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The Journal of pediatrics · Dec 1976
Case ReportsRecurrent hypernatremia; a proposed mechanism in a patient with absence of thirst and abnormal excretion of water.
- S B Conley, J T Brocklebank, I T Taylor, and A M Robson.
- J. Pediatr. 1976 Dec 1; 89 (6): 898-903.
AbstractA 7-year-old girl twice developed severe hypernatremia (serum sodium values up to 194 mEq/l) without obvious cause. The ability of her kidneys to conserve water was normal, and increasing her plasma osmolality stimulated an appropriate ADH response. Unable to excrete a water load, her kidneys continued to conserve water even with a serum sodium concentration of 133 mEq/l. She was never thirsty and did not ingest sufficient fluid by choice. Although there was no demonstrable anatomic lesion, we postulate a localized defect of her thirst center. This may have modified release of ADH and resulted in an inability to dilute the urine by interrupting a pathway that could exist from the thirst center to the supraoptic nuclei. A therapeutic regimen based on these studies has prevented further hypernatremia.
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