Thirst, resetting of the osmostat, and water intoxication following encephalitis

Howe, J. G.; Penney, M D; Currie, S.; Morgan, Diane

doi:10.1002/ana.410130217

Cited by 12 publications

(5 citation statements)

References 15 publications

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“…This is seen in patients with mineralocorticoid deficiency [8,24], pulmonary diseases [7][8][9]24] or congestive heart failure [26], although this type is rarely seen in patients with neurological diseases [7][8][9][27][28]. On the other hand, the leaky type was demonstrated in sheep with the ablated lamia terminalis from which the neural pathway may form a link between the osmoreceptor and the supraoptic and paraventricular nuclei [29] .…”

Section: Hypertonic Saline Infusionmentioning

confidence: 99%

Osmoregulation of Vasopressin Secretion in Patients with the Syndrome of Inappropriate Antidiuresis Associated with Central Nervous System Disorders.

et al. 1999

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Abstract.To clarify the characteristics of vasopressin (AVP) secretion in patients with the syndrome of inappropriate antidiuresis (SIAD) related to central nervous system disorders, we examined the response of AVP secretion to osmotic stimulus by hypertonic saline infusion and analyzed the possible causative factors in six patients with SIAD associated with head trauma or cerebral infarction. Hyponatremia developed after head trauma in four patients and cerebral infarction in two patients.In all patients the clinical state and laboratory findings fulfilled the criteria for SIAD, which was supported by either nonsuppressible plasma AVP levels or effectiveness of treatments with water restriction, demeclocycline, nonpeptide V2 AVP antagonist or diphenylhydantoin.Although patterns of plasma AVP response to the osmotic stimulus varied, plasma AVP concentrations neither increased nor decreased to undetectable levels with a rise in plasma osmolality. In one patient, plasma AVP levels responded to increasing plasma osmolality when plasma osmolality normalized; in which the threshold and the sensitivity of osmostat were normal. In two other patients, AVP secretion responded to plasma osmolality after the treatment.The changes in AVP secretion were not due to nonosmotic stimuli for AVP release.In conclusion, this study shows that patients with SIAD and central nervous system disorders may have persistent AVP secretion with a loss of hypotonic suppression such as found in patients with adrenal insufficiency or depletional hyponatremia in central nervous system disorders, indicating that careful evaluation is necessary to determine the relationship between persistent AVP secretion and the pathogenesis of hyponatremic disorders.

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Section: Hypertonic Saline Infusionmentioning

confidence: 99%

Osmoregulation of Vasopressin Secretion in Patients with the Syndrome of Inappropriate Antidiuresis Associated with Central Nervous System Disorders.

et al. 1999

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“…However, a coexisting pathological thirst control cannot be completely ruled out. Pathological thirst with severe hyponatremia has been previously described in a 26-year old as sequelae of viral encephalitis [11]. In the setting of hyponatremia and compulsive drinking, psychogenic polydipsia can be considered in the differential diagnosis after ruling out other medical causes for this.…”

Section: Discussionmentioning

confidence: 99%

Management Challenges in a Child with Chronic Hyponatremia: Use of V2 Receptor Antagonist

Krishnan

Deshpande

Mallappa

et al. 2017

Case Reports in Pediatrics

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Chronic hyponatremia is very rare in children and is often seen in the setting of congestive heart failure or liver failure in adults. Here, we report an 8-year-old child with hypothalamic glioma who presented with severe hyponatremia. Initial management consisted of fluid restriction. This was very difficult for the child to follow and the child developed bizarre drinking habits requiring intervention from child psychiatry. So therapy was initiated with low dose V2 receptor antagonist under close inpatient monitoring. While initial response was reassuring, her sodium levels tended to drift down with longer duration of treatment requiring us to increase the dose frequently. Her response to therapy and her stable clinical situation off therapy suggest that she may have reset osmostat.

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“…The identification of causative factors in our study was constrained due to the small sample size, with inferences primarily drawn from individual case reports. Documented causes in the literature include intracranial arteriovenous malformations, intraventricular hemorrhage, cerebral palsy, Lewy Body dementia, colorectal and gastric carcinoma, venlafaxine use, and encephalitis [ 5 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ].…”

Section: Discussionmentioning

confidence: 99%

Chronic Hyponatremia: The Role of Reset Osmostat in Patients with Suspected SIAD

Kiewiet,

Schuinder,

Doornebal

et al. 2024

JCM

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Background: Hyponatremia is common, particularly among the elderly. Reset osmostat (RO) serves as an alternative diagnosis to the syndrome of inappropriate antidiuresis (SIAD). There is limited information available regarding the prevalence of RO in outpatient clinics and hospital wards. The water-diluting test is considered the gold standard for the diagnosis of RO. The recent identification of copeptin provides an additional diagnostic marker alongside the utilization of fractional uric acid excretion. Methods: This single-center, prospective, observational study involved eight patients undergoing a water-diluting test over a study period of 2 years. Results: Reset osmostat was diagnosed in 50% of cases, while SIAD was confirmed in one patient. The tests were inconclusive for the remaining three patients. Conclusions: Our findings suggest that reset osmostat, despite its rarity, is a plausible diagnosis in chronic hyponatremia. The relevance of copeptin could not be confirmed in this study. Moreover, fractional uric acid excretion might be as effective as the water-diluting test in diagnosing reset osmostat.

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Thirst, resetting of the osmostat, and water intoxication following encephalitis

Cited by 12 publications

References 15 publications

Osmoregulation of Vasopressin Secretion in Patients with the Syndrome of Inappropriate Antidiuresis Associated with Central Nervous System Disorders.

Osmoregulation of Vasopressin Secretion in Patients with the Syndrome of Inappropriate Antidiuresis Associated with Central Nervous System Disorders.

Management Challenges in a Child with Chronic Hyponatremia: Use of V2 Receptor Antagonist

Chronic Hyponatremia: The Role of Reset Osmostat in Patients with Suspected SIAD

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