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Summary:Random estimations of plasma arginine vasopressin concentration were undertaken in 6 non-oedematous patients receiving diuretic therapy for hypertension, who were admitted to hospital with severe hyponatraemia. Hyponatraemia resolved within 2 weeks of discontinuing the diuretic. Measurable amounts of plasma arginine vasopressin were detected in all 6 patients.Sequential biochemical measurements in one patient, performed when plasma sodium concentration and osmolality were returning to the normal range, disclosed that urine osmolality remained higher than plasma osmolality during the first 5 days, when urine volume and sodium excretion were low. Thus the rise in plasma sodium was not initially related to water diuresis. The ability to excrete a water load was severely limited on the fifth day, but improved progressively by the tenth and seventeenth days.Diuretic-induced hyponatraemia is associated with incomplete suppression of anti-diuretic hormone secretion arising from non-osmotic stimulation, in conjunction with transient impairment of renal diluting ability which could be due to net sodium deficit.

the right leg at age 52 and later of left leg. No history of DVT; no family history of leg ulcers. Left inguinal herniorrhaphy at age 45. Case 2-Born 1915, single, height 1-8 m, weight 95 3 kg. Ulceration of left leg at age 39. Mild eczema of the right leg. No history of DVT. Mother and maternal aunt had leg ulcers. Case 3-Born 1944, single, height 1 8 m, weight 93-9 kg. Ulceration of the right leg at age 29. Four years previously he injured the right foot. This was followed by DVT and pulmonary embolus. Case 4-Born 1918, married, height 1 77 m, weight 92 1 kg. At age 53 ulceration of the left leg developed and later eczema of the right leg. Thrombophlebitis of the left leg occurred before ulceration. History of varicose veins in his mother's family. Case 5-Born 1924, height 1-77 m. Ulceration of right leg at age 40. Operation for varicose veins at 27. No history of phlebitis or thrombosis. His mother had varicose veins and his maternal grandmother leg ulcers. Two brothers had no leg trouble. Case 6-Born 1907, very tall, weight 76-9 kg. Ulceration of legs present with a generalised rash at age 44. Subsequently he had eczema of both legs and a small ulcer on the medial aspect of the left ankle.

1 Six previously untreated emergency admissions to hospital with severe hypertension were given oral treatment with labetalol. 2 Pre‐treatment diastolic BP exceeded 130 mmHg, and clinical evidence of either accelerated hypertension or encephalopathy was present. 3 Hypotensive response after treatment followed two patterns. 4 Quick‐responders (n = 3) showed a sharp fall in BP to normal levels within 2 h, which was subsequently sustained for 10 or more hours. The daily dose of labetalol eventually required to achieve good BP control in this group was relatively low: 600–1200 mg. 5 Slow‐responders (n = 3) showed a gradual, less marked fall in BP, which was sustained for many hours. These patients required further doses of labetalol to reduce BP to normal. The eventual daily dose of labetalol that ensured good BP control was high: 1200–2400 mg. 6 Heart rate was little changed by treatment. 7 Complications or side‐effects were not observed.