Abstract
Acute water intoxication with deepening coma and uncontrolled epileptiform seizures in a 25-year-old previously fit male schizophrenic was treated with hypertonic (2 N) saline and a 20% mannitol solution. This improved his neurological state but precipitated severe pulmonary oedema. Intravenous frusemide increased his urinary output sufficiently to clear the pulmonary oedema. In acute water intoxication the use of hypertonic solutions may thus precipitate left heart failure by expanding the intra-pulmonary blood volume beyond the capacity of even a healthy left ventricle to compensate. Simple water restriction will produce a slower but perhaps safer improvement.
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- Alexander E. R., Crow T. J., Hamilton S. M. Water intoxication in relation to acute psychotic disorder. Br Med J. 1973 Jan 13;1(5845):89–89. doi: 10.1136/bmj.1.5845.89. [DOI] [PMC free article] [PubMed] [Google Scholar]
- BEWLEY T. H. ACUTE WATER-INTOXICATION FROM COMPULSIVE WATER-DRINKING. Br Med J. 1964 Oct 3;2(5413):864–864. [PMC free article] [PubMed] [Google Scholar]
- Brisman R., Parks L. C., Benson D. W. Pitfalls in the clinical use of central venous pressure. Arch Surg. 1967 Dec;95(6):902–907. doi: 10.1001/archsurg.1967.01330180050009. [DOI] [PubMed] [Google Scholar]
- Forrester J. S., Diamond G., McHugh T. J., Swan H. J. Filling pressures in the right and left sides of the heart in acute myocardial infarction. A reappraisal of central-venous-pressure monitoring. N Engl J Med. 1971 Jul 22;285(4):190–193. doi: 10.1056/NEJM197107222850402. [DOI] [PubMed] [Google Scholar]
- LEAF A., BARTTER F. C., SANTOS R. F., WRONG O. Evidence in man that urinary electrolyte loss induced by pitressin is a function of water retention. J Clin Invest. 1953 Sep;32(9):868–878. doi: 10.1172/JCI102805. [DOI] [PMC free article] [PubMed] [Google Scholar]
- WYNN V., HOUGHTON B. J. Observations in man upon the osmotic behaviour of the body cells after trauma. Q J Med. 1957 Jul;26(103):375–392. [PubMed] [Google Scholar]
- WYNN V., ROB C. G. Water intoxication; differential diagnosis of the hypotonic syndromes. Lancet. 1954 Mar 20;266(6812):587–594. doi: 10.1016/s0140-6736(54)91360-4. [DOI] [PubMed] [Google Scholar]