1
|
Hurwit AA, Parker JM, Uhlyar S. Treatment of Psychogenic Polydipsia and Hyponatremia: A Case Report. Cureus 2023; 15:e47719. [PMID: 38021912 PMCID: PMC10675986 DOI: 10.7759/cureus.47719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Psychogenic polydipsia occurs during water or fluid intoxication and can lead to electrolyte disturbances, such as hyponatremia. Hyponatremia can give rise to signs and symptoms, including lethargy, psychosis, seizures, or death. Psychogenic, or primary polydipsia, can be compared to other medical conditions that cause excessive thirst. This case report will focus on the symptoms, disease, and treatment involved in the care and hospitalization of a 30-year-old male patient who reported ingesting up to 40 liters of water a day for the last three years. This patient with psychogenic polydipsia, chronic schizophrenia, and active psychosis was diagnosed with metabolic encephalopathy secondary to severe hyponatremia (day one sodium level: 108 mEq/L). The management goal was to stabilize electrolytes and increase sodium levels without causing osmotic demyelination syndrome. During subsequent hospitalization, the psychiatry team worked towards the normalization of sodium levels and managed behavioral patterns contributing to water consumption. The patient achieved a normal sodium level on day 21 of inpatient psychiatric treatment with the following medication regimen: acetazolamide, candesartan, olanzapine, sodium chloride, and trazodone.
Collapse
Affiliation(s)
- Alyse A Hurwit
- Psychiatry and Behavioral Sciences, Ross University School of Medicine, Miami, USA
| | - Jonathan M Parker
- Psychiatry and Behavioral Sciences, Jackson Behavioral Health Hospital, Miami, USA
- Psychiatry and Behavioral Sciences, University of Miami Health System, Miami, USA
| | - Stepan Uhlyar
- Psychopharmacology, Jackson Behavioral Health Hospital, Miami, USA
| |
Collapse
|
2
|
Evanson DJ, Espiridion ED. The Catastrophic Effects of Psychogenic Polydipsia: A Case Report. Cureus 2023; 15:e44766. [PMID: 37809219 PMCID: PMC10557044 DOI: 10.7759/cureus.44766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
Patients with hyponatremia are at risk of severe complications including seizures, coma, and death. Psychiatric patients are particularly susceptible to death from hyponatremia due to the association between psychiatric conditions and psychogenic polydipsia, characterized by water intoxication. We report a case of a schizophrenic patient who presented with altered mental status, leading to a differential diagnosis narrowed through clinical investigations to include hypovolemic hyponatremia, syndrome of inappropriate antidiuretic hormone secretion (SIADH), and psychogenic polydipsia. This case underscores the need to inquire about schizophrenic patients' water intake, advocating for a standardized approach. The timely diagnosis of disorders causing electrolyte abnormalities can prevent severe complications and aid in the management of psychiatric patients.
Collapse
Affiliation(s)
- Davin J Evanson
- Division of Diagnostic Radiology, Drexel University College of Medicine, Wyomissing, USA
| | - Eduardo D Espiridion
- Psychiatry, West Virginia School of Osteopathic Medicine, Lewisburg, USA
- Psychiatry, Drexel University College of Medicine, Philadelphia, USA
- Psychiatry, Philadelphia College of Osteopathic Medicine, Philadelphia, USA
- Psychiatry, Reading Hospital - Tower Health, West Reading, USA
| |
Collapse
|
3
|
Bafarat AY, Labban SA, Alhatmi N, Aly H, Bashah DM, Alshaiki F. Hyponatremia-Induced Seizure in a Patient With Psychogenic Polydipsia: A Case Report. Cureus 2023; 15:e37710. [PMID: 37206512 PMCID: PMC10191386 DOI: 10.7759/cureus.37710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
Psychogenic polydipsia is a rare condition characterized by overconsumption of water. It can lead to water intoxication, which is potentially a life-threatening situation. Moreover, it usually occurs in patients with mental disorders, mainly schizophrenia. This report discusses a successful treatment of a 16-year-old male with psychogenic polydipsia and delusional disorder presenting to the emergency room with a hyponatremia-induced seizure. After stabilizing the patient, he was referred to a psychologist, and behavioral therapy was conducted. Post-discharge follow-ups revealed that behavioral therapy and the use of self-monitoring technique were effective in controlling the patient's condition. His water intake was reduced from 15 liters per day to three liters per day. This case highlights the importance of psychological assessment for patients with features suggestive of psychogenic polydipsia. It also highlights the need for immediate admission and prompt treatment for such patients as it is a high-risk condition.
Collapse
Affiliation(s)
| | - Suhail A Labban
- Medicine, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Jeddah, SAU
| | - Nada Alhatmi
- Medicine, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Jeddah, SAU
| | - Hanan Aly
- Psychiatry and Behavioral Sciences, King Abdulaziz Hospital, Jeddah, SAU
- Psychiatry and Behavioral Sciences, Sohag University, Sohag, EGY
| | | | - Fatma Alshaiki
- Internal Medicine, Saudi Ministry of Health, Jeddah, SAU
| |
Collapse
|
4
|
Haskins W, Ting MYL, Wood J, Leong C, Crump-Haill O, Bovill I, Janssen J, Carswell C, Mizoguchi R. An atypical presentation of frontotemporal dementia. Quant Imaging Med Surg 2019; 9:1891-1895. [PMID: 31867238 DOI: 10.21037/qims.2019.09.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- William Haskins
- Department of Care of the Elderly Medicine, Chelsea and Westminster Hospital, London, UK
| | - Magdalene Y L Ting
- Department of Care of the Elderly Medicine, Chelsea and Westminster Hospital, London, UK
| | - Jonathan Wood
- Department of Care of the Elderly Medicine, Chelsea and Westminster Hospital, London, UK
| | - Clare Leong
- Department of Care of the Elderly Medicine, Chelsea and Westminster Hospital, London, UK
| | - Olivia Crump-Haill
- Department of Care of the Elderly Medicine, Chelsea and Westminster Hospital, London, UK
| | - Iñaki Bovill
- Department of Care of the Elderly Medicine, Chelsea and Westminster Hospital, London, UK
| | - John Janssen
- Department of Care of the Elderly Medicine, Chelsea and Westminster Hospital, London, UK
| | - Chris Carswell
- Department of Care of the Elderly Medicine, Chelsea and Westminster Hospital, London, UK
| | - Ruth Mizoguchi
- Department of Care of the Elderly Medicine, Chelsea and Westminster Hospital, London, UK
| |
Collapse
|
5
|
Rizvi S, Gold J, Khan AM. Role of Naltrexone in Improving Compulsive Drinking in Psychogenic Polydipsia. Cureus 2019; 11:e5320. [PMID: 31598428 PMCID: PMC6777931 DOI: 10.7759/cureus.5320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Psychogenic polydipsia or self-induced water intoxication is a potentially lethal condition seen in many chronic psychiatric patients. This is a literature review based on therapeutic significance of Naltrexone in improving compulsive water drinking behavior in chronic psychiatrically ill patients with psychogenic polydipsia. Naltrexone is an opioid antagonist approved by FDA for alcohol dependence. Extensive literature search provides a line of evidence that suggests correlation of opioid receptor with compulsive water ingestion in animals. However, there is limited data regarding clinical utility of naltrexone in improving psychogenic polydipsia in human species. This review highlights the necessity for further research and trials to elucidate the role of naltrexone in human psychogenic drinking behavior.
Collapse
Affiliation(s)
- Sukaina Rizvi
- Psychiatry, Manhattan Psychiatric Center, Manhattan, USA
| | - Jeffrey Gold
- Psychiatric, Manhattan Psychiatric Center, Manhattan, USA
| | - Ali M Khan
- Psychiatry, University of Texas Rio Grande Valley, Harlingen, USA
| |
Collapse
|
6
|
Vanhaebost J, Palmiere C, Scarpelli MP, Bou Abdallah F, Capron A, Schmit G. Postmortem diagnosis of hyponatremia: case report and literature review. Int J Legal Med 2017; 132:173-179. [PMID: 28503702 DOI: 10.1007/s00414-017-1601-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 05/03/2017] [Indexed: 01/06/2023]
Abstract
Hyponatremia is defined as a plasma sodium concentration less than 135 or 130 mEq/L (or mmol/L) and may be responsible for life threatening symptoms that can be observed in a variety of medical conditions. Cases of fatal hyponatremia have been reported in both clinical and forensic literature in situations of water intoxication due to psychogenic polydipsia, amphetamine derivative drug intake, high-endurance exercise, iatrogenic causes, and exceptional cases of child abuse by forced water intoxication. Vitreous sodium levels have been determined to be relatively stable during the early postmortem period and similar to levels found in normal serum of living subjects. Nevertheless, there are relatively few cases of fatal hyponatremia described in literature that underwent exhaustive postmortem biochemical investigations. A case of fatal water intoxication in a psychiatric patient who underwent medicolegal investigations, including postmortem biochemistry, was chosen as a starting point to a literature review of deaths by hyponatremia that may be encountered in the forensic setting.
Collapse
Affiliation(s)
- Jessica Vanhaebost
- Service d'Anatomie Pathologique et Médecine Légale, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Cristian Palmiere
- CURML, University Center of Legal Medicine, Chemin de la Vulliette 4, 1000, 25, Lausanne, Switzerland.
| | - Maria Pia Scarpelli
- CURML, University Center of Legal Medicine, Chemin de la Vulliette 4, 1000, 25, Lausanne, Switzerland
| | - Fabiola Bou Abdallah
- University Paris-Descartes, Laboratory of Medical Ethics and Forensic Medicine, Paris, France
| | - Arnaud Capron
- Clinical Chemistry Department, Cliniques Universitaires St Luc, Brussels, Belgium.,Louvain Center for Toxicology and Applied Pharmacology, Université Catholique de Louvain, UCL, Brussels, Belgium
| | - Gregory Schmit
- Service d'Anatomie Pathologique et Médecine Légale, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| |
Collapse
|
7
|
Subramanian K, Rajan TM, Menon V, Rajkumar RP. Converging Neurobiological Evidence In Primary Polydipsia Resembling Obsessive-Compulsive Disorder. Indian J Psychol Med 2017; 39:369-372. [PMID: 28615780 PMCID: PMC5461856 DOI: 10.4103/0253-7176.207327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Compulsive water drinking can have phenomenological and pharmacotherapeutic similarities with obsessive-compulsive disorder (OCD). Substantiating neurobiological evidence is lacking for such an association. We report a patient who was referred with a diagnosis of primary polydipsia with no signs of organic pathology in structural neuroimaging. However, positron emission tomography revealed basal ganglia hypometabolism indicating that primary polydipsia with compulsive water drinking is neurobiologically related to OCD. The diagnostic complexities displayed by primary polydipsia and the use of systematic evaluation with supporting neuroimaging evidence in reaching a reliable diagnosis are discussed. The neurobiological evidence will foster the treatment decisions for starting anti-OCD measures when clinicians encounter patients with primary polydipsia exhibiting compulsive patterns of drinking. Nevertheless, such findings need to be replicated in future studies with a larger sample size.
Collapse
Affiliation(s)
- Karthick Subramanian
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Tess Maria Rajan
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ravi Philip Rajkumar
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| |
Collapse
|
8
|
Conduite automobile et amphétamines dans le sang – bases bibliographiques pour un consensus de la Société française de toxicologie analytique. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2015. [DOI: 10.1016/j.toxac.2015.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|