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Normal Diluting Capacity in Hyponatremic Patients: Reset Osmostat or a Variant of the Syndrome of Inappropriate Antidiuretic Hormone Secretion

RALPH A. DeFRONZO, M.D.; MARTIN GOLDBERG, M.D.; F.A.C.P.; and ZALMAN S. AGUS, M.D.
[+] Article and Author Information

Grant support: by Research Grant HL-00340 from the National Heart and Lung Institute; and by Training Grant AM-05634 from the National Institute of Arthritis, Metabolic and Digestive Diseases. Doctor Agus is a Clinical Investigator of the Veterans Administration.

▸Requests for reprints should be addressed to Zalman S. Agus, M.D., Renal Electrolyte Section, 860 Gates Bldg., Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104.


Philadelphia, Pennsylvania


Ann Intern Med. 1976;84(5):538-542. doi:10.7326/0003-4819-84-5-538
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Four patients with chronic illnesses and stable hyponatremia and plasma hypotonicity had normal urinary diluting capacity, with excretion of > 80% of a standard water load (20 ml/kg) within 4 hours and maintenance of a urine osmolality < 100 mosmol/kg, during sustained water diuresis. Administration of a chronic salt load did not correct the hyponatremia. However, it was stabilized after treatment of the underlying medical condition. These subjects may represent a true resetting of the osmostat or a variant of the syndrome of inappropriate antidiuretic hormone secretion.

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