1/18. Severe hyponatraemia in an amiloride/hydrochlorothiazide-treated patient.A 85-year-old woman treated with, among other drugs, a thiazide diuretic presented with a severe hyponatraemia. She met several of the criteria for SIADH and, besides drugs, no cause for SIADH was found. After stopping the thiazide diuretic and restricting fluid intake the patient recovered fully. It was later proved that the thiazide was the cause of the water intoxication by rechallenging the patient with a single dose of amiloride/hydrochlorothiazide 5/50 mg. This "thiazide provocation test" showed its usefulness in the differential diagnosis of suspected SIADH. Moreover, the test demonstrated the paradoxal effect of thiazide diuretics to cause water retention in susceptible patients.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
2/18. 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 = 4keywords = intoxication (Clic here for more details about this article) |
3/18. 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 = 5keywords = intoxication (Clic here for more details about this article) |
4/18. 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 = 4keywords = intoxication (Clic here for more details about this article) |
5/18. water intoxication in asthma assessed by urinary arginine vasopressin.A 3-year-old girl with status asthmaticus developed a grand mal seizure in association with hyponatraemia after 16 h of fluid therapy. Urinary arginine vasopressin (AVP) was elevated during the attack and rose strikingly before the onset of the convulsion. In 13 of 17 other patients with moderately severe asthmatic attacks, increases in urinary AVP levels occurred before the initiation of treatment. Dilutional hyponatraemia (water intoxication) must be prevented in patients with severe asthmatic attacks in whom diuretic capacity is impaired.- - - - - - - - - - ranking = 5keywords = intoxication (Clic here for more details about this article) |
6/18. The syndrome of inappropriate secretion of antidiuretic hormone (SIADH): an overview.We have reviewed 14 cases of water intoxication in psychiatric patients. In these cases the possibility of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) was suspected or diagnosed. The SIADH should be suspected in psychotic patients who drink water excessively, develop seizures, disorientation and deterioration of mental status.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
7/18. 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.- - - - - - - - - - ranking = 5keywords = intoxication (Clic here for more details about this article) |
8/18. Idiopathic, sustained, inappropriate secretion of ADH with associated hypertension and thirst.A 15 year old girl presented with excessive thirst and hypertension (170/110 mm Hg). Biochemical investigations revealed serum sodium 118 meq/liter, serum osmolality 238 mosmol/liter, urine sodium 90 meq/liter, urine osmolality 700 mosmol/liter, persistenly elevated serum antidiuretic hormone (ADH) levels (5.8 to 11.9 pg/ml) and no obvious cause for the hypertension. The hypertension is, at least in part, volume-related, diminishing with fluid restriction. Features of gross water intoxication (e.g., confusion, coma) have not occurred. The etiology of the inappropriate secretion of ADH is not obvious but is not thought to be due to "resetting of osmoreceptors" as evidenced by failure to maximally dilute urine following a water load test and persistently elevated serum ADH levels. A similar patient described by Epstein and associates in 1962 is presently well with persistent features of inappropriate secretion of ADH.- - - - - - - - - - ranking = 1keywords = intoxication (Clic here for more details about this article) |
9/18. Hyposthenuria as a marker for self-induced water intoxication and schizophrenic disorders.Four patients with the syndrome of self-induced water intoxication and schizophrenic disorders, as well as inappropriate antidiuresis, are described. In each case, severe hyposthenuria preceded the clinical symptoms by 1 to 7 years. Hyposthenuria may be a marker for this syndrome.- - - - - - - - - - ranking = 5keywords = intoxication (Clic here for more details about this article) |
10/18. demeclocycline in the prophylaxis of self-induced water intoxication.demeclocycline, a competitive inhibitor of antidiuretic hormone at renal tubules, was studied in a patient with the syndrome of psychosis, psychogenic polydipsia, and episodic water intoxication. Under double-blind, placebo-controlled conditions, demeclocycline substantially reduced the severity and frequency of hyponatremic episodes.- - - - - - - - - - ranking = 5keywords = intoxication (Clic here for more details about this article) |
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