11/113. 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 = 1keywords = intoxication (Clic here for more details about this article) |
12/113. water intoxication and symptomatic hyponatremia after outpatient surgery.Severe hyponatremia is associated with a mortality rate of more than 50%, primarily from cerebral edema and central nervous system dysfunction. water intoxication is an unusual but potentially lethal cause of perioperative hyponatremia. We report a patient with severe postoperative hyponatremia resulting from excessive perioperative water consumption. Anesthesiologists should maintain an index of suspicion for hyponatremia from water intoxication in patients with neurologic symptoms during the perioperative period. Routine preoperative instructions regarding maximum perioperative water intake and inquiry into any concurrent alternative medical therapies may help to avoid this preventable complication. IMPLICATIONS: water intoxication is an unusual but potentially lethal cause of perioperative hyponatremia. We report a patient with severe postoperative hyponatremia resulting from excess perioperative water consumption.- - - - - - - - - - ranking = 1.1666666666667keywords = intoxication (Clic here for more details about this article) |
13/113. 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.- - - - - - - - - - ranking = 0.66666666666667keywords = intoxication (Clic here for more details about this article) |
14/113. A sudden death during a saline drip in a schizophrenic patient with polydipsia.A young woman with polydipsia died suddenly while receiving a normal saline drip in a hospital for psychiatric care. Slight symptoms due to water intoxication, more specifically, nausea, vomiting, and anorexia, appeared and her serum sodium and potassium measured 106 and 1.7 mEq/l, respectively. General convulsions are thought to be the most common result of water intoxication in emergency cases, however, when she was found with circulatory collapse, no severe neurological symptoms were present. The cause of her collapse did not seem to be due to hyponatremia but to hypopotassemia. Although epinephrine is contraindicated with some psychiatric drugs, the doctor used it to raise blood pressure in treating circulatory collapse. It is possible that epinephrine induced cardiac arrest.- - - - - - - - - - ranking = 0.33333333333333keywords = intoxication (Clic here for more details about this article) |
15/113. water intoxication presenting as a suspected contaminated urine sample for drug testing.A patient was evaluated medically after submitting a urine sample for drug screening that was considered inappropriately dilute. Although it was thought that the dilute urine was the result of purposely adding water, the medical evaluation revealed that the patient had chronic water intoxication from a very strict weight loss regimen. The effect of dietary solute intake on water metabolism by the kidneys and the development of hyponatremia are discussed.- - - - - - - - - - ranking = 0.83333333333333keywords = intoxication (Clic here for more details about this article) |
16/113. The dipsomania of great distance: water intoxication in an Ironman triathlete.Of 371 athletes (62% of all finishers) whose weights were measured before and after the 226 km South African Ironman Triathlon, the athlete who gained the most weight (3.6 kg) during the race was the only competitor to develop symptomatic hyponatraemia. During recovery, he excreted an excess of 4.6 litres of urine. This case report again confirms that symptomatic hyponatraemia is caused by considerable fluid overload independent of appreciable NaCl losses. Hence prevention of the condition requires that athletes be warned not to drink excessively large volumes of fluid (dipsomania) during very prolonged exercise. This case report also shows that there is a delayed diuresis in this condition and that it is not caused by renal failure.- - - - - - - - - - ranking = 0.66666666666667keywords = intoxication (Clic here for more details about this article) |
17/113. 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 = 0.66666666666667keywords = intoxication (Clic here for more details about this article) |
18/113. Maternal water intoxication as a cause of neonatal seizures.A term infant was admitted at 6 h of age with seizures related to hyponatraemia. During the last hours of labour the infant's mother had drunk 3 L of water. After delivery the serum sodium was 121 mmol/L in the mother and 126 mmol/L in the infant. Both resolved spontaneously. We discuss this case and the impact of maternal fluid intake during labour on the fetus and neonate. women should be advised that excessive oral fluid intake during labour could adversely affect both mother and infant.- - - - - - - - - - ranking = 0.66666666666667keywords = intoxication (Clic here for more details about this article) |
19/113. Fatal water intoxication in a schizophrenic patient--an autopsy case.We report a case of fatal water intoxication due to polydipsia. A 69-year-old schizophrenic male was found dead at his room of the hospital in which he had been admitted. Medico-legal autopsy was carried out to determine the cause of his death. The autopsy revealed no severe trauma leading him to the death. Internally, it was noticed that the stomach was vigorously expanded, including fluid contents. Intracardiac blood, being dark-red in color, seemed to be diluted. The both lungs ballooned aqueously, showing apparently edema. However, there was neither macroscopic nor histopathological lesion, being responsible for his death. Postmortem biochemical analyses revealed severe hyponatremia of 92 mEq/ml. In cases with short postmortem interval, serum sodium level almost similarly reflected antemortem level. According to his psychiatric doctor, he had been diagnosed as water intoxication due to polydipsia. Moreover, at 2 h before the discovery of his body, he had been found to drink much running water. It was concluded the cause of his death as fatal water intoxication.- - - - - - - - - - ranking = 1.1666666666667keywords = intoxication (Clic here for more details about this article) |
20/113. rhabdomyolysis after correction of hyponatremia in psychogenic polydipsia possibly complicated by ziprasidone.OBJECTIVE: To report a case of rhabdomyolysis related to correction of hyponatremia secondary to psychogenic polydipsia, possibly complicated by the use of ziprasidone. CASE SUMMARY: A 50-year-old white man treated for 3 weeks with ziprasidone 40 mg twice daily for chronic paranoid schizophrenia was admitted to the intensive care unit after a witnessed generalized seizure. Marked hypotonic hyponatremia was present secondary to psychogenic polydipsia. After correction of hyponatremia with intravenous NaCl 0.9%, he developed a substantial elevation in the creatine kinase level without any evidence of muscle trauma, stiffness, or swelling or any signs of neuroleptic malignant syndrome. Renal failure or compartment syndrome did not complicate the clinical picture. DISCUSSION: It is well known that severe hyponatremia can cause neurologic complications such as stupor, seizures, and even coma. hyponatremia from water intoxication (n = 28) and its correction with intravenous fluids (n = 2) may cause non-neurologic complications such as rhabdomyolysis. An explanation may lie within the calcium-sodium exchange mechanism across the skeletal myocyte or the failure of cell volume regulation secondary to extracellular hypo-osmolality. Neuroleptic medications have been linked to the development of rhabdomyolysis, with antipsychotics being the primary offenders. As of August 2005, there has been only one reported case of rhabdomyolysis related to correction of hyponatremia complicated by an atypical antipsychotic (clozapine). It is possible that ziprasidone, like clozapine, may enhance muscle cell permeability leading to rhabdomyolysis under similar conditions. CONCLUSIONS: Psychiatric patients treated with atypical antipsychotic medications should be closely monitored for rhabdomyolysis during correction of hyponatremia, thus permitting prompt therapy to limit its complications.- - - - - - - - - - ranking = 0.16666666666667keywords = intoxication (Clic here for more details about this article) |
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