The occurrence of diuresis in humans in stressful situations and its possible relation to the diuresis of early starvation.

It is a common clinical observation that persons involved in stressful situations associated with feelings of anxiety and apprehension may have frequency of urination. Whether this phenomenon is the result of the ingestion of water, reflex irritability of the bladder, or a true polyuria of undetermined origin has not been entirely clear. That stimuli acting through the central nervous system may affect the rate at which the kidney excretes urine is well known. Rydin and Verney (1, 2) have shown that a water diuresis in dogs may be inhibited by the stimulation of afferent nerves or by loud noises. Kelsall (3), Wolf (4), and Odell and Aragon (5) have demonstrated a similar phenomenon in humans in reaction to pain. On the other hand "emotional diuresis" has also been observed experimentally (6). Marx (7), Heilig and Hoff (8), and Hoff and Wermer (9), have reported the induction of diuresis by hypnotic suggestion. Marx later reported (10) that he had succeeded in conditioning one of four dogs to a reflex diuresis after sham drinking. Bykow and Alexejew-Berkmann (11) also reported a conditional reflex diuresis in dogs, and Eagle (12) was able to condition animals to a reflex inhibition of diuresis after the ingestion of water. Anderson (13) observed a soldier with an ureteral fistula from which an increased urine flow could be produced by various "psychic" stimuli, and Rooke (14) stated that he has repeatedly observed an increased flow from ureteral catheters when patients were told to think about drinking beer or tea. Sheba observed that during an eight hour period soldiers, in expectation of going "over the line," excreted as much as 4 liters of urine with a specific gravity near 1.000 (15). A diuresis has been observed to occur in persons with diabetes mellitus under circumstances of environmental stress (16, 17), and it is well known that a transient diuresis accompanies the first stages of a total fast (18, 19). Both of these phenomena are temporally associated with changes in fat and carbohydrate metabolism. The present study concerns the experimental production of a water diuresis in humans during stressful situations. To provide an indication of other metabolic changes occurring at the same time, simultaneous measurements of blood glucose and blood ketone bodies were made throughout the experimental period.