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Q J Med 2003; 96: 421-426
© 2003 Association of Physicians

Solute loss plays a major role in polydipsia-related hyponatraemia of both water drinkers and beer drinkers

W. Musch1,2, O. Xhaet1 and G. Decaux2

From the 1Department of Internal Medicine, Bracops Hospital, and 2Research Unit for the Study of Hydromineral Metabolism, Erasme University Hospital, Free University of Brussels, Brussels, Belgium

Received 13 September 2002 and in revised form 10 February 2003

Background: Polydipsia-related hyponatraemia is generally considered an acute dilutional state.

Aim: To determine whether solute loss plays a role in the pathogenesis of polydipsia-related hyponatraemia.

Design: Prospective uncontrolled study

Methods: We studied routine biochemical volume-related parameters before and after 2 l isotonic saline infusion over 24 h, in 10 consecutive hyponatraemic polydipsia patients (mean age 55 ± 11 years; 6 beer drinkers and 4 compulsive water drinkers) with initial urinary osmolality <220 mosm/kg H2O. In five of these patients, we measured balance data over 24 h.

Results: Mean initial plasma protein concentration in the 10 studied polydipsia patients was 7 ± 0.7 g/dl, unexpectedly high for an acute dilutional state. Mean plasma sodium concentration increased from 126 ± 5 mmol/l before saline, to 135 ± 5 mmol/l after infusion of 2 l isotonic saline (p < 0.01). Balance data in five polydipsia patients showed a mean decrease of 1.6 kg of their initial body weight and a mean salt retention of 406 mosm.

Discussion: Polydipsia-related hyponatraemia is a mixed disorder, in which about half of sodium decrease is due to solute loss. This explains the apparent paradox of a normal plasma protein concentration, despite the increase in body weight due to water intoxication.

Address for correspondence to Dr G. Decaux, Research Unit for the study of hydromineral metabolism, Department of General Internal Medicine, University Hospital Erasme, 808 Route de Lennik, 1070 Brussels, Belgium. e-mail: guy.decaux{at}skynet.be


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