Da: Stefano Palazzi <s.palazzi@ausl.fe.it>
A: autismo-biologia@autismo33.it
Inviato: Sab 9 luglio 2011, 12:51:38
Oggetto: Re: [autismo-biologia] diuretic bumetanide
Le note di Liana Baroni e Daniela Mariani Cerati sugli elettroliti nell'autismo richiamano questioni di attualità clinica e scientifica. Fin dalle storiche osservazioni di Jean Itard la sete è descritta nel quadro (o fenotipo) autistico. Anche gli autori psicoanalitici lo notano, aggiungendovi suggestive interpretazioni simboliche sull'acqua e il latte materno. In internet si trova molto su autism+thirst eccetera. Molti "se dicenti" Asperger riferiscono che hanno sempre sete, o che non la sentono per niente. La loro percezione del sistema vegetativo è presumibilmente altrettanto
disordinata quanto quella del sistema sensoriale generale (ipo/iper/dis-estesia). Vi è il filo conduttore del diabete insipido, vasopressina, ossitocina, disfunzione ipotalamica... Ho seguito un episodio psicotico in un ragazzino africano non ancora teenager ricoverato in unità adolescenti, già in trattamento con aripiprazolo, diagnosticato con deficit di vitamina D e sospettato di diabete insipido, risultato positivo all'ADI/ADOS, e infine prelevato dai servizi sociali essendosi segnalate le carenze non solo vitaminiche che aveva subito. Aneddoticamente ricordo inoltre che la figlia di Lorna Wing è deceduta per una complicazione cardiovascolare postmenopausale correlata all'eccessivo bere. Come altri pazienti, anche Susie Wing aveva assunto neurolettici associati a effetti collaterali parasimpatici - sete inclusa.
www.guardian.co.uk/lifeandstyle/2011/may/24/autistic-spectrum-disorder-lorna-wing .
Dell’eccesso di cloruri intraneuronali ipotizzata da Lemonnier non sapevo nulla e ho inoltrato la domanda di Liana Baroni all’autore.
La problematica segnalata da Stefano Palazzi, ovvero la compulsione a bere in modo pericoloso per la salute e addirittura per la vita, mi era nota e, cercando su Pubmed, ho trovato i due lavori seguenti
No To Hattatsu. 1997 Sep;29(5):367-72.
[Two cases of infantile autism with intermittent water intoxication due to compulsive water drinking and episodic release of antidiuretic hormone (SIADH)].
[Article in Japanese]
Hiratani M, Munesue T, Terai
K, Haruki S.
Source
Department of Pediatrics, Center of Developmental Medicine and Education for Handicapped Children, Fukui Prefecture.
Abstract
The syndrome of water intoxication, resulting from dilutional hyponatremia and characterized by lethalgy, confusion, seizures, and coma was seen in two autistic boys living in the institution for mentally retarded children. Patient 1, a 19 year-old autistic boy showed loss of attention, inactiveness, sleepiness and delirium and then followed by overbreathing, severe vomiting and finally convulsive seizures several times, or coma, since October 1985. In August 1988, he was admitted with generalized tonic clonic convulsion associated with frequent vomiting EEG showed diffuse spike and wave complex with slow background activity. Laboratory data showed inappropriately high
serum ADH level (8.5 pg/ml), low sodium concentration (121 mOsm/m/l), serum osmolality (237 mOsm/l) which was lower than urine osmolality (334 mOsm/l), and remarkable body weight gain (8.5 kg). He was diagnosed as water intoxication due to compulsive water drinking and SIADH. Diminished GH secretion to insulin-induced hypoglycemia and exaggerated prolactin response to LHRH stimulation suggested a hypothalamic lesion. Patient 2, a 17-year-old autistic boy, showed essentially the same symptoms and laboratory data as Patient 1, except that he had no epileptic discharge in EEG, and curious GH response to insulin-induced hypoglycemia. A remarkable daily body weight change suggested excessive water drinking and a possible episodic release of ADH. With mild water restriction, this became
smaller. Since Patient 1 had epileptic attacks several times without hyponatremia and his EEG showed epileptic discharges, he was diagnosed as having epilepsy. Patient 2 has been seizure-free until now. Abnormality of hypothalamic or pituitary defects and polydipsia and possibility of water intoxication should always be considered when an autistic patients shows recurrent epileptic attacks or episodic strange behaviors with hyponatremia.
J Behav Ther Exp Psychiatry. 1988 Mar;19(1):57-61.
Behavioral treatment of psychogenic polydipsia.
McNally RJ, Calamari JE, Hansen PM, Kaliher C.
Source
Dept of Psychology, University of Health Sciences, Chicago Medical School, IL 60064.
Abstract
This report describes the behavioral treatment of psychogenic polydipsia in an autistic, severely mentally retarded woman who had a history of self-induced water intoxication. Treatment emphasized the use of edibles and reductions in activity demands to reward water refusal. Employing this procedure, paraprofessional staff normalized the client's water consumption, and thereby prevented further episodes of potentially-fatal water intoxication.