SALT WASTAGE, PLASMA-VOLUME CONTRACTION AND HYPOKALEMIC PARALYSIS IN SELF-INDUCED WATER-INTOXICATION

Eleven episodes of severe hyponatremia secondary to hiccup-induced pot omania were recorded in 3 years in a man who had essential hypertensio n, a low protein intake and a normal diluting ability. Paradoxical inc rease in hematocrit and plasma protein with acute extensive natriuresi s was associated as well as urine potassium loss and hypokalemia produ cing paralysis in 1 episode. During a chronic water loading test, the defect in water excretion was related to a low urine solute delivery w hich was partially reverted by the natriuretic response to plasma volu me expansion, promoting water diuresis. In acute water intoxication, t his natriuretic response was exaggerated, producing a brisk water diur esis. Plasma volume was rapidly normalized but without any improvement in plasma sodium due to the concomitant negative sodium balance. Thus , water diuresis persisted until plasma volume was significantly contr acted. Potassium loss appeared to be related to sodium excretion. Meta bolic disturbances have not reoccurred despite persistent hiccup and p otomania during 2 years of urea therapy.