“WATER DIURESIS” PRODUCED DURING RECUMBENCY BY THE INTRAVENOUS INFUSION OF ISOTONIC SALINE SOLUTION 1

Abstract

Control of renal excretion of water in man is largely vested in the supra-optico-hypophyseal system. When the tonicity of the blood plasma and extracellular fluid rises, an increased secretion of antidiuretic hormone (ADH) leads to the conser-vation of water inasmuch as urinary solutes are excreted with a minimum of water. Conversely, when tonicity falls, a diminution of ADH output permits the excretion of a large volume of dilute urine. In both instances homeostasis is served. Many stimuli, in addition to hypertonicity, in-crease ADH production, including certain anaes-thetic (1) and narcotic drugs (2), barbiturates (3), smoking (4, 5) and nicotine (6, 7), acetyl-choline (8), exercise (9), emotion (9), syncope (10), pain (11) and conditioned reflexes (11), as well as the direct electrical (12) or acetylcholine (13) stimulation of nerve cells and fibers con-nected with the pars nervosa of the pituitary gland. Removal of amounts of blood insufficient to alter blood pressure significantly may nevertheless lead to increased ADH activity (9). There is also suggestive evidence that there may at times be in-creased ADH activity in patients with cirrhosis of the liver (14, 15). In contrast to the many factors which may lead to increased antidiuretic activity few other than destructive lesions involving the supra-optico-hy-pophyseal system and hypotonicity of the plasma and extracellular fluid have been reported to cause a decline in ADH activity. These are hypnotic suggestion (1), alcohol administration (16-18), and exposure to cold (19).