Studies in So-called Water Intoxication.

Water retention and hydremia have attracted considerable attention in the last decade. In 1921 Miller and Williams (1) reported observations on three patients with hypertension and nephritis who were given 5 to 10 liters of water in 24 hours by Rehfuss tube. Two of these patients developed headache, dizziness, general depression, increased blood pressure and cramps in the legs. The third patient developed no such symptoms presumably because of extremely rapid elimination of water by the kidneys. The following year (1922) Weir, Larson and Rowntree (2) reported observations on patients with diabetes insipidus. In these patients urination had been suppressed with pituitary extract while they continued to take their customary large amounts of fluid. Headache, nausea and vomiting resulted. Further observations were carried out on animals. Asthenia, salivation, vomiting, tremor, muscular twitching, ataxia, convulsions, coma and death occurred when large amounts of distilled water were given by stomach tube, both with and without pituitary injections. Dilution of the blood could not be demonstrated in either the patients with diabetes insipidus or in the experimental animals. The total nitrogen and chloride content of the plasma usually decreased slightly after the onset of symptoms. These investigators failed to find an explanation of the symptoms in edema of the brain, increase in blood volume or significant blood pressure change. Rowntree (3) continued the investigation and in 1923 reported that the syndrome of water intoxication had been produced in dogs, cats, rabbits and guinea pigs. He found that intravenous salt solution prevented as well as cured the syndrome, which could not be produced by rectal administration of water or by an equal amount of normal saline given orally. An increased intracranial pressure was demonstrated in one animal at the time symptoms developed and a subsequent autopsy showed what was considered to be "increase of fluid within the brain substance." Rowntree concluded that "water intoxication is accompanied by, and is probably due to, increased intracranial pressure; this in turn is probably a manifestation of disturbance in the water-salt equilibrium of the central nervous system." About the same time Moss (4) in England described the loss of large amounts of chloride in colliers by sweating. The miner's cramp which sometimes developed in these men, he attributed to this loss and the coincident excessive water intake. He was able to prevent cramp and fatigue associated with it by the administration of chloride.