Thompson C J, Edwards C R, Baylis P H
Department of Medicine, Western General Hospital, Edinburgh, UK.
Clin Endocrinol (Oxf). 1991 Sep;35(3):221-8. doi: 10.1111/j.1365-2265.1991.tb03526.x.
To examine the osmotic and non-osmotic regulation of thirst and AVP release in patients with compulsive water drinking.
A 2-hour intravenous infusion of hypertonic (855 mmol/l) sodium chloride solution, followed by a 2-hour drinking period.
Seven patients with compulsive water drinking, seven patients with diabetes insipidus and seven healthy controls.
Plasma AVP, osmolality, sodium and haematocrit, thirst ratings on a visual analogue scale and the volume of water drunk in 2 hours following infusion.
Plasma AVP responses to osmotic stimulation, and non-osmotic inhibition by drinking, were normal in patients with compulsive water drinking. Basal thirst ratings were higher in compulsive water drinking than in either diabetes (P less than 0.001) or controls (P less than 0.001), despite lower basal plasma osmolalities. There was a significant rise in thirst ratings during saline infusion, which correlated closely with plasma osmolality, in all three groups, but the final thirst ratings were higher in compulsive water drinkers, who subsequently drank more water than in either diabetes insipidus (P less than 0.01) or controls (P less than 0.001). Drinking rapidly lowered thirst ratings in controls and diabetes insipidus before changes occurred in plasma osmolality, but remained elevated in patients with compulsive water drinking. Linear regression analysis defined a lower osmotic threshold for thirst in compulsive water drinking compared with controls or diabetes insipidus.
There are abnormalities of the osmotic stimulation and non-osmotic inhibition of thirst in compulsive water drinking, suggesting that the underlying defect is one of interpretation of osmotic and non-osmotic inputs. Measurement of thirst responses during hypertonic saline infusion and subsequent water drinking may provide useful diagnostic information in the differentiation of polyuric states.
研究强迫性饮水患者口渴及抗利尿激素（AVP）释放的渗透调节和非渗透调节。
静脉输注高渗（855 mmol/l）氯化钠溶液2小时，随后进行2小时饮水期。
7例强迫性饮水患者、7例尿崩症患者和7例健康对照者。
血浆AVP、渗透压、钠和血细胞比容，视觉模拟量表的口渴评分以及输注后2小时内的饮水量。
强迫性饮水患者血浆AVP对渗透刺激的反应以及饮水引起的非渗透抑制均正常。尽管基础血浆渗透压较低，但强迫性饮水患者的基础口渴评分高于尿崩症患者（P<0.001）和对照组（P<0.001）。在所有三组中，输注生理盐水期间口渴评分均显著升高，且与血浆渗透压密切相关，但强迫性饮水者的最终口渴评分更高，随后其饮水量也多于尿崩症患者（P<0.01）和对照组（P<0.001）。在血浆渗透压发生变化之前，饮水迅速降低了对照组和尿崩症患者的口渴评分，但强迫性饮水患者的口渴评分仍保持升高。线性回归分析表明，与对照组或尿崩症患者相比，强迫性饮水患者口渴的渗透阈值更低。
强迫性饮水患者在口渴的渗透刺激和非渗透抑制方面存在异常，提示潜在缺陷在于对渗透和非渗透输入的解读。在输注高渗盐水及随后饮水期间测量口渴反应，可能为多尿状态的鉴别提供有用的诊断信息。
