1/38. Effect of adjunctive cortisol on serum sodium in a polydipsic hyponatremic schizophrenic patient.1. Many polydipsic schizophrenics exhibit enhanced antidiuretic hormone (ADH) activity and thus are hyponatremic and suffer life-threatening water intoxication. Excess cortisol inhibits ADH, while cortisol insufficiency produces impairments in water balance resembling those seen in hyponatremic schizophrenics. Furthermore, hyponatremia normally upregulates cortisol receptors on the neurons which synthesize ADH, which should make them more sensitive to the effects of cortisol. 2. The author treated a hyponatremic schizophrenic, whose water imbalance was unresponsive to standard clinical interventions including clozapine, with a 4-week open trial of 60 mg cortisol daily, followed by a three week taper. 3. Mean serum sodium levels appeared to increase modestly from 114.3 to 118.5 mEq/l while the patient received adjunctive cortisol (P < .06). 4. While a modest effect was seen, the results do not suggest that adjunctive cortisol will reverse hyponatremia, and instead support other data indicating that these patients exhibit a central resistance to glucocorticoid actions.- - - - - - - - - - ranking = 1keywords = antidiuretic hormone, antidiuretic, hormone (Clic here for more details about this article) |
2/38. University of Miami Division of Clinical pharmacology Therapeutic Rounds: the water-intolerant patient and perioperative hyponatremia.Perioperative hyponatremia has been recognized as a serious in-hospital complication for many years. Because the kidney responds to changes in extracellular fluid tonicity by adjusting water excretion, a defect in any of several key elements of water excretion can lead to water retention and hyponatremia. Most cases of hyponatremia are caused by impaired renal water excretion in the presence of continued water intake. For the kidney to excrete excess free water and thereby protect the extracellular fluid against hyponatremia, there must be an adequate glomerular filtration rate (GFR), adequate delivery of glomerular filtrate to the diluting segments of the distal nephron, intact tubular diluting mechanisms, and appropriate inhibition of antidiuretic hormone (ADH) synthesis and release. Virtually all of the clinical disorders producing hyponatremia are based on abnormalities of these few mechanisms of water regulation. Finding the reason for impaired renal water excretion is the key to diagnosing the cause of hyponatremia. Impaired renal water excretion may be caused by impaired GFR (renal failure), impaired water delivery to the diluting segments of the distal nephron because of increased proximal reabsorption (decreased extracellular fluid volume and edematous states), impaired renal diluting mechanism (thiazide diuretics), the syndrome of inappropriate ADH (SIADH) due to a variety of causes including the perioperative state, and hypothyroidism or adrenal insufficiency. Any of the states that impair water excretion can produce hyponatremia in a patient with an initially normal serum sodium concentration if sufficient free water is supplied. Therefore, a patient who has one of the conditions listed above, including the perioperative state, may be considered "water intolerant" even if the serum sodium is normal. Such a patient is at risk for developing severe hyponatremia if given hypotonic IV fluids or a large oral water load. An understanding of the basic mechanisms leading to impaired water excretion and "water intolerance" is therefore an important key to avoiding perioperative hyponatremia.- - - - - - - - - - ranking = 1keywords = antidiuretic hormone, antidiuretic, hormone (Clic here for more details about this article) |
3/38. coma and seizures due to severe hyponatremia and water intoxication in an adult with intranasal desmopressin therapy for nocturnal enuresis.Desmopressin, a synthetic analogue of the antidiuretic hormone, is an effective medication for primary nocturnal enuresis for both children and adults. Its safety is well established. Although it has a favorable side effect profile, because of its pharmacological effect, intranasal desmopressin can rarely induce water intoxication with profound hyponatremia if given without adequate restriction of water intake. The authors describe an adult patient with water intoxication and severe hyponatremia accompanied by loss of consciousness and seizures after 2-day intranasal administration of desmopressin. The present and the previously reported cases emphasize the need for greater awareness of the development of this serious and potentiallyfatal complication. In addition, to adjust the drug to the lowest required dosage, adequate restriction of water intake is recommended, and serum levels of sodium should be measured periodically to allow for early detection of water intoxication and hyponatremia.- - - - - - - - - - ranking = 1keywords = antidiuretic hormone, antidiuretic, hormone (Clic here for more details about this article) |
4/38. water intoxication induced by low-dose cyclophosphamide in two patients with systemic lupus erythematosus.cyclophosphamide (CY) is an alkylating agent used to treat a variety of autoimmune disorders. water intoxication is a well-known complication of high-dose intravenous (i.v.) CY, but is rare in patients treated with low dose i.v. CY. We describe two patients with lupus nephritis and water intoxication following low dose i.v. CY. The first patient was treated with oral prednisolone and azathioprine for eight weeks with inadequate response and persistent renal inflammatory activity. Eight hours after the first i.v. CY pulse she had a grand mal seizure. The second patient had WHO class III lupus nephritis, and after a single i.v. CY pulse developed vomiting, diarrhoea and grand mal seizures. They were both fluid-restricted and their serum sodium levels returned to normal. In conclusion, even at low doses i.v. CY may induce hyponatremia related to inappropriate antidiuretic hormone secretion. This potentially life-threatening complication of i.v. CY could be minimized by avoidance of overhydration following pulse i.v. CY.- - - - - - - - - - ranking = 1.0083546539682keywords = antidiuretic hormone, antidiuretic, secretion, hormone (Clic here for more details about this article) |
5/38. 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.- - - - - - - - - - ranking = 1.991799522354keywords = inappropriate secretion, antidiuretic hormone, antidiuretic, secretion, hormone (Clic here for more details about this article) |
6/38. water intoxication: a complication of pelvic US in a patient with syndrome of inappropriate antidiuretic hormone secretion.A woman was first seen with water intoxication caused by the voluntary ingestion of water in an attempt to fill her bladder before undergoing pelvic ultrasound (US). As in two other reported cases, this woman was receiving medication that causes the syndrome of inappropriate antidiuretic hormone secretion. A patient undergoing transabdominal pelvic US who is receiving these medications and whose bladder is not full should undergo examination by means of a transvaginal or endorectal route.- - - - - - - - - - ranking = 5.0417732698412keywords = antidiuretic hormone, antidiuretic, secretion, hormone (Clic here for more details about this article) |
7/38. Dramatic recovery from neurological deficits in a patient with central pontine myelinolysis following severe hyponatremia.A 28-year-old woman developed central pontine myelinolysis (CPM) following severe hyponatremia. Radiological examinations demonstrated a characteristic pontine lesion of CPM. Her neurological symptoms (drowsiness, emotional lability, dysarthria, dysphagia, and quadriparesis) were improved dramatically by treatment with thyrotropin-releasing hormone (TRH) and rehabilitation. However, results of repeat computed tomographic (CT) scans of the brain remained unchanged. This case therefore suggests that TRH may be beneficial for the treatment of CPM, and that CT findings appear to be a limited prognostic indicator for CPM.- - - - - - - - - - ranking = 0.00088027054404778keywords = hormone (Clic here for more details about this article) |
8/38. Urinary arginine vasopressin in asthma: consideration of fluid therapy.To elucidate the role of antidiuretic hormone (ADH) on water and electrolyte balance in patients with asthmatic attacks, urinary arginine vasopressin (AVP) was assayed in 28 asthmatic patients. In a 3-year-old girl with status asthmaticus who developed a grand mal seizure in association with hyponatremia, urinary AVP levels remained high and fluctuated before convulsion; the cause of the convulsion was considered to be water intoxication due to inappropriate ADH secretion. In 19 of 28 patients with moderately severe asthmatic attacks, increases in urinary AVP levels occurred before treatment (300 /- 80 pg/ml vs. 40 /- 24 pg/ml (normal controls), p less than 0.01); elevated AVP levels tended to fall in response to intravenous fluid therapy (appropriate ADH secretion) in 2 of 6 patients, but did not fall (inappropriate ADH secretion) in the remaining patients. It is concluded that inappropriate ADH secretion may occur in asthmatic attacks, and that in such a condition there seems to be a potential risk of water intoxication during fluid therapy, as demonstrated in the present patient.- - - - - - - - - - ranking = 1.1114639162285keywords = antidiuretic hormone, antidiuretic, vasopressin, secretion, hormone (Clic here for more details about this article) |
9/38. multiple sclerosis associated with water intoxication.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.- - - - - - - - - - ranking = 1.0083546539682keywords = antidiuretic hormone, antidiuretic, secretion, hormone (Clic here for more details about this article) |
10/38. schizophrenia and fatal self-induced water intoxication with appropriately-diluted urine.A 31-year-old woman with untreated chronic schizophrenia developed extreme polydipsia which rapidly led to coma and death due to cerebral edema. hyponatremia (120 mEq/liter) and serum hypo-osmolality (260 mOsm/kg) were associated with marked polyuria (up to 1850 ml/hour) and appropriately low urinary osmolality (90 mOsm/kg) which responded to treatment. This case and few qualifying previous reports which are reviewed support the possibility that pure self-induced water intoxication with no major contribution of inadequate release of antidiuretic hormone may occur, and that extreme polydipsia can sometimes overwhelm normal renal diluting capacity in psychotic patients.- - - - - - - - - - ranking = 1keywords = antidiuretic hormone, antidiuretic, hormone (Clic here for more details about this article) |
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