Symptomatic normovolemic essential hypernatremia: A clinical and physiologic study

doi:10.1016/0002-9343(73)90031-4

The American Journal of Medicine

Volume 54, Issue 3, March 1973, Pages 359-370

https://doi.org/10.1016/0002-9343(73)90031-4 Get rights and content

Abstract

A 23 year old man presenting with episodic muscle paralysis and persistent normovolemic hypernatremia and hyperosmolality was investigated. Metabolic studies at the time of presentation and during a 10 hour fast, and the responses to acute and chronic water loading, alcohol, vasopressin and nicotine infusion, sodium restriction and intravenous sodium loading were all normal, with the exception of the acute water load. These results suggested abnormal hypothalamic function leading to an altered regulation of the central osmoreceptors controlling thirst and sodium metabolism; however, no central nervous system lesion was demonstrable. Despite normal levels of plasma [potassium], total exchangeable body potassium was reduced. It is proposed that the muscle paralysis was secondary to both the hypernatremia and the reduced total body potassium status. Progressive symptomatic improvement with lowering of plasma sodium and osmolality occurred following 24 months on a low sodium-high potassium-high fluid regimen although total body potassium status has remained low.

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^☆: This work was supported in part by the National Institutes of Health, HE 11580-01 (GMB), the National Medical Research Council of Australia and the National Heart Foundation of Australia.

^∗: Present address: Department of Medicine, Stanford University Medical School, Palo Alto, California 94305.

¹: From the Department of Endocrinology, Royal Melbourne Hospital and the Howard Florey Institute of Experimental Physiology and Medicine, University of Melbourne, Victoria, Australia.

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Case reportSymptomatic normovolemic essential hypernatremia: A clinical and physiologic study☆

Abstract

Amer J Med

Amer J Med

Amer J Med

Amer J Med

Amer J Cardiol

Hypo- and hypernatremia

Ann Intern Med

Chronic and sustained hypernatremia, absence of thirst, diabetes insipidus and adrenocorticotrophin insufficiency resulting from widespread destruction of the hypothalamus

Ann Intern Med

Neurogenic hypernatremia

Arch Neurol (Chicago)

Hypernatremia due to hypodipsia and elevated threshold for vasopressin release

New Eng J Med

Biochemical normals. 1

Med J Aust

Pilocarpine iontophoresis sweat testing: result of seven years experience

Mod Probl Pediat

Measurement of corticosteroids in adrenal vein blood of sheep

Aust J Exp Biol Med Sci

Measurement of aldosterone in peripheral blood of man and sheep

J Clin Endocr

Improved assay methods for renin “concentration” and “activity” in human plasma

Circ Res

Effect of saline infusions on aldosterone secretion and electrolyte excretion in normal subjects and patients with primary aldosteronism

New Eng J Med

Hyperosmolarity in adults. A critical review

J Chronic Dis

Neurogenic hyperosmolarity (hypernatremia)

Neurology (Minneap)

Drinking antidiuresis and milk ejection from electrical stimulation within the hypothalamus of the goat

Acta Physiol Scand

Case report
Symptomatic normovolemic essential hypernatremia: A clinical and physiologic study☆