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July 5, 1971

Toxic Psychosis Following Nondialytic Therapy of Chronic Renal Failure

Author Affiliations

From the Department of Medicine, Harvard Medical School and the Peter Bent Brigham Hospital, Boston. Dr. Merrill is an investigator, Howard Hughes Medical Institute. Lt Col Ockner is with the US Air Force Medical Center, Scott AFB, Ill.

JAMA. 1971;217(1):74-76. doi:10.1001/jama.1971.03190010056016

The clinical status of two patients with chronic renal failure had deteriorated because of protracted vomiting. Intravenous repletion of fluids and electrolytes produced a marked improvement in uremic symptoms and azotemia. However, within two and four days, respectively, of this improvement, transient toxic psychosis occurred. The pathogenesis of this psychosis was felt to be similar to that responsible for the striking central nervous system symptoms which frequently occur in association with dailysis or spontaneously during the diuretic phase of acute renal failure.