pituitrin and Coma

Topics: Africa, Eastern; Albumins; Anemia; Child; Coma; Critical Illness; Developing Countries; Dose-Response Relationship, Drug; Drug Administration Schedule; Fever; Fluid Therapy; Humans; Meningitis, Bacterial; Pneumonia; Randomized Controlled Trials as Topic; Resuscitation; Shock; Sodium Chloride; Vasopressins

Water intoxication is a rare cause of coma. The leading causes of excessive hydration are endurance exercise, drug abuse, iatrogenic, cerebral salt wasting, or psychiatric conditions. Self-induced water intoxication in an otherwise healthy person is exceedingly rare.. Single patient case report and review of the literature.. We describe a previously fit and healthy 13-year-old girl who was admitted to the Accident and Emergency department in a comatose state following an unwitnessed seizure. On examination she had a fluctuating Glasgow Coma Score, bilateral mydriatic pupils that responded poorly to light, and an upgoing right plantar. Blood pressure, pulse rate, and oximetry, as well as body mass index, were normal. Routine blood examination revealed hyponatremia, hypochloremia, and a low hematocrit. Water intoxication was suspected and confirmed by reduced urine sodium, serum, and urine osmolality. The computed tomographic brain scan, lumbar puncture opening pressure, and cerebrospinal fluid examination were all normal. She regained consciousness and was fully orientated within 24 hours following intravenous NaCl administration. In this case, thirst without any other apparent pathology led to voluntary water intoxication.. Our case illustrates the classic picture of self-induced water intoxication in a previously fit and healthy patient.

Topics: Adult; Coma; Female; Humans; Hyponatremia; Vasopressins; Water

A 39-year-old man was hospitalized after divalproate self-poisoning. He presented coma requiring tracheal intubation and mechanical ventilation at 11 hours and central diabetes insipidus. Serum valproic acid concentration was 590 mg/l at 30 hours. Progressive improvement occurred after hydratation and administration of vasopressin.

Topics: Adult; Bipolar Disorder; Coma; Diabetes Insipidus; Fluid Therapy; Humans; Intubation, Intratracheal; Male; Poisoning; Polyuria; Respiration, Artificial; Suicide, Attempted; Valproic Acid; Vasopressins

A 66-year-old hypertensive male with acute intracerebral hemorrhage developed acute hyponatremic coma 3 days after the addition of enalapril and a combination of amiloride and a thiazide diuretic to his hypotensive regimen. The patient recovered consciousness and serum sodium normalized 2 days after fluid restriction and withdrawal of both medications. Three weeks later, upon inadvertent reinstitution of enalapril and indapamide, severe hyponatremic encephalopathy promptly recurred; recovery was again rapid following fluid restriction and withdrawal of both medications. This temporal relationship establishes the thiazide diuretic or the angiotensin converting enzyme inhibitor or both as the cause of the profound symptomatic hyponatremia in this patient. Results of simultaneous serum and urine osmolality assays on several occasions were consistent with a decrease in free water clearance, a result of either increased antidiuretic hormone (ADH) secretion or potentiation of its peripheral action, and thiazide-induced natriuresis. The use of a thiazide diuretic in the presence of either of these aberrations of ADH homeostasis most likely explains the profound and rapid development of hyponatremia. Drug-induced disturbances in serum osmolality are a potentially reversible cause of deterioration of the mental state in a patient with an acute cerebrovascular accident.

Topics: Aged; Amiloride; Benzothiadiazines; Central Nervous System; Cerebral Hemorrhage; Coma; Diuretics; Enalapril; Humans; Hypertension; Hyponatremia; Indapamide; Male; Osmolar Concentration; Sodium; Sodium Chloride Symporter Inhibitors; Vasopressins; Water

Topics: 3,4-Methylenedioxyamphetamine; Adult; Coma; Hallucinogens; Humans; Hyponatremia; Male; Serotonin Agents; Vasopressins

delta-Aminolevulinic acid dehydratase deficiency porphyria (ALAD porphyria, ADP) with syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in a 69-year-old woman is reported. The patient was admitted to our hospital complaining of slight cough with low-grade fever, and treated with piperacillin sodium, resulting in complete resolution of the symptoms, following a diagnosis of bronchopneumonia. Thereafter, however, she began to complain of vomiting, abdominal pain, facial numbness and paresis of the extremities with gait disturbance, and became comatose with hyponatremia (serum Na concentration 119 mEq/L) in a few days. Laboratory tests revealed an antidiuretic hormone (ADH) level of 13.5 pg/mL, plasma osmolality 218 mOsm/KgH2O, urinary osmolality 429 mOsm/KgH20, urinary Na concentration > 20 mEq/L, and no abnormalities of thyroid, adrenal or renal function. Neither edema nor dehydration was evident. These data indicated the presence of SIADH. No abnormalities suggestive of malignant or infectious diseases such as lung cancer, pneumonia and Guillain-Barré syndrome were evident from laboratory and roentgenographic findings. As the cause of SIADH, therefore, porphyria was suspected. Metabolites and activities of enzymes in the heme biosynthetic pathway were examined, and very low activity of delta-aminolevulinic acid dehydratase (ALA-D) (0.14 mumol PBG/mL RBC/h) was found. The patient was neither an alcoholic nor a heavy smoker, and she had no past history of heavy metal intoxication, photosensitivity or tyrosinemia. On the basis of these data and clinical features, she was diagnosed as having ADP. We consider this to be the first case of ADP reported in Japan.

Topics: Abdominal Pain; Aged; Coma; Female; Humans; Inappropriate ADH Syndrome; Japan; Osmolar Concentration; Paresis; Porphobilinogen Synthase; Porphyrias; Porphyrins; Sodium; Vasopressins; Vomiting

Hyponatremia is usual during myxedema coma. Hereafter we report two cases with increased plasma arginine vasopressin (AVP). Patients were admitted because of hypothyroid coma. In each case, there was an hyponatremia with normal urine sodium and low serum osmolality. Renal function was normal. On hormonal results, primary hypothyroidism was evident. Plasma AVP was increased. The plasma cortisol of one patient was high. Immediate therapy associated: water restriction, hypertonic saline infusion, furosemide, oral thyroid hormones with low doses. On the fourth day, conscience improved obviously. Natremia and plasma AVP went back to normal state before returning to euthyroid state. Patients went on improving along with normalizing thyroid status. Hyponatremia can be a serious sign of hypothyroidism. In case of myxedema coma with hyponatremia, clinical improvement seems to be related to fast correction of water and electrolyte disturbances and we prefer to give low doses of thyroid hormones at first. The hyponatremia and increased plasma AVP mechanisms are complex. However, in each of these cases, plasma AVP come back to normal before returning to euthyroid state. In one case, high plasma cortisol level rules out adrenal insufficiency as causal mechanism of electrolyte disorders.

Topics: Aged; Coma; Female; Humans; Hyponatremia; Hypothyroidism; Male; Myxedema; Vasopressins

Since 1963, a prospective evaluation of the emergency portacaval shunt procedure has been conducted in 264 unselected patients with cirrhosis and bleeding varices who underwent operation within 8 hours of admission to the emergency department. Of 153 patients who underwent operation 10 or more years ago, 45 (29 percent) have survived from 10 to 22 years and their current status is known. On admission, 40 percent of the long-term survivors had jaundice, 44 percent had ascites, 13 percent had encephalopathy (with an additional 9 percent with a history of encephalopathy), 29 percent had severe muscle wasting, and 82 percent had a hyperdynamic state. There were 9 Child's class A patients, 33 Child's class B patients, and 3 Child's class C patients. At operation, all patients had portal hypertension which was reduced by the shunt to a mean corrected free portal pressure of 18 mm saline solution. The emergency portacaval shunt procedure permanently controlled variceal bleeding. None of the patients bled again from varices, and the shunt remained patent throughout life in every patient. Encephalopathy did not affect 91 percent of the patients, but was a recurrent problem in 9 percent, usually related to the use of alcohol. Lifelong abstinence from alcohol occurred in 58 percent of the long-term survivors, but 11 percent resumed regular drinking and 31 percent consumed alcohol occasionally. Liver function declined compared with preoperative function in only 18 percent of the patients, almost always because of alcohol use. Ten years after operation, 73 percent of the patients were in excellent or good condition, and 68 percent were gainfully employed or engaged in full-time housework. Comparison of the 10 to 22 year survivors with our early group of 180 patients reported previously and our recent group of 84 patients showed no significant differences in preoperative or operative data. The single factor that appeared to influence long-term survival was resumption of regular use of alcohol. We conclude that the emergency portacaval shunt procedure, by preventing hemorrhage from varices, results in prolonged survival and an acceptable quality of life for a substantial number of patients with advanced alcoholic cirrhosis.

Topics: Adult; Aged; Alcohol Drinking; Coma; Emergencies; Esophageal and Gastric Varices; Follow-Up Studies; Gastrointestinal Hemorrhage; Humans; Liver Cirrhosis, Alcoholic; Male; Middle Aged; Portacaval Shunt, Surgical; Postoperative Complications; Prospective Studies; Quality of Life; Time Factors; Vasopressins

A 45-year-old woman with myxedema coma due to primary hypothyroidism manifested hyponatremia, impaired water excretion, and elevated urine osmolarity as well as natriuresis suggestive of a syndrome of inappropriate antidiuretic hormone secretion. However, plasma vasopressin was undetectable or very low and plasma aldosterone levels were suppressed in the presence of hyponatremia. Subsequent replacement therapy with levothyroxine caused a rapid decline in sodium clearance which was independent of the change in glomerular filtration rate, and corrected the impaired water excretion and hyponatremia. Plasma vasopressin levels returned to the normal range after the correction of hyponatremia. Thus, the results indicate that neither vasopressin nor aldosterone plays a dominant role in the pathogenesis of the hyponatremia in this patient. It appears that thyroid hormone deficiency itself caused the derangement of tubular cell function, which resulted in the development of the impaired water excretion and hyponatremia.

Topics: Coma; Female; Glomerular Filtration Rate; Humans; Hyponatremia; Hypothyroidism; Inappropriate ADH Syndrome; Middle Aged; Myxedema; Osmolar Concentration; Sodium; Thyroxine; Vasopressins

A case report is presented in which myxedema coma and inappropriate antidiuretic hormone secretion developed as a result of radiation therapy and surgery to the neck area in a patient with recurrent metastatic squamous cell carcinoma of the floor of the mouth. Laboratory findings of low thyroxine level and the findings of persistent hyponatremia and hypoosmolality of serum in spite of persistent sodium loss in the urine were helpful in diagnosing the problem. Treatment included thyroid hormone replacement and fluid restriction resulting in complete reversal of her condition. We believe that patients with head and neck cancer who have undergone a course of radiation to the neck, and particularly when thyroid function might have been altered by previous subtotal thyroidectomy as part of a curative resection, should be carefully followed with periodic thyroid function assays and serum electrolytes with particular attention to serum sodium values.

Topics: Carcinoma, Squamous Cell; Coma; Female; Head and Neck Neoplasms; Humans; Hyponatremia; Hypothyroidism; Middle Aged; Myxedema; Neoplasm Metastasis; Radiation Injuries; Vasopressins

The authors report a case of coma due to peripheral myxoedema with severe hyponatremia (111 mq) and low urinary sodium. The clinical and metabolic disorders regressed within ten days under treatment with thyroid. The frequency of hyponatremia during myxoedema coma is recalled and the pathogenic mechanism discussed. Although the adrenal origin seems excluded, there is possibly some hypervasopresinism, but it seems finally that the thyroxin-dependent hyponatremia is of renal origin.

Topics: Coma; Female; Humans; Hydrocortisone; Hyponatremia; Hypothyroidism; Kidney; Male; Mineralocorticoids; Myxedema; Vasopressins

Symptomatic compulsive water drinking is uncommon. The pathophysiology of compulsive water drinking is essentially that of an acute organic brain syndrome from cerebral edema. The syndrome does not occur clinically unless there is an impairment of water excretion, since normal renal function allows up to 20 liters per day excess intake without accumulation. It has been reported that about 80 percent of cases are neurotic middleaged females. In almost all cases there is at least a history of neurotic symptoms or maladaptive symptoms if the history is probed. In most reported cases the patients were psychotic. When symptoms and laboratory aberration are mild, the sole treatment is water restriction. In moderate but very symptomatic cases, treatment includes both intravenous saline and water restriction. In severe cases treatment includes water restriction, intravenous hypertonic saline, diuretics, and anticonvulsants. After the acute phase, patient education may suffice as in the above case, but if psychosis is present, appropriate therapy is indicated accompanined by frequent checks of serum electrolytes to detect early aberration.

Topics: Aged; Coma; Compulsive Behavior; Diagnosis, Differential; Drinking Behavior; Female; Humans; Vasopressins

Topics: Adult; Age Factors; Coma; Dehydration; Female; Humans; Infant, Newborn; Kidney; Male; Methods; Middle Aged; Neurophysins; Nicotine; Pituitary Gland, Posterior; Pregnancy; Radioimmunoassay; Smoking; Sodium Chloride; Twins; Vasopressins

Topics: Aged; Alcohol Drinking; Beer; Carcinoma, Small Cell; Coma; Hormones, Ectopic; Humans; Hyponatremia; Lung Neoplasms; Male; Middle Aged; Osmolar Concentration; Paraneoplastic Endocrine Syndromes; Sodium; Vasopressins

A patient with ectopic pinealoma first presented with apparent anorexia nervosa and hypernatraemic coma. A history of diabetes insipidus two months previously was not known on admission to hospital. The diabetes insipidus was unmasked by the administration of steroids. Neuroendocrinal and neuropathological aspects of the case are discussed with reference to the march of symptoms due to the growth of the tumour. Histochemical evidence is presented supporting the similarity between ectopic pinealoma and seminoma which suggests that they may more properly be referred to as atypical teratomas.

Topics: Acid Phosphatase; Adult; Alkaline Phosphatase; Anorexia Nervosa; Brain Neoplasms; Coma; Diabetes Insipidus; Dihydrolipoamide Dehydrogenase; Dysgerminoma; Electron Transport Complex IV; Esterases; Female; Humans; Hydrocortisone; Hypernatremia; Hypothalamus; Male; Osmolar Concentration; Oxidoreductases; Pinealoma; Sodium; Testicular Neoplasms; Thyroxine; Tuberculosis; Vasopressins

Three cases of coma after vincristine therapy are described. One patient had hyponatraemia and other features of inappropriate secretion of antidiuretic hormone. The effects were temporary, and full recovery occurred in all three patients.

Topics: Adolescent; Aged; Coma; Electroencephalography; Female; Hodgkin Disease; Humans; Hyponatremia; Leukemia; Lymphadenitis; Male; Vasopressins; Vincristine

Topics: Coma; Diet Therapy; Electroencephalography; Endocrine System Diseases; Female; Humans; Hypokalemia; Hyponatremia; Injections, Intravenous; Kidney Function Tests; Middle Aged; Natriuresis; Potassium; Psychophysiologic Disorders; Sodium; Vasopressins; Water

Topics: Adult; Aged; Autopsy; Beer; Blood Urea Nitrogen; Coma; Diarrhea; Electroencephalography; Feeding and Eating Disorders; Female; Hemiplegia; Humans; Hypokalemia; Hyponatremia; Male; Middle Aged; Nutrition Disorders; Sodium; Tremor; Vasopressins; Vomiting; Water Intoxication

Topics: Adrenal Cortex Hormones; Body Weight; Coma; Electrocardiography; Electroencephalography; Female; Humans; Hyponatremia; Hypopituitarism; Middle Aged; Sodium; Vasopressins; Water; Water-Electrolyte Balance

Topics: Acetates; Acute Disease; Adult; Chlorides; Coma; Cortisone; Craniopharyngioma; Diabetes Insipidus; Diet Therapy; Electrocardiography; Humans; Hypernatremia; Hypokalemia; Male; Natriuresis; Osmolar Concentration; Paralysis; Pituitary Neoplasms; Postoperative Complications; Potassium; Sodium; Thirst; Thyroxine; Vasopressins

Topics: 17-Hydroxycorticosteroids; Acidosis, Respiratory; Adolescent; Adrenal Cortex Hormones; Adrenocorticotropic Hormone; Adult; Aged; Brain; Carbon Dioxide; Cerebrovascular Circulation; Circadian Rhythm; Coma; Dexamethasone; Encephalitis, St. Louis; Female; Growth Hormone; Humans; Hyponatremia; Insulin; Male; Metyrapone; Middle Aged; Oxygen; Pituitary-Adrenal System; Vasopressins

Topics: Child; Coma; Epilepsy, Tonic-Clonic; Humans; Hyponatremia; Hypotension; Leukemia, Lymphoid; Male; Reflex, Abnormal; Vasopressins; Vincristine

Topics: Adolescent; Anti-Bacterial Agents; Brain Edema; Child; Child, Preschool; Coma; Electroencephalography; Encephalitis; Female; Humans; Hyponatremia; Male; Vasopressins

Topics: Aged; Cerebrovascular Disorders; Coma; Female; Humans; Hyponatremia; Hypopituitarism; Potassium Deficiency; Vasopressins

Topics: Coma; Congenital Hypothyroidism; Female; Humans; Hyponatremia; Infant; Myxedema; Vasopressins; Water Intoxication

Topics: Aged; Calcium; Coma; Dehydration; Humans; Magnesium; Potassium; Secretory Rate; Vasopressins; Water Intoxication; Water-Electrolyte Balance