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The patient A.C., 75 years old, was admitted to hospital because of confusion, lack of reaction on verbal stimuli and gradually developing stupor.

Patient´s history:
According to the information from his relatives, A.C, has been treated for atherosclerosis of the lower extremities for 5 years with Trental (pentoxifylline) and Cavinton (neopeviton). For the last three months he has been suffering from a headache. Two weeks ago he was seen by a practitioner. During examination a high blood pressure was recorded (180/110 mmHg). The doctor prescribed Hydrochlorothiazide 1tabl/day (25 mg) as a single morning dose. Soon after starting the therapy A.C. was thirsty and drinking a lot of water. After 5-day usage of Hydro-chlorothiazide he became confused. Consequently, vomiting and sleepiness appeared. He was admitted to hospital.

Physical examination:
The patient weighs about 65 kg, in unconsciousness, and does not answer verbal stimuli. Blood pressure: 150/90 mmHg, pulse rate: 70/min. Pupils: the shape, size and reaction to light are normal. Heart: without pathological phenomenon. Lungs: resonant and clear percussion of the chest, vesicular breathing. Abdomen: well palpa-ble, differential tympanitic percussion. Lower extremities: freely mobile, the pulse above arteries only weekly palpable. The response on neurologic examination - the plantar extension (dorsiflection of the great toe- Babinski reflex) bilaterally positive.

Laboratory examinations:
Blood: sodium 110 mmol/L, potassium 2.2 mmol/L, creatinine 130 mmol/L, clearance of creatinine (Clcr ) 1. 4 mL/s, ALT 0.30 mkat/L, AST 0.25 mkat/L, AF 1.5 mkat/L, bilirubin 10 mmol/L, uric acid 300 mmol/L, thyroxin normal values, triiodothyronine normal values, glucose 6.4 mmol/L.
Urine: glucose, acetone 0
       Na secretion 300 mmol/24h, K secretion 50 mmol/24h
Lumbar puncture: negative finding
CT of brain: negative finding
ECG: within limits for the age