Abstract
A fourteen year old girl with persistent hypernatremia was studied. Measurements were made of electrolyte compartments and renal clearance of total solute under conditions of acute and chronic water loading, alcohol infusion and exogenous vasopressin administration. In contrast to previously reported studies, extracellular space and electrolyte compartments were contracted. In addition, the response to water loading was blunted. Normal responsiveness to ethanol infusion and exogenous vasopressin, with normal renal function, suggested a central nervous system etiology for this disorder. Extensive roentgenologic and neurologic evaluation failed to establish the presence of a cerebral tumor, although a persistently elevated spinal fluid protein level supports such suspicions. Asymptomatic hypovolemic hypernatremia should be added to the clinical spectrum of essential hypernatremia.
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