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At least 19 recordsLinked to original sources

Pulmonary oedema during treatment of acute water intoxication.

Acute water intoxication with deepening coma and uncontrolled epileptiform seizures in a 25-year-old previously fit male schizophrenic was treated with hypertonic (2 N) saline and a 20% mannitol solution. This improved his neurological state but precipitated severe pulmonary oedema. Intravenous frusemide increased his urinary output sufficiently to clear the pulmonary oedema. In acute water intoxication the use of hypertonic solutions may thus precipitate left heart failure by expanding the intra-pulmonary blood volume beyond the capacity of even a healthy left ventricle to compensate. Simple water restriction will produce a slower but perhaps safer improvement.

Acute Disease

Target weight procedure: preventing water intoxication.

1. Prevention of water intoxication depends on early intervention for polydipsic patients who seem to be retaining fluid. The Target Weight Procedure is designed to detect early signs of fluid retention by means of weight gain and low sodium levels. 2. The use of this protocol, in addition to successfully decreasing the number of acute water intoxication episodes, has also led to increased awareness of the meaning of patient behavior, an increased sense of control of patients with water intoxication over their behavior, and an increased feeling of competence among the staff. 3. The success of the protocol seems to be based on its purpose of identifying patients at risk and those with an impending episode, as well as secondary advantages, for example, giving the patients the option to alter their behavior to be removed from the protocol.

Drinking

Early detection of water intoxication.

1. It has been estimated that between 3% and 6% of patients in psychiatric treatment settings are affected by water intoxication. Water intoxication with consequent hyponatremia can result in disturbing clinical conditions. 2. Early detection is an important factor because of the insidious nature and rapid development of this syndrome. 3. A risk analysis for the early detection of this serious condition has been developed. It is easily administered and effective in categorizing a patient's level of risk.

Adult

Self-induced water intoxication in a schizophrenic patient.

Water intoxication occurred in a 53-year-old woman with chronic simple schizophrenia and poorly controlled diabetes. For several years she had had a compulsive habit of drinking excessive amounts of water. Coma, fever, convulsions and other neurologic signs appeared suddenly, and she had severe hyponatremia. Her condition improved rapidly when the electrolyte abnormality was corrected.

Drinking

Water intoxication associated with oxytocin administration during saline-induced abortion.

Four cases of water intoxication in connection with oxytocin administration during saline-induced abortions are described. The mechanism of water intoxication is discussed in regard to these cases. Oxytocin administration during midtrimester-induced abortions is advocated only if it can be carried out under careful observations of an alert nursing staff, aware of the symptoms of water intoxication and instructed to watch the diuresis and report such early signs of the syndrome as asthenia, muscular irritability, or headaches. The oxytocin should be given only in Ringers lactate or, alternately, in Ringers lactate and a 5 per cent dextrose and water solutions. The urinary output should be monitored and the oxytocin administration discontinued and the serum electrolytes checked if the urinary output decreases. The oxytocin should not be administered in excess of 36 hours. If the patient has not aborted by then the oxytocin should be discontinued for 10 to 12 hours in order to perform electrolyte determinations and correct any electrolyte imbalance.

Abortion, Induced

Water intoxication by the oral route in an infant.

Symptomatic water intoxication is common when hypo-osmolar fluids are given therapeutically, usually intravenously, but it is rare after drinking voluntarily (Wynn and Rob, 1954). We report a case of water intoxication caused by voluntary drinking in an infant.

Drinking

Carbamazepine therapy complicated by nodal bradycardia and water intoxication.

A case is reported of water intoxication and cardiac conduction disturbances occurring as a late complication of carbamazepine therapy for trigeminal neuralgia. These uncommon but potentially hazardous complications of therapy are reported because of the wide use of carbamazepine as the agent of choice for trigeminal neuralgia and as an anticonvulsant.

Aged

[A water intoxication patient who showed remarkable ST depression and suspected ischemic heart disease].

A 63 year old female, who was admitted to a psychiatric hospital for schizophrenia, was referred to our emergency room because of sudden loss of consciousness and convulsions. On arrival, she was drowsy and hypoxemic. Her chest X-ray showed cardiomegaly with pulmonary edema. ECG showed marked ST depression in precordial leads and serum chemistry revealed marked elevation of CPK, GOT and LDH along with hyponatremia and hypochloremia. She was immediately admitted to CCU on suspicion of acute non-transmural myocardial infarction complicated with congestive heart failure. After fluid restriction and intravenous infusion of dopamine she passed large amount of urine, and her consciousness level, electrolyte imbalance and ECG change, improved gradually. Although serum CPK level increased as high as 32,307 IU/ml, there were no signs of left ventricular asynergy on UCG and CPK isozyme analysis performed later revealed more than 99% of serum cCPK was MM-type. We concluded that water intoxication was the cause of the ECG change and the elevated serum CPK, GOT and LDH levels. There are few reports on elevated CPK level in association with water intoxication, in which rhabdomyolysis is speculated as the cause of CPK elevation. But there is no report on ECG change complicated with water intoxication. In our case, electrolyte imbalance caused by water intoxication seemed to play a major role in ST depression and QT prolongation. Although water intoxication is a rare disorder in the general population, it is not infrequent among patients with psychiatric diseases. Care must be taken when such patients present ECG change and serum enzyme elevation mimicking ischemic heart disease.

Aspartate Aminotransferases

[Water intoxication after polydipsic episodes. (8 cases)].

Eight cases of convulsive coma by water intoxication without predisposing disease in the majority of instances in psychiatric patients, added to 25 cases from the literature make it possible to describe a stereotyped picture of "psychogenic" water intoxication. This includes episodes of polydipsia preceding convulsions and altered conscious level, accompanied by severe hyponatraemia. Cure occurs spontaneously after an acute hypotonic polyuric phase. Study of free water clearances and dynamic ADH suppression tests demonstrate hypovasopressinism which is difficult to inhibit, with "lower osmoreceptor reset". This abnormality is transient and sometimes relapsing.

Adult

[Water intoxication].

In uncharacteristic clinical symptomatology the excess of water or the water intoxication render themselves conspicuous less by the signs of an increased fluid content than by central-nervous disturbances. Among the results of laboratory examinations the hypoosmolarity measured cryoscopically always, the hyponatraemia in most cases prove the excess of free water. Exceptions are discussed. A decreased capacity of the elimination of water pathogenetically plays a larger role than primarily excessive water supply. Apart from acute and chronic renal insufficiency the various forms of the Schwartz-Bartter-syndrome (inadequate ADH-secretion) play an increasingly more important role. The therapy demands the reduction of every supply of free water, the treatment of the evoking cause and only in cases of exception the administration of hypertonic saline solution, at the most dialysis treatment.

Diabetic Coma

Psychosis and water intoxication.

Three cases of psychosis, polydipsia, and water intoxication are presented as examples of a syndrome that is potentially unrecognized in psychiatric settings. Diagnostic and etiologic considerations, with particular attention to the syndrome of inappropriate antidiuretic hormone secretion (SIADH), are discussed through a review of relevant literature. A schema for a routine psychiatric evaluation is described that will minimize overlooking this association of psychosis and disturbed water balance.

Adult

Water intoxication death following hypothalamic lesions in the rat.

Rats received large, bilateral lesions of the ventromedial hypothalamus. Water or saline intakes, urine outputs and body temperatures were observed for up to 24 hr after surgery. Fifty percent of the operated animals drank excessively and died within 4-6 hr when permitted access to water. Urine outputs were low and symptoms of water intoxication were evident. When allowed access to saline, outputs rose and the number of animals which survived increased as the saline concentration increased. Body temperatures approached 40 degrees C during drinking, but did not differ from operated animals which refused to drink. It was concluded that the deposition of metallic ions strongly stimulates a hypothalamic drinking system which results in overhydration and water intoxication death.

Animals

Water intoxication and Syntocinon infusion.

A case of severe water intoxication with convulsion and prolonged coma, following the use of a high dose Syntocinon infusion is described. The pathogenesis and treatment of the condition are discussed.

Adult

[Water intoxication and brain edema in psychogenic polydipsia (author's transl)].

A case of psychogenic polydipsia is presented that showed psychic decompensation and compulsive drinking under the acute stress of an imminent operation for ovarian cyst. Without any indication of an underlying organic disease process the patient developed acute water intoxication due to the uncontrolled intake of water from the tap, this caused hyponatremia, brain edema, coma and status epilepticus. The physiology of water intoxication is reviewed in relation to this case, which is also remarkable for the acute onset and the shortness of the polydipsic state.

Adult

Hyperglycemia, hypoinsulinemia, and hyperglucagonemia in acute water intoxication.

When acute (four-hour) hyponatremia with clinical signs of water intoxication was produced in normal weanling mice by the use of hypotonic glucose or deionized water, there was a two-to-fourfold increase in plasma glucose concentration. Concomitantly, concentrations of plasma insulin fell 63 to 68 per cent, whereas plasma glucagon increased to 262 per cent of control. The findings are compatible with stress-induced catecholamine release.

Acute Disease

Water intoxication after oxytocin-induced midtrimester abortion.

Two cases of water intoxication assoicated with midtrimester induction of abortion with oxytocin are presented. Both patients recovered from this potentially fatal condition which is associated with acute hyponatraemia. Some of the pertinent literature is reviewed and the possible mechanisms of causation and measures for prevention and treatment are discussed.

Abortion, Induced

A survey of patient attitudes toward self-induced water intoxication.

Twenty male chronic schizophrenics suffering from self-induced water intoxication were administered a 15 item questionnaire to assess their understanding of and attitudes toward drinking fluids. Eighty-five percent stated they drank excessive amounts of fluids in order to feel better. These findings have implications for the treatment of patients with this disorder.

Attitude to Health