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Reset Osmostat in a Healthy Patient

Joshua H. Lipschutz, MD; and Allen I. Arieff, MD
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From the Veterans Administration Medical Center, University of California at San Francisco, San Francisco, California. Requests for Reprints: Joshua H. Lipschutz, MD, Division of Nephrology, University of California, San Francisco, Box 0532, Room 1065 HSE, San Francisco, CA 94121. Acknowledgment: The authors thank Dr. David Lovett for referring this patient and Jenifer Schaten for assisting in manuscript preparation. Grant Support: In part by the research service of the Veterans Administration Medical Center, San Francisco, California; grant RO1AG08575 from the National Institute of Aging; and Academic Nephrology Training grant DK07219 from the Academic Nephrology Training Program from the National Institute of Diabetes and Digestive and Kidney Disease, Bethesda, Maryland.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1994;120(7):574-576. doi:10.7326/0003-4819-120-7-199404010-00007
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Reset osmostat is a rare condition in acutely ill patients with severe pulmonary [12], neurologic [34], or malignant processes [5]. When hyponatremia occurs because of “reset osmostat,” renal concentrating and diluting capacities are normal but the regulation of arginine vasopressin to maintain serum tonicity takes place at a lower osmolal threshold.

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Figure 1.
A healthy man with reset osmostat.Top left.2Top right.Bottom left.

Changes in the urinary osmolality and the plasma arginine vasopressin (AVP) level during the course of the water (H O) load. Changes in the urinary osmolality and the serum osmolality during the entire course of the water and hypertonic saline (3% NaCl) load. Changes in the urinary osmolality and the plasma arginine vasopressin level during the water deprivation test.

Grahic Jump Location




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