Vieweg W V, Robertson G L, Godleski L S, Yank G R
Western State Hospital, Department of Mental Health and Mental Retardation, Staunton, VA 24401.
Schizophr Res. 1988 Sep-Oct;1(5):351-7. doi: 10.1016/0920-9964(88)90048-5.
Among seven schizophrenic patients subject to water intoxication (six men and one woman, mean age 39.1 +/- 6.9 years), we measured serum sodium, plasma arginine vasopressin, and urine osmolality at 7 a.m. and 4 p.m. on eight consecutive Thursdays. On the days of greatest diurnal change in serum sodium, the 7 a.m. serum sodium was 141.1 +/- 1.8 mEq/l and the 4 p.m. value was 129.9 +/- 3.2 mEq/l. Plasma vasopressin also tended to be lower at 4 p.m. but, in many cases, was inadequately suppressed for the level of hyponatremia. The urine was dilute at both 7 a.m. and 4 p.m. and mean urine osmolality did not differ at the two times. In three patients, urine osmolality was consistently subnormal relative to plasma vasopressin at both 7 a.m. and 4 p.m. This abnormality was consistent with nephrogenic diabetes insipidus secondary to lithium and, possibly, phenytoin which the patients received to protect them against hyponatremia. We conclude that the combination of polydipsia and abnormal osmoregulation of vasopressin secretion contributes importantly to the afternoon hyponatremia found in schizophrenic patients subject to water intoxication.
在七名患有水中毒的精神分裂症患者（六名男性和一名女性，平均年龄39.1±6.9岁）中，我们在连续八个星期四的上午7点和下午4点测量了血清钠、血浆精氨酸加压素和尿渗透压。在血清钠昼夜变化最大的日子里，上午7点的血清钠为141.1±1.8 mEq/L，下午4点的值为129.9±3.2 mEq/L。下午4点时血浆加压素也往往较低，但在许多情况下，对于低钠血症水平而言，其抑制作用不足。上午7点和下午4点时尿液均呈稀释状态，两个时间点的平均尿渗透压无差异。在三名患者中，上午7点和下午4点时相对于血浆加压素，尿渗透压始终低于正常水平。这种异常与锂以及可能与患者为预防低钠血症而服用的苯妥英钠继发的肾性尿崩症一致。我们得出结论，烦渴和加压素分泌的渗透调节异常共同导致了水中毒的精神分裂症患者下午出现低钠血症。
