Pediatric Nephrology

, Volume 3, Issue 4, pp 438–442 | Cite as

Recurrent hypertonic dehydration due to selective defect in the osmoregulation of thirst

  • Farahnak K. Assadi
  • Barbara Johnston
  • Mark Dawson
  • Bin Sung
Original Article


A 6-year-old girl with recurrent episodes of hypertonic dehydration was studied. She denied thirst even with a plasma osmolality as high as 421 mosmol/kg. The hypernatremia was associated with an ability to concentrate urine (854 mosmol/kg). Volume expansion with water corrected hypernatremia (162 to 148 mEq/l) and resulted in an increased urine flow and urinary dilution (137 mosmol/kg) because of suppression of endogenousvasopressin (AVP) release (5.1 pg/ml). Hypertonic saline infusion raised the plasma AVP level (25.6 pg/ml) in response to changes in plasma osmolality (305 to 330 mosmol/kg) and led to a maximal urine osmolality of 818 mosmol/kg. With chronic forced fluid intake, the patient maintained a normal resum sodium concentration (range, 135–145 mEq/l) with a urine osmolality as low as 65 mosmol/kg. These findings are consistent with an isolated defect in the osmoregulation of thirst as the cause of the chronic hypertonic dehydration without deficiency in AVP secretion.

Key words

Hypodipsia Hypernatremia Hyperosmolality Osmoreceptors Arginine vasopressin 


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Copyright information

© IPNA 1989

Authors and Affiliations

  • Farahnak K. Assadi
    • 1
  • Barbara Johnston
    • 1
  • Mark Dawson
    • 1
  • Bin Sung
    • 1
  1. 1.Department of PediatricsUniversity of Illinois HospitalChicagoUSA

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