Excessive Water Intake Research Articles

Physiopathological, Epidemiological, Clinical and Therapeutic Aspects of Exercise-Associated Hyponatremia.

Exercise-associated hyponatremia (EAH) is dilutional hyponatremia, a variant of inappropriate antidiuretic hormone secretion (SIADH), characterized by a plasma concentration of sodium lower than 135 mEq/L. The prevalence of EAH is common in endurance (<6 hours) and ultra-endurance events (>6 hours in duration), in which both athletes and medical providers need to be aware of risk factors, symptom presentation, and management. The development of EAH is a combination of excessive water intake, inadequate suppression of the secretion of the antidiuretic hormone (ADH) (due to non osmotic stimuli), long race duration, and very high or very low ambient temperatures. Additional risk factors include female gender, slower race times, and use of nonsteroidal anti-inflammatory drugs. Signs and symptoms of EAH include nausea, vomiting, confusion, headache and seizures; it may result in severe clinical conditions associated with pulmonary and cerebral edema, respiratory failure and death. A rapid diagnosis and appropriate treatment with a hypertonic saline solution is essential in the severe form to ensure a positive outcome.

Acute effect of excess water intake on blood pressure in healthy Individuals

Background: It is a common habit in our country to drink exces s water presuming that it keeps the kidney clean. The effect of excess water intake on hypertension i s poorly known and there is some conflicting data i n this regard. Thus we aimed to study the effect of excess water i ntake in short time on the blood pressure of health y adult individuals. Materials and Methods: We conducted an open labeled, randomized, cross over trial with 12 healthy volunteers without any clinically significant disease. Each in dividual was asked to drink 2000ml of water over a period of 20 minutes after overnight fasting or observed without water intake according to a pre-randomized schedu le after a washout period of 3 days. Results: In healthy adults (mean age 29.2±3.5yrs) after an intake of 2000ml over a period of 16.5±2.6min, ther e was a significant increase in systolic BP of 113.6±6.2 mmHg at 0 hrs to 127.7±9.6 mmHg at 15 min (p<0.001) and 120.7±5.5 mm Hg at 75 min (p<0.05). The diastolic BP also increased from 73.6±6.2 mmHg to 85.9±7.4 mmHg at 30 min (p< 0.01). There was no significant change i n BP during no water intake phase. Conclusion: Excess water intake increases blood pressure in he althy individuals. The underlying mechanism and the long term effect of excess water intake need to be explored.

Optimizing clinical outcomes resulting from glucose‐lowering therapies in type 2 diabetes: increased confidence about the DPP‐4 inhibitors and continued concerns regarding sulphonylureas and exogenous insulin

Optimizing clinical outcomes resulting from glucose‐lowering therapies in type 2 diabetes: increased confidence about the <scp>DPP</scp>‐4 inhibitors and continued concerns regarding sulphonylureas and exogenous insulin

Severe Hyponatremia due to Phlegmonous Trismus.

We describe a patient with dysphagia and trismus associated with lower jaw inflammation due to phlegmon who developed severe hyponatremia from water intoxication due to excessive water intake after diaphoresis caused by abnormally hot weather. A 63-year-old woman presented with severe swelling of the floor of the mouth and trismus. As she had spasms and numbness of the extremities and restlessness and water intoxication caused by excessive water intake was suspected, she was hospitalized for the treatment of inflammation and electrolyte disorder. Although swelling of the floor of the mouth subsided over time after antimicrobial therapy, vomiting, diarrhea, and numbness of the extremities continued. On day 5 of hospitalization, severe vomiting and diarrhea recurred, and serum sodium levels decreased to 108 mEq/L. Decrease in water intake is essential in the treatment of hyponatremia. However, in patients with severe vomiting and diarrhea who can swallow only liquids because of hot weather and eating disorder, the risk of sodium depletion is high. It is important to restore electrolyte balance and fluid volume through supplementation with sodium, chlorine, potassium, and glucose among others, the reduction of intravenous fluid volume, and diuresis in order to correct the sodium level slowly.

Effect of excessive water intake on body weight, body mass index, body fat, and appetite of overweight female participants.

Objective:Drinking plenty of water is commonly recommended in weight loss regimens; however, very limited scientific evidence is available to justify this. Here we studied the effect of drinking 1.5 L of water, over and above the usual intake on body weight, body mass index (BMI), body fat, and appetite score in overweight female participants.Materials and Methods:The study was done on 50 overweight female participants, who were instructed to drink 500 mL of water, three times a day 30 min before breakfast, lunch, and dinner. The 1.5 L water intake was over and above their daily water intake and was continued for 8 consecutive weeks. Body weight, BMI, body fat, and appetite score was measured pre and post-study; and the values were compared by paired t-test using Statistical Packages for Social Sciences (SPSS) version 14.0.1.Results:All the parameters tested were lower after 8 weeks: body weight (pre-study 65.86 ± 3.614 kg vs post-study 64.42 ± 3.704 kg; P < 0.01); BMI (pre-study 26.7002 ± 0.9423 vs post-study 26.1224 ± 1.0632; P < 0.01); sum of skinfold thickness (pre-study 79.626 ± 10.385 mm vs post-study 76.578 ± 10.477 mm; P < 0.01); and the appetite score (pre-study 36.880 ± 4.170 vs post-study 34.673 ± 3.845; P < 0.01).Conclusions:Our study establishes the role of drinking 1.5 L of excessive water in weight reduction, body fat reduction, and appetite suppression in overweight female participants.

Olanzapine-Induced Hyponatremia in a Patient with Autism

Journal of Child and Adolescent PsychopharmacologyVol. 23, No. 10 Letters to the EditorOlanzapine-Induced Hyponatremia in a Patient with AutismChih-lin Chiang, Yu-Hsuan Lin, and Ming H. HsiehChih-lin ChiangDepartment of Psychiatry, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.Search for more papers by this author, Yu-Hsuan LinDepartment of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.Search for more papers by this author, and Ming H. HsiehDepartment of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan.Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, Taiwan.Search for more papers by this authorPublished Online:18 Dec 2013https://doi.org/10.1089/cap.2013.0055AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Olanzapine-Induced Hyponatremia in a Patient with Autism." Journal of Child and Adolescent Psychopharmacology, 23(10), pp. 699–700FiguresReferencesRelatedDetailsCited byLow-Dose Lurasidone–Induced Polydipsia Complicated by Hyponatremia in a Patient With Bipolar Disorder22 September 2021 | Clinical Neuropharmacology, Vol. 44, No. 6Letter to the Editor: Olanzapine Treatment and Polyuria-Polydipsia in Two Children with Autism Spectrum Disorder Ecem Selin Akbas Aliyev, Hande Günal Okumuş, Yagmur Karakus, Burcu Ersoz Alan, and Halime Tuna Cak17 September 2021 | Journal of Child and Adolescent Psychopharmacology, Vol. 31, No. 7Zyprexa13 March 2021Safety and tolerability of antipsychotic agents in neurodevelopmental disorders: a systematic review29 September 2020 | Expert Opinion on Drug Safety, Vol. 19, No. 11Relationship between polydipsia and antipsychotics: A systematic review of clinical studies and case reportsProgress in Neuro-Psychopharmacology and Biological Psychiatry, Vol. 96Hyponatremic Seizure in an Autistic Child associated with Excessive Water Intake with Herbal MedicinePediatric Oncall, Vol. 17, No. 3Hyponatremia and Psychotropic Drugs24 July 2019Psychogenic polydipsia associated with sertraline treatment: a case report9 March 2018 | Psychiatry and Clinical Psychopharmacology, Vol. 29, No. 1Zyprexa26 November 2018Hyponatremia-induced Seizures in Schizophrenic Patient Treated with Olanzapine30 April 2018 | Journal of the Korean Neurological Association, Vol. 36, No. 2A case report of rapid-onset hyponatremia induced by low-dose olanzapineJournal of Family Medicine and Primary Care, Vol. 6, No. 4Polydipsia Secondary to Quetiapine Use: A Case Report8 November 2016 | Klinik Psikofarmakoloji Bülteni-Bulletin of Clinical Psychopharmacology, Vol. 26, No. 1Antipsychotic DrugsOlanzapine25 October 2014 | Reactions Weekly, Vol. 1524, No. 1 Volume 23Issue 10Dec 2013 InformationCopyright 2013, Mary Ann Liebert, Inc.To cite this article:Chih-lin Chiang, Yu-Hsuan Lin, and Ming H. Hsieh.Olanzapine-Induced Hyponatremia in a Patient with Autism.Journal of Child and Adolescent Psychopharmacology.Dec 2013.699-700.http://doi.org/10.1089/cap.2013.0055Published in Volume: 23 Issue 10: December 18, 2013Online Ahead of Print:November 21, 2013PDF download

Hyponatremia

Hyponatremia

Spontaneous Imbibition of Brine and Oil in Gas Shales: Effect of Water Adsorption and Resulting Microfractures

We measure spontaneous imbibition of aqueous (deionized water and KCl solutions of various concentrations) and oleic (kerosene and iso-octane) phases in several dry organic shale samples selected from two wells drilled in the Horn River basin. We find that the imbibition rate of aqueous phases is much higher than that of oleic phases even when plotted versus scaling dimensionless time, contrary to capillary-driven imbibition models. The observed difference is more pronounced in samples with higher clay content. The results suggest that the excess water intake is due to (1) the additional driving force provided through water adsorption by clay minerals, and (2) the enhancement of sample permeability through adsorption-induced microfractures.

Acute Pulmonary Edema Due to Excessive Water Intake in Pyschiatric Patient

Water taking diseases are frequent in psychiatric patient. Approximately 3-6% of psychiatric patient water intoxication is seen. Although water intoxication is defined well, the metabolism of this is not understood. In psychiatric patients, headache, ataxia, confusion, urinary incontinence and electrolyte imbalance is reported. If not treated, confusion, acute delirium, coma and death is seen. Cerebellar edema, pulmonary edema, electrolyte imbalance and urinary incontinence due to water intoxication are reported (1). In this case diagnosis and treatment of psychiatric patient that take excessive water is discussed. The patient a 50-year-old woman schizophrenic had been drinking large amounts of water for several hours before and rapid onset respiratory distress and confusion. In history she started to have fear and stress before 6 years. These symptoms began to increase progressively and last year agitation also seen. Respiratory distress began due to water intake above 10 liters. She was confused, dispneic on admission. TA: 160/90 mmHg, pulse rate 90, respiration 26/min. Cardiovascular and neurologic system was normal and rales were heard in both lungs. In laboratory: Glucose: 100, BUN: 7, Creatinine: 0.8, Na: 129, CI: 87, K: 4.2, albumin:4.1, WBC:8000, Hb:12.2, platelet:367000. Blood gas analysis: Ph 7.32, Pco2 55 mmHg, po2 134 mmHg, Bicarbonate; 36.1 and O2Sat: 99.4. His chest X-ray showed bilateral patch consolidation of the lung fields, cardiomegaly was not seen. Echocardiography; ejection fraction 60 % and no failure. These were suggesting non –cardiogenic pulmonary edema due to excessive water intake and treatment started in our emergency department. 5-ml/min oxygen was given, 3 mg intravenous morphine was done and 5-mcg/kg/min nitroglycerin infusion started, 400 mg intravenous furosemide in 12 hours was given. Patient urinate 3500 cc totally in 12 hours.The clinical outcome was favourable after the treatment. She became alert and ralles decreased. After 24 hours all vital symptoms became stable and patient discharged. Water intoxication is reported in marathon runners, psychiatric patients and soldiers. Psychos, psycotrop drugs, diuretics, nicotine and alcohol can cause excessive water intake. Pyschogenic water intoxication is discussed in the light of 150 observations published in the literature since 1935. 87% of all patients were schizophrenic, and 13% had other psychoses (2). In a long-term psychiatric setting, self-induced water intoxication may be a life-threatening situation. At first glance, the symptoms or behaviors of self-induced water intoxication are similar to schizophrenia, i.e., inappropriate behavior, delusions, hallucinations, confusion, and disorientation.. Affected individuals develop polydipsia, which is accompanied by overhydration and dilutional hyponatremia. If untreated, the symptoms may progress from mild confusion to acute delirium, seizures, coma, or death (3). In our case excessive water intake was due to schizophrenic condition. Pulmonary edema is a rare complication of water intoxication in a psychiatric patient.The physiology of pulmonary edema caused by excessive water intake can’t be explained. Furosemide and water restriction in these patients give good response (2). In our case, echo was normal, bilateral rales were heard and bilateral opacity was seen, these suggested is non –cardiogenic pulmonary edema.

Hyponatremia caused by excessive intake of water as a form of child abuse.

Hyponatremia is the most common electrolyte disorder that requires careful management. Water intoxication with hyponatremia is rare condition that originated from overhydration. Water intoxication, also known as dilutional hyponatremia, develops only because the intake of water exceeds the kidney's ability to eliminate water. Causes of this water intoxication include psychiatric disorder, forced water intake as a form of child abuse and iatrogenic infusion of excessive hypotonic fluid. We experienced and reported a case of symptomatic hyponatremia by forced water intake as a form of child abuse.

Liquid Intake of Organic Shales

Organic shales are exposed to treatment fluids during and after hydraulic fracturing operations. The fluid–shale interaction influences the petrophysical alteration of the fractured shale and the fate of the fracturing fluid. We systematically measured the spontaneous water and oil intake of five shale samples collected from the cores of two wells drilled in the Horn River basin. The samples represent three shale formations with different mineralogy and petrophysical properties. We characterize the samples by measuring the porosity, conducting X-ray diffraction, and interpreting the well logging data and scanning electron microscopy images. The water intake is higher than the oil intake for all samples. The excess water intake and the physical alteration degree correlate with the shale mineralogy and petrophysical properties. The ratio between the water and oil intake is much higher than the ratio between the water and oil capillary pressures, even for the non-swelling shales. The comparative study indica...

The clinical biochemistry of anorexia nervosa

In anorexia nervosa, under-nutrition and weight regulatory behaviours such as vomiting and laxative abuse can lead to a range of biochemical problems. Hypokalaemia is the most common electrolyte abnormality. Metabolic alkalosis occurs in patients who vomit or abuse diuretics and acidosis in those misusing laxatives. Hyponatraemia is often due to excessive water ingestion, but may also occur in chronic energy deprivation or diuretic misuse. Urea and creatinine are generally low and normal concentrations may mask dehydration or renal dysfunction. Abnormalities of liver enzymes are predominantly characterized by elevation of aminotransferases, which may occur before or during refeeding. The serum albumin is usually normal, even in severely malnourished patients. Amenorrhoea is due to hypogonadotrophic hypogonadism. Reduced concentrations of free T4 and free T3 are frequently reported and T4 is preferentially converted to reverse T3. Cortisol is elevated but the response to adrenocorticotrophic hormone is normal. Hypoglycaemia is common. Hypercholesterolaemia is a common finding but its significance for cardiovascular risk is uncertain. A number of micronutrient deficiencies can occur. Other abnormalities include hyperamylasaemia, hypercarotenaemia and elevated creatine kinase. There is an increased prevalence of eating disorders in type 1 diabetes and the intentional omission of insulin is associated with impaired metabolic control. Refeeding may produce electrolyte abnormalities, hyper- and hypoglycaemia, acute thiamin depletion and fluid balance disturbance; careful biochemical monitoring and thiamin replacement are therefore essential during refeeding. Future research should address the management of electrolyte problems, the role of leptin and micronutrients, and the possible use of biochemical markers in risk stratification.

Geometry of compensatory feeding and water consumption inDrosophila melanogaster

Feeding behaviour is an expression of an animal's underlying nutritional strategy. The study of feeding decisions can hence delineate nutritional strategies. Studies of Drosophila melanogaster feeding behaviour have yielded conflicting accounts, and little is known about how nutrients affect feeding patterns in this important model species. Here, we conducted two experiments to characterize nutrient prioritization and regulation. In a choice experiment, we allowed female flies to self-regulate their intake of yeast, sucrose and water by supplying individual flies with three microcapillary tubes: one containing only yeast of varying concentrations, another with just sucrose of varying concentrations, and the last with just water. Flies tightly regulated yeast and sucrose to a constant ratio at the expense of excess water intake, indicating that flies prioritize macronutrient regulation over excess water consumption. To determine the relative importance of yeast and sucrose, in a no-choice experiment, we provided flies with two microcapillary tubes: the first with one of the 28 diets varying in yeast and sucrose content and the other with only water. Flies increased total water intake in relation to yeast consumption but not sucrose consumption. Additionally, flies increased diet intake as diet concentration decreased and as the ratio of sugar to yeast equalized. Using a geometric scaling approach, we found that the patterns of diet intake can be explained by flies prioritizing protein and carbohydrates equally and by the lack of substitutability between the nutrients. We conclude by illustrating how our results harmonize conflicting results in the literature once viewed in a two-dimensional diet landscape.

P-773 - Episodic psychogenic polydipsia and water intoxication in a male patient with mental retardation

Introduction Psycogenic polydipsia is described as excessive water intake which is not appropirate to the homeostatic balance. We report a case of mild mental retardation with episodes of severe psychogenic polydipsia. Objectives Prevalance of psycogenic polydipsia is %3,1 in mentally retarded patients (1). The case we present is unique because polydipsia is episodic, it is occuring after stressful life events and the patient has no comorbid psychotic or autism spectrum disorder. Aims We would like to inform about the good treatment response to olanzapine of this rare clinical phenomenon. Methods The patient who had first been referred to the internal medicine clinic for complaints of severe nausea, insomnia and fainting, was hospitalized in psychiatry department becuse of refusal to eat and vomiting. Details of the inpatient treatment, laboratory results and the follow up after hospitalization were analysed. Results After the investigation, history of episodic polydipsia for 10 years is determined, with 3–4 episodes per year. He was drinking 25–30 lt of water a day during these episodes. All of the episodes were occuring after psychological stressors, including the death of his grandmother, grandfather and father. Conclusions Reactions of mentally retarded individuals to life stressors can be extremely different from normal. Olanzapine may be a treatment option in psychogenic polydipsia which is triggered with psychological stress.

Un análisis del origen del consumo excesivo de agua del beber inducido por el programa

El propósito del estudio fue analizar el origen del consumo excesivo de agua durante las sesiones de beber inducido por el programa (BIP). Tres ratas vivieron dentro de las cámaras experimentales y se registró el consumo de agua continuamente. En el Experimento 1 se distribuyeron tres sesiones de BIP en cada período de 24 horas, en las que se entregaron uno, tres u ocho gramos de comida conforme a un programa de tiempo fijo 180 s. El consumo diario de agua se concentró dentro de las sesiones y el volumen de agua consumida fue proporcional a la cantidad de comida entregada. En el Experimento 2 se presentaron las bolas de comida juntas al inicio de cada sesión de BIP y en una segunda condición se entregaron las bolas de comida juntas al inicio de cada día. El volumen de agua consumida permaneció constante durante cada período de 24 horas a través de los dos experimentos del estudio, independientemente de la distribución temporal de la comida. Se concluyó que el consumo de agua durante las sesiones de BIP no es excesivo. La privación de comida y la entrega de comida a intervalos son conducentes a confinar el beber durante las sesiones.

Cochrane Review: Restricted versus liberal water intake for preventing morbidity and mortality in preterm infants

AbstractBackgroundMost premature infants are not sufficiently mature physiologically to ingest all of their required water and nutrients orally. Therefore, premature infants rely on their caregivers to regulate their volume of water intake. Thus, the caregiver must determine the amount of water to be given each day to such infants.ObjectivesTo determine the effect of water intake on postnatal weight loss, the risks of dehydration, and other morbidities and mortality in premature infants.Search strategyRandomized clinical trials (RCTs) identified in previous versions of this review were re‐examined and, in each case, retained. Additional trials were sought that compared the outcomes of interest in groups of premature infants who were given different levels of water intake according to experimental protocol. Such trials were sought in a list of trials provided by the Cochrane Neonatal Review Group, with a PubMed search, and in the authors' personal files.This search was updated in 2010.Selection criteriaOnly RCTs of varying water intake in premature infants are included. The review was limited to trials that included infants whose water intake was provided mainly or entirely by intravascular infusion.Data collection and analysisStandard methods of the Cochrane Collaboration were used. Study selection and data abstraction was performed independently by each reviewer. The adverse event rates were calculated for the restricted and liberal water intake groups for each dichotomous outcome, and the relative risk and risk difference were computed. In addition, the maximal weight loss results were recorded, and the weighted mean difference was computed.Main resultsThe analysis of the five studies taken together indicates that restricted water intake significantly increases postnatal weight loss and significantly reduces the risks of patent ductus arteriosus and necrotizing enterocolitis. With restricted water intake, there are trends toward increased risk of dehydration and reduced risks of bronchopulmonary dysplasia, intracranial hemorrhage, and death, but these trends are not statistically significant.Authors' conclusionsBased on this analysis, the most prudent prescription for water intake to premature infants would seem to be careful restriction of water intake so that physiological needs are met without allowing significant dehydration. This practice could be expected to decrease the risks of patent ductus arteriosus and necrotizing enterocolitis without significantly increasing the risk of adverse consequences.Plain Language SummaryRestricted versus liberal water intake for preventing morbidity and mortality in preterm infantsMost babies born before 37 weeks of pregnancy (preterm babies) are not developed enough to take all the water and nutrients they need by mouth. As a result, they are unable to regulate their intake of water. Inadequate water intake can cause the baby to become dehydrated. Excessive water intake can cause heart and lung problems or intestinal damage. Systematic review of trials related to this issue leads to the conclusion that careful restriction of water for preterm babies, to amounts that meets their physical needs without causing dehydration, reduces the risk of certain complications. More research on this topic is needed.

2,8-Dihydroxyadenine Urolithiasis. Case Report and Literature Review

2,8-Dihydroxyadenine (DHA) urolithiasis is a rare type of urinary stone disease secondary to deficiency of adenine phosphoribosyltransferase (APRT) activity, a rare, inherited autosomal recessive disease with an incidental rate from 0.4 to 1.2%. The prevalence is higher among Japanese than other ethnic groups. APRT normally catalyzes the conversion of adenine to adenosine monophosphate and its deficiency results in 2,8-dihydroxyadenine (2,8-DHA) accumulation. This compound is extremely insoluble and its crystallization can lead to stone formation and renal failure. We report the case of 2,8-dihydroxyadenine (DHA) urolithiasis in a 52-year-old male patient. In December 2008 a 52-year-old Caucasian man was admitted to our hospital with sudden pain in the left lumbar region. Abdominal X-ray did not show any radiopaque urinary stone. I.V. pielography showed a radiolucent left lumbar ureteral (0.6 mm) and renal (1.5 cm) stone. After therapy with tamsulosin, the ureteral stone was excreted. Successful ESWL treatment was performed for renal stone. He presented a clinical history of several episodes of bilateral renal colic and two prior ESWL treatment for radiolucent stones. Chemolitholysis was never successful. RESULTS. Stone analysis by infrared spectroscopy and microscopic examination of urine reveal typical 2,8-DHA crystals. APRT deficiency was detected in the hemolysate of erythrocyte. Partial deficiency of APRT in the patient's relatives showed heterozygosity of the enzyme defect. Allopurinol therapy successfully prevented further stone formation. 20 months later the patient remains stone free. Two types of deficit are commonly distinguished, depending on the level of residual APRT activity. Type I is complete enzyme deficiency. Type II shows residual activity in cell lysates, but enzyme activity is not demonstrable in intact cells. About 78% of the Japanese patients belong to type II. The diagnosis of the disease is based on stone analysis by infrared spectroscopy or microscopic examination of urine, which may reveal typical 2,8-DHA crystals. Molecular approach can identify mutations, which are responsible of this inherited disease. Excessive water intake, restriction of foods with high adenine contents and administration of allopurinol are useful treatments. APRT deficiency is a rare disease but we can consider this pathology in case of recurrent radiolucent stones after chemolitolysis.

A Rare Case of Fatal Hyponatremia Due to a Combination of Psychotropic Polypharmacy and Hypothyroidism

A Rare Case of Fatal Hyponatremia Due to a Combination of Psychotropic Polypharmacy and Hypothyroidism

Two Unusual Pediatric Cases of Dilutional Hyponatremia

Dilutional hyponatremia, although not uncommon, is an underestimated problem in the pediatric population. In most cases, it results from excessive hydration or water retention, also described as the so-called water intoxication. One of the most known causes is the use of desmopressin in enuretic children. This drug enhances the free water reabsorption in the renal collecting ducts. The addition of the anticholinergic agent oxybutynin aggravated the condition by causing a dry mouth with excessive thirst and water intake in our first case. Dietary water overconsumption, either voluntary or involuntary, is a phenomenon seen in formula-fed babies. But in our second case, a game involving forced ingestion of large amounts of water had serious consequences including hyponatremia-related coma. An effort should therefore be made to inform caretakers about the risks of these games. These cases, provoked by rather unusual and peculiar causes, illustrate again that electrolytes and especially serum [Na(+)] are key points to be determined in a child with diminished consciousness. Moreover, an accurate history including the intake of medication and dietary information should be made.

Hyponatremia is Associated with Increased Severity of Disease in Critically Ill Children with Bronchiolitis

INTRODUCTION: Hyponatremia is the most common electrolyte abnormality seen in the intensive care unit (ICU), and is associated with increased morbidity and mortality. Critically ill children with bronchiolitis are at risk of developing hyponatremia, due to impaired renal free water excretion and exogenous sources of excess free water intake. We hypothesize that the development of hyponatremia is associated with a more complicated clinical course in critically ill children with bronchiolitis. METHODS: A retrospective case-control study was conducted that included all children admitted to the ICU with bronchiolitis over a two year period (n = 59). Patients were divided into two clinical groups: those that were hyponatremic (serum sodium < 136 mmol/L) during their ICU stay and those that remained normonatremic (serum sodium ≥ 136 mmol/L). RESULTS: Forty-three children (73%) developed hyponatremia while in the ICU. Hyponatremic children were intubated more often than normonatremic children (OR 16.7; 95% CI 4.1-68.5); however, hyponatremia rarely developed before intubation (2%). Hyponatremic children also had a longer ICU length of stay (209 ± 137 hrs vs. 130 ± 85 hrs, p = 0.01). In a subset of intubated children (n = 44), thirty-eight (88%) developed hyponatremia. These intubated children had a lower mean serum sodium concentration (132.8 mmol/L vs. 137.3 mmol/L, p < 0.0001) than non-intubated children. CONCLUSIONS: Hyponatremia is a common comorbidity in children admitted to the ICU with bronchiolitis, and is associated with increased illness severity, as evidenced by a higher frequency of intubation and a longer ICU length of stay.