Altered water metabolism in tuberculosis: Role of vasopressin

Complexity of Differentiating Cerebral-Renal Salt Wasting from SIADH, Emerging Importance of Determining Fractional Urate Excretion

“…(Wall, 1993) They are typically untreated, but this approach poses a therapeutic dilemma because of our tendency to treat most if not all hyponatremics. (DeFronzo et al, 1976;Decaux et al, 2009;Elisaf et al, 1990;Hill et al, 1990;Kahn, 2003) We encountered 3 patients with hyponatremia and normal FEurate, who were noted to excrete urines with Uosm < 200 mosm/kg, that was consistent with RO. Based on these findings, we decided to perform water-loading tests in nonedematous hyponatremic patients with normal FEurates without a dilute urine in a randomly collected urine, regardless of UNa or serum urate.…”

Ticks and salt: an atypical case of neuroborreliosis

“…This is when the brain resets its osmostat to maintain serum sodium at a lower concentration than normal, and is facilitated by increased release of ADH [11]. Reset osmostat has been reported in diseases like tuberculosis and malaria [12,13]. In 1995, Patwari et al studied 60 children diagnosed with bacterial meningitis and demonstrated that approximately 35% were diagnosed with SIADH and that the diagnosis was associated with severe meningeal inflammation [14].…”

Chronic Hyponatremia Due to Reset Osmostat in a Patient with Colon Cancer

“…More over, despite hypoosmolality, our patient was asymptom atic like the majority of patients with this syndrome. The absence of symptoms is due to the ability of the brain to alter the solute content in order to maintain a normal cell volume in the presence of chronic hypoosmolality [9,10], Reset osmostat is a variant of the syndrome of inappro priate ADH secretion, presenting in approximately one third of these patients [8], but may occur in several other conditions such as hypovolemic states, quadriplegia, psy chosis, pregnancy, and other chronic debilitating illnesses, including tuberculosis, encephalitis, and malnutrition [5,8,[11][12][13][14], In our patient, the exclusion of the other causes confirmed the diagnosis of the reset osmostat variant of the syndrome of inappropriate ADH secretion, although a test for the detection of a low osmotic threshold for ADH release was not performed. Even though the reset osmo stat variant of this syndrome occurs less frequently than the syndrome of inappropriate ADH secretion owing to ectopic ADH secretion as a manifestation of cancer, it has been suggested that a thorough investigation for the un-masking of an underlying malignancy should be undertak en in all cases [6].…”