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PubMed2006

Therapeutic approach in patients with dysnatraemias.

BACKGROUND: Rapid correction of dysnatraemias is frequently associated with increased morbidity and mortality. Therefore, it is important to estimate the proper volume and type of infusate required to change the serum sodium concentration predictably. The aim of this study is to evaluate the utility or/and the accuracy of the Adrogue-Madias formula in managing patients with hyponatraemia and hypernatraemia. METHODS: Among the 317 patients who either on admission to our internal medicine clinic or during their hospitalization were found to have hyponatraemia or hypernatraemia, we studied 189 patients (59.6%) in whom the administration of intravenous solutions was required for the correction of dysnatraemias. RESULTS: Twelve hours after starting the administration of intravenous solutions the anticipated as well as the achieved serum sodium concentration were as follows: in volume depleted patients 130.2+/-4.1 vs 131.3+/-5.2 meq/l (n = 45; P = NS), in syndrome of inappropriate antidiuretic hormone secretion (SIADH) patients 127.4+/-5.7 vs 128.9+/-5.9 meq/l (n = 10; P = NS), in patients with diuretic-induced hyponatraemia 123.8+/-6 vs 125.5+/-5.6 meq/l (n = 29; P = NS), in patients with primary polydipsia 122.5+/-0.7 vs 129+/-1.4 meq/l (n = 2; P = 0.02), while in patients with hypernatraemia 153.6+/-7.5 vs 156.5+/-8.9 meq/l (n = 92; P = 0.021). Furthermore, 24 h from the initiation of the therapeutic intervention the expected and the achieved serum sodium concentrations were 130+/-4 vs 135.6+/-3.3 meq/l (n = 15; P = 0.002) in patients with volume depletion, 128.1+/-4.8 vs 130+/-4.5 meq/l (n = 15; P = NS) in patients with diuretic-induced hyponatraemia and 151.5+/-6.4 vs 153.3+/-8.3 meq/l (n = 67; P = NS) in patients with hypernatraemia. CONCLUSIONS: The formula that has been proposed by Adrogue and Madias predicted with relative accuracy the changes in serum sodium concentration in almost all patients. Thus, it should be considered as a very useful tool for the management of dysnatraemias. However, special attention should be paid when this equation is used in patients with hyponatraemia due to extracellular volume depletion after euvolaemia's restoration and primary polydipsia in order to avoid rapid correction of hyponatraemia.

Adolescent↗

PubMed1990

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.

Adult↗

PubMed1992

Naloxone attenuates drinking behavior in a schizophrenic patient displaying self-induced water intoxication.

This study was performed to examine the effect of naloxone on drinking behavior in a schizophrenic inpatient with psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome). His body weight was checked five times daily, and the maximum and minimum weight gains during a day were chosen as an index of polydipsia. Both daily (0.6 mg) and repeated (0.6 mg for 6 days) injections of naloxone suppressed his weight gain significantly for 2 weeks. Withdrawal of the drug for 4 weeks resulted in weight gain recovering to control level. Thereafter, a second trial was performed to examine the long-term effect of this treatment. A daily naloxone (0.6 mg) injection series was performed once every 2 weeks for six series (12 weeks). This drug regimen also suppressed his weight gain in a continuous fashion. The study showed that naloxone seems to be a potential treatment for PIP syndrome and that endogenous opioid systems play a part in the compulsive drinking behavior of the PIP syndrome.

Drinking Behavior↗

PubMed1985

Death from self-induced water intoxication among patients with schizophrenic disorders.

Review of 60 consecutive records of patients who died before the age of 53 years in a state mental hospital revealed that 27 of those patients (45%) had a schizophrenic disorder. Of those 27 patients, five (18.5%) died of the complications of self-induced water intoxication and schizophrenic disorders (SIWIS). Clinical, laboratory, and autopsy features of those five SIWIS patients and of an additional five SIWIS cases obtained from the literature include psychosis, polydipsia, polyuria, severe hyposthenuria (specific gravity 1.003 or less), hyponatremia, seizures, coma, and cerebral and visceral edema. SIWIS characteristically develops during Arieti's third or "preterminal" stage (5 to 15 years after onset of psychosis) of schizophrenic disorders and it must be included in the differential diagnosis of unexplained death among psychiatric patients. As there are no pathognomonic SIWIS tissue changes, the pathologist must carefully integrate clinical, laboratory, and autopsy findings to arrive at the proper diagnosis. When premortem findings of polydipsia and hyponatremia are not available, evidence of antecedent severe hyposthenuria and postmortem vitreous humor hyponatremia of less than 120 mEq/1 are strongly supportive of the diagnosis of death due to SIWIS.

Adult↗

PubMedDate not supplied

Schedule-induced chronic hypertension.

Rats were fed on an intermittent-feeding schedule one 45-mg food pellet every 90 sec for 5 hours per day (experimental group) or an equivalent food ration as a single, daily feeding (control group). All animals were mononephrectomized and given saline to drink. Experimental animals became polydipsic (schedule-induced polydipsia). The rate and amount of fluid intakes between the two groups were controlled in the second experiment. In both experiments a significant blood pressure difference developed between the groups and remained terminally after water replaced saline as the drinking fluid for about 3 weeks. The development of chronic hypertension in the experimental group in the second experiment is regarded as a psychosomatic counterpart of other excessive and persistent behaviors (e.g., polydipsia, aggression), which can be induced by certain intermittent-feeding schedules. Observations on the heart (increased weight), kidney (minor pathologic changes), and adrenals (no change) were consistent with essential hypertension.

Animals↗

PubMed1987

Transient diabetes insipidus and preeclampsia.

A woman with triplet gestation had polydipsia and polyuria during pregnancy. She subsequently had preeclampsia for which she was delivered. The presumed diabetes insipidus was transient, resolving by postpartum day 5. The association of preeclampsia and diabetes insipidus may be confusing to the practitioner. Careful attention to fluid status and consideration of this abnormality will lead to the best outcome when hypertension is accompanied by polydipsia and polyuria.

Adult↗

PubMed1999

Establishing preference for lidocaine solution to water: comparison between a fading and an abrupt-removal procedure for withdrawing a compound vehicle.

Rats were exposed to daily, 3-h, fixed-time 1-min food-pellet delivery sessions, which is a procedure that produces overdrinking (schedule-induced polydipsia). In previous polydipsia studies, rats came to prefer solutions of drug or non-drug agents to concurrently presented water if the agents had first been offered in a glucose-saccharin vehicle that was slowly eliminated (faded), leaving a choice between a substance in water vehicle vs water. In the first experiment, a more rapid vehicle-fading procedure was used to produce a preference for 0.19mg/ml lidocaine to water. In the second experiment, the vehicle was abruptly changed to water, which also resulted in a strong preference for lidocaine solution, although the lidocaine solution volumes ingested for the final sessions were significantly less than in the first experiment. The results are consistent with a conditioned flavor/nutrient preference interpretation for the institution of the lidocaine preference in both experiments. Although flavor/nutrient conditioning can be a sufficient condition for generating a substance preference, a previous experiment showed that it was not a necessary condition.

Anesthetics, Local↗

PubMed2004

Characterization of an aquaporin-2 water channel gene mutation causing partial nephrogenic diabetes insipidus in a Mexican family: evidence of increased frequency of the mutation in the town of origin.

A Mexican family with partial congenital nephrogenic diabetes insipidus (NDI) that resulted from a mutation in the aquaporin-2 water channel (AQP2) was characterized, and the source of this rare mutation was traced to the family's town of origin in Mexico. Affected individuals with profound polyuria and polydipsia were homozygous for an autosomal recessive missense V168M mutation in the AQP2 gene. Expression in oocytes revealed that, although retained in the endoplasmic reticulum (ER) to a great extent, a considerable amount of the partially functional AQP2-V168M was expressed at the plasma membrane, and that its ER retention was less than AQP2-T126M, a functional mutant in severe recessive NDI. None of the affected AQP2-V168M individuals had neurologic deficits, which also suggested a milder form of the disease. The homozygous individuals reported subjective improvement in polyuria and polydipsia with the use of dDAVP (1-desamino-8-D-arginine-vasopressin). When clinically tested, infusion of dDAVP at variable doses produced a partial increase in the urinary osmolality in homozygous individuals and decreased their water intake. Heterozygotes were unaffected when compared with controls. Samples were obtained from the population of the Mexican town of origin of the family; 30% of the population was heterozygous for the V168M AQP2 mutation and 1% was homozygous for the mutation. The high frequency of this rare mutation in the town provides evidence for an important health care problem in the village with consequences for future generations.

Aquaporin 2↗

PubMed2004

Clinical presentation of childhood type 1 diabetes mellitus in the Al-Madina region of Saudi Arabia.

AIM: To describe the clinical pattern and the laboratory characteristics at presentation of childhood type 1 diabetes mellitus in the Al-Madina region of the north-west province of Saudi Arabia. METHODS: The clinical and laboratory data of a total of 230 children who presented with diabetes during a 10-year period (1992-2001) were retrospectively analyzed based on hospital records. RESULTS: Polyuria and polydipsia were by far the most frequent symptoms at presentation (96%); three quarters of the children (76.6%) had weight loss at presentation. One hundred and twenty-seven children (55.2%) of 230 presented with ketoacidosis. The mean age at diagnosis was 6.9 yr. The average duration of presenting symptoms before the hospital encounter was 17.1 d ranging from 3.0 to 45.0 d, with an average of 16.2 d in boys and 17.7 d in girls, a difference which was not significant. CONCLUSION: Polyuria, polydipsia, and weight loss are the most common symptoms at presentation of childhood diabetes mellitus in our region. The frequency of diabetic ketoacidosis was relatively high. The commonly recognized symptoms of diabetes were present in most of the children for a relatively long duration before the diagnosis. This calls for a collaboration of efforts for the early recognition of symptoms by patients and physicians to avoid the more severe types of presentation.

Adolescent↗

PubMed2005

Clinical presentation of type 1 diabetes.

OBJECTIVE: To identify the presenting features of type 1 diabetes in a national incident cohort aged under 15 yr, the duration of symptoms, the occurrence of diabetic ketoacidosis (DKA) at presentation, and the frequency of a family history of diabetes. METHODS: A prospective study was undertaken of incident cases of type 1 diabetes using an active monthly reporting card system from January 1, 1997 to December 31, 1998 in the Republic of Ireland. Follow-up questionnaires were distributed to pediatricians nationally. RESULTS: Two hundred and eighty-three incident cases were identified. Polyuria, polydipsia and weight loss were the main presenting symptoms in all age categories. Nocturnal enuresis was reported in 19% under 5 yr and in 31% aged 5-9.99 yr. Constipation was noted in five patients and in 10.4% under 5 yr of age. The median duration of symptoms was highest in the youngest (under 2 yr) and oldest (10-14.99 yr) age categories. Presentation in moderate/severe DKA occurred in 25% overall and six of nine of those aged under 2 yr. A family history of type 1 diabetes in a first-degree relative was found in 10.2%. CONCLUSIONS: This study confirms the abrupt onset of type 1 diabetes, the absence of a family history, and the importance of the classical symptoms of polyuria, polydipsia, and weight loss in the majority of cases. It reveals secondary enuresis as an important symptom, especially in those under 10 yr, and constipation in the under 5 yr age group. The very young (under 2 yr) are more difficult to diagnose, have more variability of symptom duration, and are more likely to present in moderate/severe DKA. A high index of suspicion aids early diagnosis.

Adolescent↗

PubMed2006

Lesions of tuberomammillary nuclei induce differential polydipsic and hyperphagic effects.

This study aimed to examine the function of the tuberomammillary complex in water and food intake of Wistar rats. The results show that lesions restricted to tuberomammillary subnuclei: caudal ventral tuberomammillary nucleus (E1), rostral ventral tuberomammillary nucleus (E2), medial ventral tuberomammillary nucleus (E3) or medial dorsal tuberomammillary nucleus (E4), induce a strong and persistent polydipsia with specific characteristics for each nucleus. Interestingly, the distribution of tuberomammillary hyperdipsia throughout the day was similar to that in non-lesioned animals, in contrast to the lack of rhythmicity observed in rats with anodic lesion to median eminence. This polydipsia appears to be independent of food intake, as food deprivation for 22 h did not significantly reduce the water intake. Finally, lesions in ventral tuberomammillary nuclei E1 and E2 induce hyperphagia, confirming a possible role for the tuberomammillary complex in food intake. This increase in food intake is not observed after lesions in medial subnuclei E3 and E4. These results are interpreted in terms of the hypothalamic systems involved in the consumption of both food and water.

Animals↗

PubMed1981

Maternal ethanol consumption and fetal development in the rat: a comparison of ethanol exposure techniques.

Comparison of the polydipsia and liquid diet procedures for ethanol exposure were used in female rats, either before and/or during gestation. Autopsy of the fetuses on day 20 of gestation found a significant weight reduction in the polydipsia-exposed animals that could be attributed to ethanol. No such effect was found in the liquid diet-exposed animals. The data are discussed in relation to the human fetal alcohol syndrome.

Animals↗

PubMed2004

Traumatic partial hypopituitarism in a cat.

Traumatic hypopituitarism was diagnosed in an 11-month-old male neutered cat. The presenting complaints were polydipsia, polyuria and lethargy of three months' duration. Craniocerebral trauma, as a result of a road traffic accident, had preceded the onset of clinical signs by six weeks. Neurological examination revealed right-sided mydriasis, reduced visual and tactile left forelimb placing reflexes and decreased proprioception in both the left fore- and hindlimb. Initial laboratory findings included hypernatraemia, hyperchloraemia, mild azotaemia, eosinophilia and isosthenuria. Low basal cortisol, thyroxine, thyroid-stimulating hormone and insulin growth factor-1 were noted. Subsequent to treatment with prednisolone, a water deprivation test confirmed the presence of central diabetes insipidus and therapy with synthetic antidiuretic hormone successfully ameliorated the polydipsia.

Accidents, Traffic↗

PubMed1979

The use of phospholipid liposomes for lithium administration. Polydipsic effect and tissue distribution of lithium.

Administration of lithium entrapped in phospholipid liposomes increased the lithium-induced polydipsia, but did not accelerate the onset of this effect. It also resulted in a larger accumulation of lithium in the liver, kidney and spleen, but not in the brain. The time course of polydipsia suggests that it depends on the intracellular lithium concentration. However, the rate of development of this effect depends on some additional factor.

Animals↗

PubMed2000

Analysis of the vasopressin system and water regulation in genetically polydipsic mice.

Polydipsic mice, STR/N, which show extreme polydipsia and polyuria, were discovered in 1958. In the STR/N, urine outputs are much higher than in control mice. The possibility of an abnormal regulation of the arginine vasopressin (AVP) system, or an abnormality in the renal susceptibility to AVP, should be considered. In this study we investigated the AVP system and water regulation in STR/N. We sequenced the AVP and the AVP V(2)-receptor genes of the STR/N by direct sequencing. No mutation was found in either of them. AVP gene expression examined by in situ hybridization and plasma sodium in 8-wk-old STR/N was significantly lower than in control mice, whereas it was significantly higher at 20 wk. Renal sensitivity to injected AVP was attenuated in 20-wk-old STR/N. The suppression of AVP synthesis due to excessive water retention in 8-wk-old STR/N suggests that polydipsia may be the primary cause in this strain. The 20-wk-old STR/N became dehydrated with the acceleration of AVP synthesis, which might have resulted from secondary desensitization to AVP.

Amino Acid Sequence↗

PubMed1975

Polyuria and imparied ADH release following medial preoptic lesioning in the rat.

Studies were carried out in the rat to detemine if hypothalamic lesions which caused polydipsia and polyuria had their effect mediated through an alteration of the ability of the neurohypophyseal system to release ADH. Rats with medial preoptic lesions hadincreased water intake while on ad libitum access to water and slightly impaired ability to conserve water following dehydration, but with no impairment of urine-concentrating ability. These were associated with an increase in plasma osmolality both during ad libitum fluid intake and after dehydration. Urinary ADH excretion was at leastas great as in shamoperated controls during ad libitum water intake, but failed to increase during dehydration in spite of a marked increase in plasma osmolality. Pituitary ADH content did not differ from control animals either during ad libitum water intake of after dehydration. Animals with lesions in the lateral preoptic and septal areas did not differ from control animals during ad libitum fluid intake and after dehydration even though lateral preoptic lesions produced polydipsia. In all animals, lesions were remote from the supraoptic nuclei, which showed no histological evidence of damage. It is concluded thatareas of the central nervous system away from the supraoptic nuclei are involved in the regulation of both water intake and ADH release.

Animals↗

PubMed1991

Involvement of angiotensin II in water intake of genetically polydipsic mice.

The involvement of angiotensin II (ANG II) in the genetic polydipsia of the STR/N strain of mice was investigated. Daily water intake of the polydipsic inbred STR/N of both sexes ranged between five and eight times that of nonpolydipsic controls: STR/1N, a mutant of the STR/N, and Swiss-Webster (S/W) mice. Nevertheless the diurnal pattern of drinking was maintained in the STR/N. There was no difference in daily food intake, arterial blood pressure, and plasma renin activity among the three groups. Drinking responses to 48 h of water deprivation were not significantly different between the polydipsic mice and their control groups. Captopril, an angiotensin I converting-enzyme inhibitor, injected subcutaneously just before the dark period, reduced drinking for 6 h in the polydipsic strain only. Food intake of all three groups of mice was not affected. Similarly the ANG II antagonist saralasin, [Sar1,-Ile8]ANG II, injected into the lateral cerebroventricle just before the dark period, significantly reduced water intake for 6 h after injection in the polydipsic mice only. Intracerebroventricular injection of ANG II increased drinking in the nondeprived controls but not in the polydipsic mice. These findings suggest that the polydipsia in the STR/N mice may involve, at least in part, the ANG II system in the brain.

Angiotensin II↗

PubMed1993

Hormonal, fluid, and electrolyte responses of sheep during chronic intravenous infusion of epidermal growth factor.

Epidermal growth factor (EGF) has been shown to increase water intake and urine volume. To further characterize these responses the effects of EGF on fluid balance, electrolyte, and hormone profiles were examined. After an 8-day control period, ewes received intravenous EGF at doses of 0 (n = 6), 2 (low dose, n = 6), 10 (medium dose, n = 6), or 20 micrograms/h (high dose, n = 5) for 4 days. During EGF treatment, water intake and urine volume increased (both P < 0.001) in a dose-related fashion, although fluid balance was unaffected. Feed intake and fecal dry matter output were reduced (both P < 0.001) by the two higher doses of EGF. EGF had no effect on plasma potassium, sodium, or osmolality, but there was a dose-related natriuresis (P < 0.001). Treatment with EGF increased plasma renin activity and aldosterone in the medium and high dose groups (both P < 0.001). Thus chronic intravenous infusion of 10-20 micrograms EGF/h into sheep caused polydipsia, polyuria, and natriuresis with neutral fluid balance. Whether the resultant polydipsia or polyuria was the primary response to EGF remains unclear.

Animals↗