TY - JOUR
T1 - Massive polyuria and natruresis following relief of urinary tract obstruction
AU - Witte, Marlys H.
AU - Short, Floyd A.
AU - Hollander, Walter
N1 - Funding Information:
There was no history of previous symptoms suggesting genitourinary disorders, venereal disease, diabetes mellitus or tuberculosis and no family history of urinary tract abnormalities. Physical examination revealed a robust, middle-aged, lethargic and irritable man with a uriniferous odor to his breath. Rectal temperature was 99.8O~., radial pulse 72 per minute and blood pressure 200/100 mm. Hg. The skin was dry, with scaly hyperpigmentation of the forearms. There were bilateral subconjunctival hemorrhages, and a single flame-shaped hemorrhage was noted in the left optic fundus. Both nares contained clotted blood, and the tongue was coated. Neck veins were not distended. Sparse bilateral basilar inspiratory rales were heard in the lung fields. The point of maximal cardiac impulse was 2 cm. outside the mid-clavicular line in the fifth intercostal space, and there was a loud, pansystolic apical murmur transmitted to the left axilla and an aortic systolic murmur radiating into the neck. The abdomen was distended, with severe generalized tenderness. A mass, presumed to be the urinary bladder, was percussable and palpable to 5 cm. above the umbilicus, and there was bilateral flank tenderness. The urethral meatus was inflamed. The prostate gland was moderately enlarged, hard and nodular on the left, with obliteration of the left lateral sulcus. No peripheral pitting edema was noted. Deep tendon reflexes were hyperactive, including the bulbocavernosus reflex, and hyperaesthesia was noted over the distribution of the second and third sacral nerves. The packed red cell volume was 25 per cent; hemoglobin concentration was 8.4 gm. per cent; white blood cell, differential and platelet counts were normal. A reticulocyte count was 1 per cent of total red blood cells. Spontaneously voided urine the night of admission had a specific gravity of 1.014 and a pH of 6.0 by phenaphthazine (Nitrazine@) paper and was negative for protein, glucose and acetone; the centrifuged sediment revealed 2 to 3 white blood cells and 3 to 4 red blood cells per high-powered field. The serum urea nitrogen concentration was 245 mg. per cent, the serum total carbon dioxide content 5.5 mM per L., serum chloride concentration *From the Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina. Special studies were supported by Grant H-5155 from the National Institutes of Health, U. S. Public Health Service, Bethesda, Maryland. t Present address: Third and Fourth Medical Divisions, Bellevue Hospital, New York, New York. $ Present address: University Hospital, Seattle, Washington. 8 Markle Scholar in Medical Science at the time of the studies reported here.
PY - 1964/8
Y1 - 1964/8
N2 - A case report is presented which illustrates the massive urinary loss of sodium, chloride and water which occasionally develops after relief of urinary tract obstruction. Astonishingly high rates of solute and water excretion occurred in this particular patient, apparently, at least partly, the result of an unexpectedly high (normal) glomerular filtration rate and almost certainly augmented unnecessarily by the intravenous administration of glucose-containing fluids with consequent glycosuria. The data collected support the conclusion of Bricker et al. [7] that the proximal portion of the nephrons is the principal site of defective sodium reabsorption. During at least one phase of the diuresis, 24 to 36 hours after its onset, renal excretion of sodium and chloride decreased during an intravenous infusion of 9-alpha-fluorohydrocortisone; however, it is not certain that this was a cause and effect relationship. During the same period evidence was obtained which is interpreted as indicating that the renal tubules were responsive to vasopressin but that the usual renal medullary hypertonicity had been eliminated by the massive solute flow through the loops of Henle.
AB - A case report is presented which illustrates the massive urinary loss of sodium, chloride and water which occasionally develops after relief of urinary tract obstruction. Astonishingly high rates of solute and water excretion occurred in this particular patient, apparently, at least partly, the result of an unexpectedly high (normal) glomerular filtration rate and almost certainly augmented unnecessarily by the intravenous administration of glucose-containing fluids with consequent glycosuria. The data collected support the conclusion of Bricker et al. [7] that the proximal portion of the nephrons is the principal site of defective sodium reabsorption. During at least one phase of the diuresis, 24 to 36 hours after its onset, renal excretion of sodium and chloride decreased during an intravenous infusion of 9-alpha-fluorohydrocortisone; however, it is not certain that this was a cause and effect relationship. During the same period evidence was obtained which is interpreted as indicating that the renal tubules were responsive to vasopressin but that the usual renal medullary hypertonicity had been eliminated by the massive solute flow through the loops of Henle.
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U2 - 10.1016/0002-9343(64)90015-4
DO - 10.1016/0002-9343(64)90015-4
M3 - Article
C2 - 14206763
AN - SCOPUS:1842305616
SN - 0002-9343
VL - 37
SP - 320
EP - 326
JO - The American journal of medicine
JF - The American journal of medicine
IS - 2
ER -