Symptomatic hyponatremia is considered a rare complication of oral bowel preparation for colonoscopy. The pathophysiology underlying this phenomenon has been widely regarded as a mere sequela of excessive arginine vasopressin (AVP) release.This case describes a 61-year old woman who developed acute hyponatremic encephalopathy when preparing for elective outpatient lower endoscopy. She had had negligible oral solute intake for two days and ingested four liters of clear fluid within two hours. On admission, the patient was agitated and had slurred speech. Treatment with hypertonic saline lead to full recovery. A brisk aquaresis confirmed acute dilutional hyponatremia.Apart from elevated AVP-levels, the amount and speed of fluid intake and concomitant low-solute intake constitute important risk factors in the development of clinically relevant hyponatremias in patients undergoing colonoscopies. Understanding that the cause of sodium imbalance in this scenario is multifactorial and complex is pivotal to recognizing and ideally preventing this complication, for which we propose the term "bowel prep hyponatremia".
Introduction Hyponatremia is the most common electrolyte disorder, defined as a serum sodium level less than 135 meq/L. It is classified according to serum sodium concentration as mild, moderate and severe and according to its manifestation time in acute ( Purpose Discussion and management of a case of a 21 month old female infant with severe hyponatremia (Na: 117 meq/L), presented with drowsiness accompanied by polydipsia and polyuria following a febrile infection. Clinical case The infant presented with drowsiness started 12 hours ago, accompanied by polydipsia (water intake >7 Lt/day), polyuria and high temperature up to 39.8°C that started 3 days ago. From the medical history high water intake is reported from the age of 6 months old. At the time of admission, she was haemodynamically stable, afebrile, presented with tonsillitis and signs of mild dehydration. Laboratory tests revealed severe hyponatremia (Na: 117 meq/L), dehydration with normal renal function tests, low serum and urine osmolarity and normal white blood cell count and CRP. Kidney-ureter-urinary bladder-adrenal gland ultrasound and fundoscopy showed no pathological findings. The patient was treated with intravenous fluids based on the hypotonic dehydration treatment protocol, with continuous neurological, blood gas and biochemical monitoring. Serum sodium levels recovered to normal (Na: 136 meq/L) over the following 24 hours. On the third day of hospitalization she was transferred to the Childrens’ Hospital
Water intoxication due to excessive water intake: observation of initiation stage.
A patient who had experienced water intoxication despite normal renal function and normal urinary diluting ability was observed during the initiation stage of hyponatremia. Upon the excessive water intake (10 to 15 L) for several days, he developed moderate hyponatremia (121 mEq/L) and headache, an early symptom frequently seen in water intoxication. During this period, his urine was maximally dilute (50 to 60 mOsm/kg H2O), and his urinary sodium excretion increased. This report suggests that 10 to 15 L of water intake for several days can cause water intoxication in subjects with normal urinary diluting ability and that the increase in sodium excretion is prerequisite for the high urine flow rate.
Published in Japanese journal of medicine (1987)
Psychogenic polydipsia and water intoxication--concepts that have failed.
Ten patients (8 men, 2 women; mean age 38.7 +/- 8.1 years), 7 of whom had schizophrenic disorders and 3 of whom had bipolar disorder (manic-depressive illness), manifested psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome). The relationship between serum sodium and urinary water excretion among the 10 PIP patients is described in detail. The success of lithium in improving serum sodium levels and in decreasing urinary water excretion among the three PIP patients with bipolar disorder and the failure of changes in urinary water excretion to explain changes in serum sodium levels among the 10 PIP patients argue against "psychogenesis" as the explanation for the polydipsia and excessive water intake as the sole explanation for hyponatremia or complications ascribed to water intoxication.
Published in Biological psychiatry (1985)
Acute water intoxication in healthy infants.
We have described two infants with profound hyponatremia and seizures due to metabolic derangements resulting from inappropriate feeding of large volumes of solute-poor liquids. All of the 23 similar cases in the current literature described children with normal renal and neurologic function before and after the episode of hyponatremia. The chronic feeding of solute-poor fluids in these infants impaired their ability to excrete free water, and continued feeding of solute-poor fluids resulted in progressive hyponatremia and convulsions. Upon reinstitution of normal sodium intake, all metabolic abnormalities disappeared.
Published in Southern medical journal (1986)
[Water intoxication in psychiatric patients. 13 cases of severe hyponatremia]. Water intoxication mostly occurs in psychiatric patients. We observed 13 episodes of severe hyponatremia (less than 120 mmol/l) following a period of increased water consumption in 10 psychiatric patients (5 men, 5 women, mean age 48.8 years) treated with neuroleptics and/or benzodiazepines. Other causes of hyponatremia were excluded. The initial clinical signs were associated with severe gastrointestinal and neurological disorders requiring intensive care. In every case a gradual return to normal of natremia was obtained by creating a negative water balance while compensating for the sodium loss. From a study of urine and plasma osmolality ratio (U/P osm) on admission, several physiopathological mechanisms could be envisaged. A U/P osm ratio lower than 1 (6 cases) suggested a water intake exceeding the maximum dilution capacity of the kidneys (20-25 1), or a lesser water intake with little or no osmolal intake, or again an intrarenal disorder of urine dilution.
classified as acute or chronic. Acute renal failure (ARF) results from an acute insult, primarily … present, salt and water intake often increases the fluid retention. Water intake alone probably … with water intoxication there is excess fluid in the * _ compartment. 8. Water intoxication (is/is
classified as acute or chronic. Acute renal failure (ARF) results from an acute insult, primarily … present, salt and water intake often increases the fluid retention. Water intake alone probably … cause water intoxication. * _ , * _ , * _ , and * _ excess nonsolute water Intake , solute