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Original communication| Volume 31, ISSUE 5, P654-669, May 1952

Observations on water intoxication in surgical patients

DOI:https://doi.org/10.5555/uri:pii:0039606052902304
Observations on water intoxication in surgical patients
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      Abstract

      Seventeen instances of convulsive seizures following surgical operations and characterized by dilution of the extracellular electrolytes are reported. In all but one of these the convulsions occurred between 12 and 48 hours after the operation. In most instances, strongly positive fluid balance was demonstrable by the intake and output data and the change in body weight. The mechanisms of water intoxication are discussed in the light of previously reported experimental findings and the physiologic peculiarities of the postoperative patient.
      It is concluded that most complications of this nature could be prevented by the avoidance of excessive amounts of glucose solution at the time of surgery and through the days immediately following surgery. Daily estimations of the body weight and determinations of serum electrolyte levels before actual disturbances develop should make it possible to take measures to prevent this complication before it occurs. Hypertonic saline solution has been of great value in rapidly restoring the normal salt-water relationship of the extacellular fluid once seizures have occurred.
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      References

        • Ariel I.M.
        • Abels J.C.
        • Pack G.T.
        • Rhoads C.P.
        The Treatment of Hypochloremia Refractory to the Administration of Sodium Chloride, Especially in Patients With Gastrointestinal Cancer.
        J. A. M. A. 1943; 123: 28
        • Ariel I.M.
        • Kremen A.J.
        • Wangensteen O.H.
        An Expanded Interstitial (Thiocyanate) Space in Surgical Patients.
        Surgery. 1950; 27: 827
        • Ariel I.M.
        • Miller F.
        The Effects of Hypochloremia Upon Renal Function.
        Surgery. 1950; 28: 552
        • Barahal H.S.
        Water Intoxication in a Mental Case.
        Psych. Quart. 1938; 12: 767
        • Bristol W.R.
        The Relation of Sodium Chloride Depletion to Urine Excretion and Water Intoxication.
        Am. J. M. Sc. 1951; 221: 412
        • Coller F.A.
        • Bartlett R.M.
        • Bingham D.C.L.
        • Maddock W.G.
        • Pedersen S.
        Replacement of Sodium Chloride in Surgical Patients.
        Ann. Surg. 1938; 108: 769
        • Coller F.A.
        • Campbell K.N.V.
        • Vaughn H.H.
        • Iob L.V.
        • Moyer C.A.
        Postoperative Salt Intolerance.
        Ann. Surg. 1944; 119: 533
        • Coller F.A.
        • Iob V.
        • Vaughn H.H.
        • Talden N.
        • Moyer C.
        Translocation of Fluid Produced by the Intravenous Administration of Isotonic Salt Solutions in Man Postoperatively.
        Ann. Surg. 1945; 122: 663
        • Dunger R.
        Eine einfache Methode der Zahlung der eosinophilen Leukozyten und praktische Wert dieser Untersuchung.
        München med. Wchnschr. 1910; 57: 1942
        • Fay T.
        Some Factors in the “Mechanical Theory of Epilepsy” With Especial Reference to the Influence of Fluid and Its Control in the Treatment of Certain Cases.
        Am. J. Psychiat. 1929; 8: 783
        • Gaunt R.
        Protection of Normal Rats Against Death From Water Intoxication With Adrenal Cortical Substances.
        in: Proc. Soc. Exper. Biol. & Med. 54. 1943: 19
        • Gaunt R.
        Water Diuresis and Water Intoxication in Relation to the Adrenal Cortex.
        Endocrinol. 1944; 34: 400
        • Gaunt R.
        • Birnie J.H.
        Hormones and Body Water.
        Charles C Thomas, Publisher, Springfield, Ill1951
        • Gaunt R.
        • Birnie J.H.
        • Eversole W.J.
        Adrenal Cortex and Water Metabolism.
        Physiol. Rev. 1949; 29: 281
        • Gaunt R.
        • Remington J.W.
        • Schweizer M.
        Some Effects of Intraperitoneal Glucose Injections and Excess Water in Normal Adrenalectomized and Hypophysectomized Rats.
        Am. J. Physiol. 1937; 120: 532
        • Greene C.H.
        • Rowntree L.G.
        Changes in Concentration of the Blood Following the Administration of Excessive Quantities of Water.
        Am. J. Physiol. 1924; 68: 111
        • Greene C.H.
        • Rowntree L.G.
        The Effect of the Experimental Administration of Excessive Water on the Volume and Concentration of the Blood.
        Am. J. Physiol. 1927; 80: 209
        • Greene C.H.
        • Rowntree L.G.
        The Effect of the Administration of Excessive Amounts of Water on Body Temperature.
        Am. J. Physiol. 1927; 80: 230
        • Harding V.J.
        • Harris L.J.
        Urea Administration in Water Intoxication.
        Tr. Roy. Soc. Canada (Sect. V, Biol. Sc.). 1930; 24: 101
        • Hays H.W.
        • Mathieson D.R.
        Water Intoxication in Adrenalectomized Rats and Influence of Desoxycorticosterone Acetate (DCA) and Epinephrine in Water Diuresis.
        Endocrinol. 1945; 37: 147
        • Helwig F.C.
        • Schutz C.B.
        • Curry D.E.
        Water Intoxication: Report of a Fatal Case With Clinical Pathological and Experimental Studies.
        J. A. M. A. 1935; 104: 1569
        • Helwig T.C.
        • Schutz C.B.
        • Kuhn H.P.
        Water Intoxication.
        J. A. M. A. 1938; 110: 644

      23. Hippocrates: On the Sacred Disease, in Adams, F.: The Genuine Works of Hippocrates, New York, William Wood & Company.

        • Holmes J.H.
        Studies of Water Exchange in Dogs With Reduced Serum Electrolyte Concentration.
        Am. J. Physiol. 1940; 129: 384
        • Howlett J.
        • Browne J.S.L.
        Studies on Water Balance in the Alarm Reaction.
        Canad. M. A. J. 1937; 37: 288
        • Jones C.M.
        • Eaton F.B.
        Postoperative Nutritional Edema.
        Arch. Surg. 1933; 27: 659
        • Laragh J.H.
        • Almy T.P.
        Changes in Circulating Eosinophils in Man Following Epinephrine, Insulin, and Surgical Operations.
        in: Proc. Soc. Exper. Biol. & Med. 69. 1948: 499
        • Leriche R.
        La maladie postopératoire.
        Lyon chir. 1934; 31: 627
        • Lesage A.R.
        Histoire de Gil Blas de Santillane.
        1668–1747
        • Luetscher J.A.
        • Blackman Jr., S.S.
        Severe Injury to Kidneys and Brain Following Sulfathiazole Administration. High Serum Sodium Levels and Persistent Brain Damage.
        Ann. Int. Med. 1943; 18: 41
        • Lyon R.P.
        • Stanton J.R.
        • Freis E.D.
        • Smithwick R.H.
        Blood and “Available Fluid” (Thiocyanate) Volume Studies in Surgical Patients.
        Surg., Gynec. & Obst. 1949; 89: 9
        • Marriott H.L.
        Water and Salt Depletion.
        Charles C Thomas, Publisher, Springfield, Ill1950
        • McInnes G.F.
        • Bodansky O.
        • Brunschwig A.
        Blood Volume and Blood Biochemical Studies in Patients Undergoing Radical Surgery.
        Surg., Gynec. & Obst. 1950; 91: 323
        • McQuarrie I.
        Epilepsy in Children. The Relationship of Water Balance to the Occurrence of Seizures.
        Am. J. Dis. Child. 1929; 38: 451
        • McQuarrie I.
        Some Contributions of Bio-chemistry to the Study of Epilepsy.
        J. Chem. Ed. 1933; 10: 205
        • McQuarrie I.
        • Anderson J.A.
        • Ziegler M.R.
        The Antagonistic Effects of Posterior Pituitary and Cortico-Adrenal Hormones in the Epileptic Subject.
        J. Clin. Endocrinol. 1942; 2: 406
        • McQuarrie I.
        • Manchester R.C.
        • Husted C.
        Study of Water and Mineral Balances in Epileptic Children. I. Effects of Diuresis, Catharsis, Phenobarbital Therapy and Water Storage.
        Am. J. Dis. Child. 1932; 43: 1519
        • McQuarrie I.
        • Peeler D.B.
        The Effects of Sustained Pituitary Antidiuresis and Forced Water Drinking in Epileptic Children. A Diagnostic and Etiologic Study.
        J. Clin. Invest. 1931; 10: 915
        • Moyer C.A.
        Fluid and Electrolyte Balance.
        Surg., Gynec. & Obst. 1947; 84: 586
        • Moyer C.A.
        Acute Temporary Changes in Renal Function Associated With Major Surgical Procedures.
        Surgery. 1950; 27: 198
        • Peters J.P.
        • Van Slyke D.D.
        Quantitative Clinical Chemistry. Vol. II. Williams and Wilkins Company, Baltimore, Md1932: 557
        • Peters J.P.
        • Van Slyke D.D.
        Ed. 4. Quantitative Clinical Chemistry. Vol. II. Williams and Wilkins Company, Baltimore, Md1932: 834
        • Randolph T.C.
        Blood Studies in Allergy. I. The Direct Counting Chamber Determination of Eosinophils by Propylene-Glycol-Aqueous Stains.
        J. Allergy. 1944; 15: 86
        • Recant L.
        • Hume D.M.
        • Forsham P.H.
        • Thorn G.W.
        Effect of Epinephrine on the Pituitary Adrenocortical System.
        J. Clin. Endocrinol. 1950; 10: 187
        • Roche M.
        • Thorn G.W.
        • Hills A.G.
        The Levels of Circulating Eosinophils and Their Response to ACTH in Surgery.
        New England J. Med. 1950; 242: 307
        • Rowntree L.G.
        Water Intoxication.
        Arch. Int. Med. 1923; 32: 157
        • Rowntree L.G.
        The Effect on Mammals of the Administration of Excessive Quantities of Water.
        J. Pharmacol. & Exper. Therap. 1926; 29: 135
        • Schales O.
        • Schales S.
        A Simple and Practical Method for the Determination of Chloride in Biological Fluids.
        J. Biol. Chem. 1941; 140: 879
        • Selye H.
        Blood Sugar and Blood Chloride Changes During the Alarm Reaction.
        Am. J. Physiol. 1938; 122: 347
        • Smyth F.S.
        • Deamer W.C.
        • Phatak N.M.
        Studies in So-called Water Intoxication.
        J. Clin. Investigation. 1933; 12: 55
        • Swingle W.W.
        • Remington J.W.
        • Hays H.W.
        • Collings W.D.
        The Effectiveness of Priming Doses of Desoxycorticosterone in Protecting the Adrenalectomized Dog Against Water Intoxication.
        Endocrinol. 1941; 28: 531
        • Underhill F.P.
        • Sallick M.A.
        On the Mechanism of Water Intoxication.
        J. Biol. Chem. 1925; 63: 61
        • Wangensteen O.H.
        Controlled Administration of Fluid to Surgical Patients, Including Description of Gravimetric Methods of Determining Status of Hydration and Blood Loss During Operation.
        Minnesota Med. 1942; 25: 783
        • Wangensteen O.H.
        Care of the Patient Before and After Operation.
        New England J. Med. 1947; 236: 121
        • Weir J.F.
        • Larson E.E.
        • Rowntree L.G.
        Studies in Diabetes Insipidus, Water Balance, and Water Intoxication, Study I.
        Arch. Int. Med. 1922; 29: 306
        • Wilkinson B.M.
        • McCance R.A.
        The Secretion of Urine in Rats During Experimental Salt Deficiency.
        Quart. J. Exper. Physiol. 1940; 30: 249
        • Ziegler M.R.
        • Anderson J.A.
        • McQuarrie I.
        Effects of Desoxycorticosterone Acetate on Water Electrolyte Content of Brain and Other Tissues.
        in: Ed. 4. Proc. Soc. Exper. Biol. & Med. 56. 1944: 242
        • Zimmermann B.
        Endocrine Factors Concerned in Postoperative Electrolyte Changes.
        in: Surgical Forum. W. B. Saunders Company, Philadelphia1950: 447

      59. Zimmermann, B., and Freier, E. F.: The Occurrence in Surgical Patients of Severe Hypernatremia Without Exogenous Dehydration, Surgery. To be published.

      Article info

      Publication history

      Received: September 18, 1951

      Footnotes

      ☆This work was supported in part by a grant from the Office of Naval Research, Division of Medical Sciences—Contract N8onr-66210.

      Identification

      DOI: https://doi.org/10.5555/uri:pii:0039606052902304

      Copyright

      © 1952 Published by Elsevier Inc.

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