Unstable osmolar homeostasis with and without renal sodium wastage
In two hyponatremic patients with bronchogenie carcinoma metastatic to the mediastinum, dilutional factors were clearly demonstrated. One patient had a cerebral metastasis, and at times showed profound renal sodium wastage, responding to either fluid restriction, ACTH, or Florinef. The second patien...
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Veröffentlicht in: | The American journal of medicine 1962-07, Vol.33 (1), p.39-53 |
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Sprache: | eng |
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Zusammenfassung: | In two hyponatremic patients with bronchogenie carcinoma metastatic to the mediastinum, dilutional factors were clearly demonstrated. One patient had a cerebral metastasis, and at times showed profound renal sodium wastage, responding to either fluid restriction, ACTH, or Florinef. The second patient, despite overhydration and diminution of urinary aldosterone excretion, could not be induced to diurese substantial amounts of sodium, although his renal conservation was not optimally efficient.
Analysis of previously reported cases seems to correlate the presence of cerebral disease with pronounced salt wasting in patients with dilutional hyponatremia. Experimental and clinical evidence also indicates a state of variable renal refractoriness to sustained administration of Pitressin and to ACTH and mineralocorticoid therapy during Pitressin administration—a state which appears to occur in the dilutional hyponatremia syndrome. The complex interplay of central and peripheral factors involved in the secretion and renal effects of antidiuretic hormone (ADH) and aldosterone probably accounts for the diverse observations previously reported. |
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ISSN: | 0002-9343 1555-7162 |
DOI: | 10.1016/0002-9343(62)90275-9 |