Member Case Study: Water Retention

author : AMSSM

comments : 0

I believe you are experiencing transient episodes of inappropriate anti-diuretic hormone (ADH) secretion. ADH is a hormone secreted by the pituitary gland and can be triggered by several stressors.

Member Question from Gina76

I have been having an issue with water retention this past month and could really use some advice. In the month of May I have made three trips to the East coast from the West Coast but even when I was not flying I am retaining so much water to the point that you can barely see my ankles or the joints in my toes. It has not been centered around "that time of the month" nor has my diet changed in the past month. However, in April I was ill for about 4 days and was the most dehydrated I have ever been in my life. That resulted in an ER visit and an IV but I still did not urinate for 8 - 10 hours after the IV....like I said, I was extremely dehydrated.

This week I was thinking that things were getting back to normal until I just got home from Masters swim and once again you can barely see my ankles or the joints in my toes and it feels odd to make a fist with my hands. Despite the retention I am still urinating but sometimes it is a bright, bright almost fluorescent yellow which I know is not good, but I can only drink so much water. I guess I want to know if anyone else has experienced this. My mother saw me a week ago when we got off the plane and said the amount of fluid I was retaining was not normal. I have tried to do some research but I have hit dead ends. I would greatly appreciate any advice! One last point, I do tend to have dry skin but I always put lotion on after the shower.

Answer from Daniel V. Vigil, MD

Member AMSSM

I believe you are experiencing transient episodes of inappropriate anti-diuretic hormone (ADH) secretion. ADH is a hormone secreted by the pituitary gland. Under normal circumstances, ADH is secreted when your body fluids are too salty. Imagine having eaten a salty meal. The resulting thirst makes you drink more. Simultaneously released ADH acts on the kidneys causing them to reabsorb fluid in an effort to dilute the excess salt in your body.

While certain illnesses and some medications can cause inappropriate ADH secretion, recent scientific evidence suggests that various stressors can stimulate ADH secretion inappropriately. These stressors include pain, nausea (think intense athletic training or competition), and even recent illness. Your symptoms are especially interesting in that they have occurred during times of exertion (Master's swim) as well as at rest (airline travel). Your description is certainly that of fluid retention, but I wonder if your airline-associated swelling is more a gravity-related consequence of being seated for several hours. Even if this simple explanation is true, we must still explain your activity-related swelling.

A clue to all this is your description of highly concentrated urine. Under normal circumstances, this would signify dehydration, and the proper treatment would be rehydration. In the midst of inappropriate ADH secretion, however, people are usually not dehydrated. In fact, they are sometimes frankly over-hydrated. The ADH simply prevents the excretion of water, resulting in a low volume of highly concentrated urine. Since your problem is new (just started several weeks ago), I suspect your (healthy) body will re-establish its normal physiologic balance and your problem will disappear as mysteriously as it appeared.

If a firm medical explanation is necessary, however, it might be productive to check some simple blood and urine chemistries during one of your fluid retention episodes. If you have a good working relationship with your doctor, your doc might be persuaded into issuing some standing orders at the lab for you to have your kidney function and hydration status checked right after a workout. You might wonder, "why not just check my ADH level?" ADH circulates for a very short time after it is secreted, and at extremely low concentrations. While it is possible to measure ADH levels under experimental conditions, it is not possible under more common medical conditions. Therefore, confirmation of inappropriate ADH secretion due to exercise is done indirectly.

Train smart!
Dr. V

Daniel V. Vigil, MD
Division of Sports Medicine
Department of Family Medicine
Southern California Permanente Medical Group
Kaiser Permanente - Los Angeles Medical Center
4950 Sunset Blvd, Suite 4A
Los Angeles CA 90027

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date: July 11, 2007