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Article |

Unconscious on a Corner...

David Hilfiker, MD
JAMA. 1987;258(21):3155-3156. doi:10.1001/jama.1987.03400210097033.
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THE POLICE brought Mr W. to the emergency room. They had found him unconscious on a corner in Washington, DC, one more drunk littering the city, disturbing our view. Fiftytwo years old, black, dressed in rags, homeless, he was no different from the countless other tragedies that find their way to the ER. But Mr W. was not drunk. His jaw had previously been broken and—at another emergency room—wired shut to heal, whereupon he had been discharged back to the streets. He couldn't eat or drink enough to keep himself going, and so it was that the police found him, severely dehydrated, unconscious, close to death.

Mr W. was initially rehydrated with intravenous solutions, but his condition deteriorated, and he was readmitted to the intensive care unit. Tests were ordered, examinations repeated, consults held. At last it was clear: Mr W. had the syndrome of inappropriate antidiuretic hormone secretion with


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