demeclocycline and Water-Intoxication

The authors seek to extend understanding and treatment of hospitalized schizophrenics presenting with complications of polydipsia and dilutional hyponatremia. Attending physicians may ask the consultation/liaison psychiatrist to see schizophrenics with hyponatremically-induced delirium or other psychiatric syndromes. The referring physician may or may not have identified polydipsia and dilutional hyponatremia and their complications. This article will help the consultation/liaison psychiatrist recognize early evidence of water imbalance, describe evaluation, and provide somatic and behavioral treatment approaches to this life-threatening syndrome.. Over the past ten years, the authors have treated more than 100 patients with the polydipsia-hyponatremia syndrome. The authors discuss their and others' experience with drugs that help and hinder patients suffering from dilutional hyponatremia. They review current key articles from the polydipsia-hyponatremia syndrome literature including articles identified via Medline search 1985-94.. Schizophrenics with the polydipsia-hyponatremia syndrome most commonly present with polydipsia, polyuria, urinary incontinence, cognitive, affective, and behavioral changes, seizures, or coma. Quantitating polydipsia, hyponatremia, and diurnal changes in body weight facilitate therapeutic interventions. Treatment include patient and caregiver education, drug therapies to better treat psychosis and better treat osmotic dysregulation, behavioral interventions to interdict polydipsia, and diurnal weight monitoring.. Once recognized, acute, subacute, and chronic complications of the polydipsia-hyponatremia syndrome are readily treatable. Besides treating the patient, consultation/liaison psychiatrists can teach their medical colleagues about this syndrome. In so doing, they will enhance the quality of their patients' lives and help the internist and surgeon feel more comfortable when working with schizophrenics.

Topics: Angiotensin II; Anti-Inflammatory Agents, Non-Steroidal; Antipsychotic Agents; Carbamazepine; Cognition Disorders; Demeclocycline; Drinking Behavior; Electroconvulsive Therapy; Humans; Hyponatremia; Lithium; Mood Disorders; Naloxone; Phenytoin; Polyuria; Propranolol; Psychiatry; Psychotherapy; Schizophrenia; Sodium Chloride; Syndrome; Water Intoxication; Workforce

Topics: Antidepressive Agents; Demeclocycline; Diuretics; Drinking Behavior; Humans; Hypernatremia; Hyponatremia; Practice Guidelines as Topic; Water Intoxication

Topics: Demeclocycline; Humans; Hyponatremia; Mental Disorders; Water Intoxication

Carbamazepine (CBZ)-induced water intoxication occasionally limits its usefulness in refractory seizures and trigeminal neuralgia. Fluid restriction, CBZ dose reduction, or concomitant phenytoin therapy may be impractical or ineffective. Demeclocycline (7-chloro-6 demethyl tetracycline) (DMC) corrected the CBZ-induced water intoxication in a 51-year-old man with refractory complex partial seizures and a normal antidiuretic hormone (ADH) level. DMC inhibits ADH-sensitive adenylate cyclase activity in the renal collecting duct and may be useful in correcting the ADH-like or renal antidiuretic effect of CBZ.

Topics: Carbamazepine; Demeclocycline; Humans; Male; Middle Aged; Vasopressins; Water Intoxication

The anti-diuretic action of carbamazepine, before and after concurrent treatment with demeclocycline, has been studied in a single epileptic subject, in whom two episodes of status epilepticus had been associated with excessive fluid intake and hyponatraemia. After addition of demeclocyline, free water clearance, plasma arginine vasopressin concentration and serum osmolality (all appreciably reduced after carbamazepine alone) increased but did not revert to normal. The findings are consistent with direct antagonism by demeclocycline of the enhancing effect of carbamazepine on endogenous ADH activity.

Topics: Adult; Carbamazepine; Demeclocycline; Female; Humans; Vasopressins; Water Intoxication

Topics: Compulsive Behavior; Demeclocycline; Humans; Inappropriate ADH Syndrome; Water Intoxication

A case of tuberculous Addison's disease presenting with psychosis, profound hyponatraemia, and detectable plasma antidiuretic hormone is reported. Clinical and biochemical improvement after corticosteroid replacement was followed by relapse with further psychosis and inappropriate antidiuretic hormone secretion: both were promptly reversed by demethylchlortetracycline. The association of psychological symptoms with Addison's disease, the role of anti-diuretic hormone secretion in Addison's disease, and the inter-relationship between Addison's disease, psychosis and anti-diuretic hormone secretion are discussed.

Topics: Addison Disease; Body Weight; Demeclocycline; Fludrocortisone; Humans; Hydrocortisone; Inappropriate ADH Syndrome; Male; Middle Aged; Psychotic Disorders; Vasopressins; 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.

Topics: Adult; Demeclocycline; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Hyponatremia; Inappropriate ADH Syndrome; Schizophrenia; Schizophrenic Psychology; Water Intoxication

Topics: Demeclocycline; Humans; Inappropriate ADH Syndrome; Lithium; Water Intoxication

Seventeen patients with cancer or aplastic anemia received demeclocycline as treatment for hyponatremia. Prior to demeclocycline therapy no patients showed clinical signs of fluid overload or saline depletion. In all patients inappropriately concentrated urine (mean urine osmolality = 548 mOSM/kg H2O) or increased urine content of sodium (mean urine sodium = 91 mEq/L) were documented prior to demeclocycline therapy. No patient had developed hyponatremia in association with antineoplastic drug therapy. The average serum sodium (NaS) at the time of initiation of therapy was 121 mEq/L. NaS increased in all patients despite the simultaneous administration of generous volumes of fluid. NaS exceeded 130 mEq/L and average of 3.5 days following institution of demeclocycline. Patients lost an average of 2.3 kg during demeclocycline. The toxicity noted following demeclocycline was azotemia and increased serum creatinine. Eight patients developed serum urea nitrogen (SUN) in excess of 25 mg/dl; average maximum creatinine in these eight patients was 1.9 mg/dl. Average peak creatinine in eight patients who did not develop azotemia was 0.87 mg/dl. Azotemia seemed to be correlated with simultaneous administration of other nephrotoxic agents and with administration of higher doses (1200 mg/day) of demeclocycline.

Topics: Creatinine; Demeclocycline; Humans; Hyponatremia; Neoplasms; Osmolar Concentration; Uremia; Water Intoxication

Topics: Ascites; Demeclocycline; Edema; Humans; Hyponatremia; Osmolar Concentration; Vasopressins; Water Intoxication

Topics: Demeclocycline; Hormones, Ectopic; Humans; Vasopressins; Water Intoxication