Annals of Rehabilitation Medicine

Nocturnal Polyuria Developed in Patients with Central Pontine Myelinolysis: A case report.: Lee, Kwang Lae , Yim, Yoon Myung , Lim, Oh Kyung , Lee, Ju Kang , Bae, Keun Hwan , Kim, Sung Hwan , Choi, Chung Hwan , Jeong, Jeom Sun; J Korean Acad Rehabil Med 2007;31(3):356-360.

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Central pontine myelinolysis is a demyelinating disease of central pons. Nocturnal polyuria is defined as increased urination during nighttime with a nocturnal fraction exceeding from 20% to 33%. We have experienced nocturnal polyuria developed in two patients with central pontine myelinolysis. In these cases, serum antidiuretic hormone and urine osmolality were lower at nighttime than daytime. It suggests that nocturnal polyuria is caused by abnormal diurnal variation of antidiuretic hormone. In the first case, nocturnal polyuria was recovered spontaneously and also follow up brain MRI showed decreased signal intensity in pons. In the second case, nocturnal polyuria was improved after the treatment of intranasal desmopressin. It appeares that central pontine myelinolysis can cause nocturnal polyuria due to the interruption of antidiuretic hormone pathway. The symptom of nocturnal polyuria can be treated by desmopressin. (J Korean Acad Rehab Med 2007; 31: 356-360)

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The Effect of Demeclocycline on the Management of Syndrome of Inappropriate Secretion of Antidiuretic Hormone in Brain Injured Patient.: Jeon, Hyangbae , Kim, Hyundong; J Korean Acad Rehabil Med 2003;27(3):438-441.

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The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a frequent complication of severe head trauma. Fluid restriction is treatment choice of SIADH in patients with traumatic brain injury (TBI), but fluid restriction is limited because they need sufficient calories. We described a patient who, on the four months after a head injury, presented with deterioration of consciousness, which coincided with the development of the SIADH, and which rapidly reversed with the correction of the hyponatremia by demeclocycline with minimal fluid restriction. We suggest that SIADH should be included in the differential diagnosis of deterioration of consciousness during the recovery period of the patients suffering from head injury because unexpected clinical deterioration may often have a reversible cause. Also, demeclocycline will be useful, which allows for increased fluid liberalization and for provision of adequate calories, in the treatment of the SIADH in patients with TBI. (J Korean Acad Rehab Med 2003; 27: 438-441)

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Transient Pancytopenia and SIADH associated with Administration of Carbamazepine.: Jeong, Ho Joong , Kim, Ghi Chan , Chung, Heung Chae , Roh, Kyung Hwan; J Korean Acad Rehabil Med 2001;25(1):173-176.

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Carbamazepine is widely used to manage of seizures and symptomatic treatment of trigeminal neuralgia and central pain.

We experienced two cases of exceedingly rare but potentially fatal side effects following carbamazepine administration. One traumatic brain injured patient developed pancytopenia 3 weeks after beginning to take carbamazepine for prophylactic management of seizure and the other C6 incomplete spinal cord injured patient receiving carbamazepine for the management of central pain sequentially developed syndrome of inappropriate secretion of antidiuretic hormone (SIADH) 1 week after administration.

Because of more frequent indications of carbamazepine, these side effects must be borne in mind and cautious administration will be desirable.

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Relationship between Nocturnal Polyuria and Antidiuretic Hormone in Chronic Spinal Cord Injury.: Yu, Ji Yeon , Shin, Kyeong Ho , Kim, Jeong Tae , Bae, Ji Hyae , Park, Yeong Ok , Cho, Young Jin; J Korean Acad Rehabil Med 1999;23(5):961-967.

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Objective: To delineate the role of antidiuretic hormone (ADH) in relation to nocturnal polyuria, and to identify the factors influencing on the diurnal antidiuretic hormone level.

Method: The ADH was measured by radioimmuoassay at daytime (2:00 PM) and at nighttime (2:00 AM) with nocturnal polyuria group (11) and without nocturnal polyuria group (8). Urine volume, serum osmolarity, urine osmolarity, and blood pressure were also measured at the same time.

Results: 1) The ADH at 2:00 AM did not increase in nocturnal polyuria group, although it increased in no-symptom group. 2) There was a statistically significant correlation between wheelchair ambulation time and daytime ADH level. 3) The difference of ADH level between daytime and nighttime showed decrease in orthostatic hypotension group.

Conclusion: There was relationship between nocturnal polyuria and diurnal variation of ADH level. The ADH concentration seems to be influenced by the postural factors and sympathetic factors.

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The Relation between Nocturnal Polyuria and Diurnal Variation of the ADH in Patients with Cervical Cord Injury.: Kang, Dae Soo , Lee, Eon Seok , Han, Myung Seok , Kwon, Ho Jung , Park, Dong Sik; J Korean Acad Rehabil Med 1999;23(4):744-748.

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Objective: It was reported that nocturnal polyuria in cervical cord injured patients may be due to attenuation of diurnal variation of antidiuretic hormone (ADH) level. However, it has been unclear whether the attenuation of diurnal variation of ADH level caused nocturnal polyuria and bladder overdistension. To improve the management of neurogenic bladder with overdistension during the night, we investigated whether the attenuation of diurnal variation of ADH level is the cause of nocturnal polyuria or bladder overdistens-ion in patients with cervical cord injury.

Method: The subjects consisted of 17 patients with cervical cord injury. The age distribution ranged from 31 to 63 years with an average of 41.5 years. The duration of illness ranged from 5 months to 4 years. Oral intake was restricted below 2,000 ml per day. We measured urine volume and urine osmolarity during the day (8 AM∼8 PM) and night period (8 PM∼8 AM) and the level of plasma ADH and serum osmolarity at 2 PM and 2 AM.

Results: Plasma ADH level was 0.81⁑0.51 pg/ml during the day and 1.04⁑0.65 pg/ml during the night (p=0.17). Urine volume was 1050⁑410 ml during the day and 970⁑550 ml during the night (p=0.92). The average of urine osmolarity was 450.4⁑182.8 mosm during the day and 558.4⁑359 mosm during the night (p=0.25). The average of serum osmolarity was 292.4⁑14.5 mosm during the day and 290.4⁑9.3 mosm during the night (p=0.53).

Conclusion: This study showed that there was no significant difference in each parameter for two periods and urine volume was not increased in spite of attenuation of diurnal variation of ADH level. Therefore this indicated that attenuation of diurnal varia-tion of ADH was less likely responsible for nocturnal polyuria in patients with cervical cord injury.