1/5. 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 = 1keywords = thirst (Clic here for more details about this article) |
2/5. The successful treatment of psychogenic polydipsia and water intoxication with propanolol. A case report.Psychogenic polydipsia (PPD), which can lead to water intoxication (WI), is a problem with many psychiatric patients. The case history of one schizophrenic patient presented here shows that propanolol therapy can reduce PPD and WI, possibly decrease thirst, and improve schizophrenic symptoms and behavior. When combined with regular weight evaluation and behavioral treatment to restrict water intake, the therapy can further reduce the risk of developing life-threatening WI complications.- - - - - - - - - - ranking = 1keywords = thirst (Clic here for more details about this article) |
3/5. water intoxication and rhabdomyolysis.A 44-year-old woman was admitted because of stupor. She had consumed 3 liters of water due to thirst after drinking alcohol. Laboratory findings on admission revealed marked hyponatremia (sodium: 115 mEq/l). She was diagnosed as having water intoxication. She recovered from her hyponatremia upon excretion of a large amount of hypotonic urine. Subsequently, however, her serum creatine phosphokinase was markedly elevated at 28,650 IU/l, and her serum myoglobin reached 2,760 ng/ml. The relationship between the occurrence of hyponatremia secondary to water intoxication and rhabdomyolysis was suggested.- - - - - - - - - - ranking = 1keywords = thirst (Clic here for more details about this article) |
4/5. thirst, resetting of the osmostat, and water intoxication following encephalitis.A young man developed pathological thirst and hyperdipsia, hyperphagia, disordered temperature regulation, a lowered threshold for aggressive behavior, apathy, impaired memory, and seizures following encephalitis. He had marked hyponatremia. Bouts of water drinking produced water intoxication and precipitated status epilepticus. Studies of water handling with measurements of plasma osmolality and arginine vasopressin (AVP) revealed a very low thirst threshold (below 242 mOsm/kg) with resetting of the osmostat to a new level (255 mOsm/kg) but normal control of plasma osmolality at that level with adequate AVP release.- - - - - - - - - - ranking = 2keywords = thirst (Clic here for more details about this article) |
5/5. Unstable osmoreceptors and defective thirst in hypothalamic hypopituitarism.An 8-year-old girl with hypothalamic hypopituitarism is described. The clinical course was characterized by fluctuation between diabetes insipidus and water intoxication. In an attempt to find a physiological explanation she underwent two sets of dehydration and osmotic threshold tests. The presence of endogenous vasopressin, and the normally functioning volume receptors, was demonstrated by the normal urine osmolality during dehydration. The osmotic threshold was 263 mosm/kg on one test and 300 mosm/kg on the other. More extreme values might be suspected based on simultaneous urine and plasma osmolality obtained during acute episodes of water intoxication and severe dehydration. With plasma osmolality as high as 307 mosm/kg, the child denied thirst. The data appear to indicate an instability of the osmoreceptor mechanism and a deficiency of the thirst mechanism with intact volume receptors.- - - - - - - - - - ranking = 6keywords = thirst (Clic here for more details about this article) |