in psychiatric patients. Can clozapine be a new option?

Polydipsia occurs frequently in chronic schizophrenic patients, some of whom develop intermittent hyponatremia. Most therapeutic efforts have tried to control the hyponatremia. Four schizophrenic patients, followed for more than one year, showed improvement on clozapine. Case 1 was an outpatient without history of hyponatremia who improved from polydipsia and psychosis. The last three were inpatients with polydipsia, intermittent hyponatremia, and psychosis who showed minimal improvement of psychosis but significant decrease in polydipsia and water intoxication. Case 2 relapsed to polydipsia when clozapine was discontinued on two occasions. Case 3 demonstrated polyuria during 39% of days before clozapine and in 0% of days after two weeks of clozapine. In case 4, most baseline sodium levels were abnormal, but all became normal after clozapine. A time-series analysis for intervention effects showed a significant effect of clozapine (p = .017). The limited information provided by these case reports suggest the need for controlled studies of the clozapine effect on polydipsic patients.

Adult↗
PubMed2001

[Massive acute hypotonic hyperhydration following arthroscopic synovectomy].

We report the case of a 4 year old boy who developed a massive water intoxication as a complication during knee arthroscopy. The sodium plasma concentration dropped to 100 mmol/l postoperatively. This complication may be triggered by prolonged surgery time, excessive intra-articular pressure, capsular tears and low body weight. To prevent massive incorporation of hypoosmolar fluid, the inflation of a tourniquet as well as the use of NaCl 0,9% as irrigation fluid seems to be of advantage. The guidelines for replacing sodium in hyponatremia are discussed according to literature. In general, hyponatremia should be corrected in the same amount of time as it took for it to develop.

Acute Disease↗
PubMed2002

Transurethral resection syndrome--it does not have to be a mystery.

Transurethral resection of the prostate (TURP) has been the standard treatment for moderate to severe benign prostatic hypertrophy since the 1930s. Transurethral resection (TUR) syndrome, one complication that can occur during a TURP procedure, is water intoxication of the body that results in hyponatremia and other acid-base imbalances. This complication is infrequent, occurring in approximately 2% of all patients undergoing TURP procedures; therefore, it may not be recognized by caregivers unfamiliar with the syndrome. The consequences are increased intravascular volume, cellular edema, and hypothermia. Although improvements in surgical technique have lessened the occurrence of TUR syndrome, perioperative staff members still need to remain alert for signs of this complication. A team approach and early recognition can ensure a smooth postoperative course for the patient. Knowing how and why TUR syndrome occurs can enable perioperative nurses to devise a plan of care to help prevent its occurrence.

Humans↗
PubMed2005

Rhabdomyolysis after correction of hyponatremia in psychogenic polydipsia possibly complicated by ziprasidone.

OBJECTIVE: To report a case of rhabdomyolysis related to correction of hyponatremia secondary to psychogenic polydipsia, possibly complicated by the use of ziprasidone. CASE SUMMARY: A 50-year-old white man treated for 3 weeks with ziprasidone 40 mg twice daily for chronic paranoid schizophrenia was admitted to the intensive care unit after a witnessed generalized seizure. Marked hypotonic hyponatremia was present secondary to psychogenic polydipsia. After correction of hyponatremia with intravenous NaCl 0.9%, he developed a substantial elevation in the creatine kinase level without any evidence of muscle trauma, stiffness, or swelling or any signs of neuroleptic malignant syndrome. Renal failure or compartment syndrome did not complicate the clinical picture. DISCUSSION: It is well known that severe hyponatremia can cause neurologic complications such as stupor, seizures, and even coma. Hyponatremia from water intoxication (n = 28) and its correction with intravenous fluids (n = 2) may cause non-neurologic complications such as rhabdomyolysis. An explanation may lie within the calcium-sodium exchange mechanism across the skeletal myocyte or the failure of cell volume regulation secondary to extracellular hypo-osmolality. Neuroleptic medications have been linked to the development of rhabdomyolysis, with antipsychotics being the primary offenders. As of August 2005, there has been only one reported case of rhabdomyolysis related to correction of hyponatremia complicated by an atypical antipsychotic (clozapine). It is possible that ziprasidone, like clozapine, may enhance muscle cell permeability leading to rhabdomyolysis under similar conditions. CONCLUSIONS: Psychiatric patients treated with atypical antipsychotic medications should be closely monitored for rhabdomyolysis during correction of hyponatremia, thus permitting prompt therapy to limit its complications.

Antipsychotic Agents↗
PubMed2000

[Complications of hysteroscopical myomectomy: a report of two cases].

Hysteroscopical myomectomy has recently become popular in Japan. We present two patients who developed water intoxication and air embolism during surgery. [Case 1] Hysteroscopical myomectomy was performed under general anesthesia in a 37-yr-old woman (ASA I). Three hours after the start of the surgery, the patient's serum sodium concentration dropped to 118 mEq.l-1. She was treated with furosemide and recovered without sequelae. [Case 2] A 39-yr-old woman (ASA I) was scheduled to have hysteroscopical myomectomy under spinal and epidural anesthesia. Forty-five minutes after the start of the surgery, the patient complained of severe back pain, her blood pressure decreasing to 40 mmHg, SpO2 decreased to 80%, and ECG showed atrial fibrillation. After administration of ephedrine 5 mg, she recovered within 20 min. No abnormality was observed in echocardiogram, although some negative spots were detectable in a lung scintigraphy. She was discharged without sequelae. The hysteroscopical procedure is considered a non-invasive surgery, but the cases presented here emphasize the necessity for close attention to complications, especially pulmonary embolism.

Adult↗
PubMed2001

Treatment of psychogenic polydipsia: comparison of risperidone and olanzapine, and the effects of an adjunctive angiotensin-II receptor blocking drug (irbesartan).

OBJECTIVE: Our objective was to determine the outcome of novel strategies in managing a case of severe polydipsia. CLINICAL PICTURE: The patient was a 39-year-old male with a 20-year history of paranoid schizophrenia who, despite only mild residual psychotic symptoms, had been hospitalized for the previous 10 years because of severe polydipsic behaviour complicated by water intoxication. TREATMENT: Novel antipsychotic agents, risperidone and olanzapine, as well as the specific angiotensin-II receptor blocking drug, irbesartan were employed at selected intervals in a study lasting nearly 3 years. A strict behavioural management programme was ongoing, in which diurnal weight change and the number of breaches of weight limits, requiring management in a low-stimulus environment, were documented on a daily basis. Summary measures of diurnal weight change and behavioural intervention were charted against changes in treatment. OUTCOME: Polydipsic behaviour improved on risperidone up to 4 mg daily, but was not sustained. Olanzapine was similarly successful in stabilizing polydipsia, and improvement was achieved with the addition of irbesartan. CONCLUSION: We suggest that the D2-sparing profiles of receptor binding achieved with low-dose risperidone and olanzapine may account for this beneficial effect. The benefit derived with irbesartan implicates the involvement of brain angiotensin systems centrally in helping to regulate drinking behaviour.

Adult↗
PubMed1994

Restoration by corticosteroids of the hyperaldosteronism in hyponatraemic rats with panhypopituitarism.

1. In the syndrome of inappropriate secretion of antidiuretic hormone, hyponatraemia is associated with a normal bicarbonate concentration despite dilution. This normal bicarbonate concentration is related to the development of a hyperaldosteronism, which is attributed to a direct stimulation of the zona glomerulosa by the hyponatraemic state. Some workers have suggested that, to develop this hyperaldosteronism requires the presence of a pituitary factor. To determine whether the pituitary gland plays a role in this hyponatraemia-induced hyperaldosteronism, water intoxication was performed for 24 h in normal and in panhypopituitaric rats. 2. In normal rats, hyponatraemia (108 mmol/l), induced by the administration of 1-desamino-8-D-arginine vasopressin and 2.5% D-glucose-0.45% NaCl by gavage (15% body weight) was associated with a mild increase in bicarbonate concentration, and blood acid-base equilibrium showed a mixed metabolic and respiratory alkalosis (pH 7.57, partial pressure of CO2 29 mmHg, base excess +5.5 mmol/l), and aldosterone concentration was increased 3-fold as compared with the control value. When hyponatraemia (110 mmol/l) was induced in a similar manner in panhypopituitaric rats, we observed a very low aldosterone concentration (< 50 pg/ml) and a compensated respiratory alkalosis (pH 7.45, partial pressure of CO2 30 mmHg, base excess -2.6 mmol/l). The restoration of a hyperaldosteronaemic state in this group of rats was related essentially to corticosteroid intake. 3. These data suggest that corticosteroids play a critical role in the development of hyponatraemia-related hyperaldosteronism, a phenomenon not necessarily dependent on a pituitary factor.

Acid-Base Equilibrium↗
PubMed1979

Skin cancer and arsenical intoxication from well water.

A case of acute arsenical intoxication arising from ingested well water containing only 1.2 ppm of arsenic is reported. After a latent period of 14 years, multiple cutaneous basal cell carcinomas developed. The water was analyzed for a variety of other trace elements and compounds and no evidence for the existence of other carcinogens was found. This study strengthens the concept that arsenic is a carcinogen. The role of a possible selenium deficiency is also discussed.

Adult↗
PubMed1994

The struggle to maintain hydration and osmoregulation in animals experiencing severe dehydration and rapid rehydration: the story of ruminants.

Ruminants in tropical and desert areas routinely experience cycles of severe dehydration and rapid rehydration. These animals can withstand severe dehydration (18-40% of initial body weight), which exceeds considerably the capacity of most monogastric mammals. This capacity is related to their ability to use, during the course of dehydration, their large water reservoir in the rumen, which contributes 50-70% of the total water loss. As rumen fluid is in approximate isotonicity with systemic fluid, the utilization of gut water during the course of dehydration involves a considerable load of sodium and potassium. Consequently, the effectiveness of utilization of rumen fluid during dehydration depends on the capacity of the kidney to 'desalt' the water absorbed from the gut and on maintenance of salivary flow to the rumen. Following rehydration, ruminants can imbibe their entire water deficit in one drinking and the entire amount ingested is first retained in the rumen. The rumen volume at this stage may exceed the extracellular fluid volume and the sudden drop in rumen osmolality creates a huge osmotic gradient (200-300 mosmol kg-1) between the rumen and systemic fluid. Ruminant animals are confronted at this stage by two opposing tasks, each of them of vital importance: (i) the need to prevent the osmotic hazard leading to water intoxication; and (ii) the need to retain the ingested water, so that it is not missing for the next dehydration cycle. The most prevalent view until recently was a theory which attributes an osmotic protective mechanism to the rumen wall. However, such a capacity has not yet been demonstrated and is challenged by contradictory observations that large amounts of water are absorbed from the rumen following rehydration. The view that is most consistent with available information is that gustatory-alimentary and hepatoportal signals regarding the presence of large amounts of water in the rumen and the absorption of water from the gut activate a range of homeostatic responses involved in fluid and sodium restitution. The efferent elements, presumably activated by the CNS, include: a dramatic increase in secretion of hypotonic saliva and, reciprocally, a dramatic drop in urine flow. The enhanced saliva secretion recycles a considerable portion of the water absorbed from the gut back to the rumen, which allows effective retention of water while avoiding the danger of osmotic threat to the red blood cells. The enhanced saliva secretion also drains large amounts of sodium and bicarbonate from the blood. Accompanying responses are marked retention of sodium and carbonic acid in the kidney.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1997

Effect of water and bicarbonate loading in patients with chronic renal failure.

Animal studies suggest that alkalinization and increased intake of free water both serve to decrease the rate of progression in chronic renal failure. However, clinicians have been reluctant to apply either strategy because of concerns regarding volume overload and water intoxication. We tested the effects of 2 1 daily water supplementation, with either an electrolyte-poor or a HCO3-rich (47.5 mmol/1) water in 11 patients with chronic renal failure (creatinine clearance 10 +/- 5 ml/min). The patients were brought into balance on a diet containing 80 mmol/24 h Na+, 80 mmol/24 h Cl- and 70 mmol/24 h K+. After a 3-day equilibration period, the patients were randomized to one or the other regimen for 7 days. After a 3-day washout period, the alternate regimen was given for another 7 days. Neither regimen led to weight gain or hyponatremia. The supplemental 95 mmol/24 h HCO3- lowered the serum Cl- concentration and raised the serum HCO3- concentration, as well as the pH value, to normal. Creatinine clearance and protein excretion were not affected. Serum beta 2-microglobulin concentrations decreased with the NaHCO3-containing water. Na+/H(+)-antiporter activity was not consistently influenced since an order effect of the regimens was apparent. We conclude that 2 1/24 h water and NaHCO3 supplementation is well tolerated, causes no deleterious effects, and may evoke improvement in patients with chronic renal failure.

Acid-Base Equilibrium↗
PubMed1982

Reposital vasopressin response test in clinically normal dogs undergoing water diuresis: technique and results.

Maximal renal concentrating ability after parenteral administration of repositol antidiuretic hormone was evaluated in 13 clinically normal dogs undergoing water diuresis. Urine specific gravity and osmolarity progressively increased in all dogs and generally attained maximum concentrations after 8 to 12 hours. Urine specific gravity values increased from mean of 1.003 +/- 0.001 mOsm/kg of water to a mean maximal value of 1.042 +/- 0.009 mOsm/kg. Urine osmolarity increased from a mean of 132 mOsm/kg to a mean maximal value of 1,518 +/- 242 mOsm/kg. Water intoxication was observed in all dogs due to continued administration of water after antidiuretic hormone administration.

Animals↗
PubMed1984

Evaluation of brain chloride determinations in the diagnosis of water deprivation/sodium salt intoxication in pigs.

In a series of pig brains submitted from field cases where water deprivation/sodium salt intoxication was suspected, histopathological examinations and chloride determinations were performed. A poor correlation was found between brain chloride concentration and neuropathology. The ranges of chloride concentrations found were similar for brains showing the encephalopathy of water deprivation/sodium salt intoxication, brains with other neuropathological diagnoses and brains without significant histopathological lesions. A close correlation was found between brain sodium and chloride in a further similar series, suggesting that determinations of sodium would not be more helpful diagnostically than determinations of chloride. A wide range of brain chloride values was also found in a group of healthy slaughtered pigs but the significance of this was not apparent. Brain chloride determinations have little value in the diagnosis of water deprivation/sodium salt intoxication in pigs, especially when performed in isolation without concurrent neuropathology and an adequate clinical history.

Animals↗