Book Review

Clinical Disturbances of Water Metabolism

N Engl J Med 1994; 330:1910June 30, 1994

Article

Clinical Disturbances of Water Metabolism
Edited by Donald W. Seldin and Gerhard Giebisch. 305 pp., illustrated. New York, Raven Press, 1993. $150. ISBN: 0-7817-0102-3

No two electrolyte disorders engender more controversy or provoke more intense anxiety on the part of medical students, house officers, and practicing physicians than hyponatremia and hypernatremia. These disorders are no longer of interest only to the nephrologist. Rather, the quest to understand these complex perturbations in water metabolism and to treat them optimally requires the joint efforts of neurologists, endocrinologists, physiologists, and mathematicians. Clinical Disturbances of Water Metabolism is thus an ideal forum to bring together representatives of each of these specialties to blend their expertise in elucidating the pathogenesis and clinical consequences of changes in plasma tonicity and their correction. The diversity of the contributors suggests the strong point of this book but may also account for its minor shortcomings.

The book has three main sections. The first details the normal physiologic mechanisms that maintain intracellular and extracellular body-water compartments. The chapters in this section are a review of the regulation of cell volume, with emphasis on osmolyte changes in response to extracellular tonicity; a critical analysis of renal clearance techniques to estimate free-water handling by the kidney; a discussion of the physiology of thirst and secretion of antidiuretic hormone; an analysis of the countercurrent mechanisms in the kidney; and an overview of the physiology of renal osmolyte regulation. Each chapter is detailed and comprehensive, with particular emphasis on the molecular aspects of water metabolism. The sections on countercurrent exchange and volume control are particularly well done.

The second section focuses on the pathogenesis, clinical manifestations, and treatment of the various clinical disorders of water metabolism that cause hyponatremia or hypernatremia. The chapters in this section are comparable in detail to those in the first section of the book. The authors clearly outline their views on the acceptable rate of correction for hyponatremia and hypernatremia and present an objective analysis of the controversial issues. There are detailed reviews of the evaluation and treatment of central and nephrogenic diabetes insipidus and other polyuric states and of the effects of hyperglycemia on body-fluid composition and volume. The final section of the book consists of a single chapter, which briefly summarizes the most important topics covered in the first and second sections.

The few shortcomings of this ambitious book do not prevent it from successfully covering a most difficult subject. However, further editing in future editions might produce a treatise that is more easily read and reduce the need to scan several overlapping chapters to obtain the full presentation of some disorders. Although repetition is understandable in a multiauthored book such as this, the regulation of antidiuretic hormone is repeatedly reviewed. At least three separate chapters use the same graphs, each reprinted from a different source, to demonstrate the response of antidiuretic hormone to changes in osmolarity. The reader could have been referred back to the original chapter on the physiology of antidiuretic hormone rather than forced to wade through redundant reviews by several contributors. The index highlights this problem. It has separate listings for antidiuretic hormone and arginine vasopressin, with citations to different chapters of the book for essentially the same reviews. There is also redundancy between supposedly distinct chapters on the pathogenesis and clinical consequences of hypernatremia and hyponatremia, and clinical algorithms for the diagnosis and treatment of polyuria are repeated in different chapters.

Other minor but noticeable flaws include several incorrect or poorly typeset formulas, which could confuse readers, and the inconsistent quality of the reproduction of some charts and graphs. Finally, the overview at the end of the book provides only a brief synopsis of the subjects covered previously. This chapter would be improved by the use of specific references to the earlier sections in the book so that the reader could quickly refer to the more detailed explanations of the topics.

The value of this book should not be underestimated, even given these suggestions for improvement. The authors of each chapter are well-recognized scientists, and this book will be valuable to nephrologists who wish to review both the basic science and the clinical approach to this difficult subject. The majority of the book may be too focused on renal and cell physiology to appeal to the general internist, although the clinical chapters in section 2 will have broad appeal. This book is a fine resource, however, and a worthwhile addition to any nephrologist's library.

Warren L. Kupin, M.D.
Mark D. Faber, M.D.
Henry Ford Hospital, Detroit, MI 48202