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Naguy A, Alhazeem H. Clozapine Prescripers-Dogmatic or Pragmatic? Psychopharmacol Bull 2024; 54:46-50. [PMID: 38601835 PMCID: PMC11003257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Clozapine, amongst antipsychotics, has a unique composite mode of action that might translate into an expanded therapeutic potential on clinical grounds. Sorely, clozapine remains underutilized.
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Affiliation(s)
- Ahmed Naguy
- Naguy, MBBch, MSc, Child/Adolescent Psychiatrist, Al-Manara CAP Centre, Kuwait Centre for Mental Health (KCMH), Jamal Abdul-Nassir St, Shuwaikh, State of Kuwait
| | - Hessa Alhazeem
- Alhazeem, MD, Faculty of Medicine, Kuwait University, Kuwait
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2
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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3
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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5
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Abstract
In primary polydipsia pathologically high levels of water intake physiologically lower arginine vasopressin (AVP) secretion, and in this way mirror the secondary polydipsia in diabetes insipidus in which pathologically low levels of AVP (or renal responsiveness to AVP) physiologically increase water intake. Primary polydipsia covers several disorders whose clinical features and significance, risk factors, pathophysiology and treatment are reviewed here. While groupings may appear somewhat arbitrary, they are associated with distinct alterations in physiologic parameters of water balance. The polydipsia is typically unrelated to homeostatic regulation of water intake, but instead reflects non-homeostatic influences. Recent technological advances, summarized here, have disentangled functional neurocircuits underlying both homeostatic and non-homeostatic physiologic influences, which provides an opportunity to better define the mechanisms of the disorders. We summarize this recent literature, highlighting hypothalamic circuitry that appears most clearly positioned to contribute to primary polydipsia. The life-threatening water imbalance in psychotic disorders is caused by an anterior hippocampal induced stress-diathesis that can be reproduced in animal models, and involves phylogenetically preserved pathways that appear likely to include one or more of these circuits. Ongoing translational neuroscience studies in these animal models may potentially localize reversible pathological changes which contribute to both the water imbalance and psychotic disorder.
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Affiliation(s)
- Leeda Ahmadi
- Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
| | - Morris B Goldman
- Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Wassenaar E, O'Melia AM, Mehler PS. A causality dilemma: ARFID, malnutrition, psychosis, and hypomagnesemia. Int J Eat Disord 2018; 51:1113-1116. [PMID: 30192994 DOI: 10.1002/eat.22939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 07/11/2018] [Accepted: 07/18/2018] [Indexed: 01/05/2023]
Abstract
We present a novel case of a woman with coincident occurrence of auditory and visual hallucinations, electrolyte disturbances, chloride unresponsive alkalosis, and an eating disorder. The patient was ultimately diagnosed with Gitelman syndrome comorbid with schizophreniform disorder and avoidant restrictive food intake disorder. Eating disorders are often associated with electrolyte abnormalities which, in turn, can cause or contribute to other neuropsychiatric symptoms. At the same time, psychotic disorders can lead to food intake aversions or overconsumption of fluids with associated effects on electrolyte balance. In this case, a third factor, Gitelman syndrome, resulted in persistent hypomagnesemia with metabolic alkalosis and, while separate from her eating disorder, simultaneously reinforced the patient's strong food preferences, excessive fluid intake, and excessive movement related to her complaints of persistent joint pain.
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Affiliation(s)
| | | | - Philip S Mehler
- Eating Recovery Center, Denver, Colorado.,Department of Medicine, University of Colorado, Denver, Colorado.,ACUTE at Denver Health, Denver, Colorado
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Sailer CO, Winzeler B, Nigro N, Suter-Widmer I, Arici B, Bally M, Schuetz P, Mueller B, Christ-Crain M. Characteristics and outcomes of patients with profound hyponatraemia due to primary polydipsia. Clin Endocrinol (Oxf) 2017; 87:492-499. [PMID: 28556237 DOI: 10.1111/cen.13384] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/24/2017] [Accepted: 05/24/2017] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Hyponatraemia due to excessive fluid intake (ie primary polydipsia [PP]) is common. It may culminate in profound hyponatraemia-carrying considerable risk of morbidity. However, data on patients with PP leading to hyponatraemia are lacking. Herein, we describe the characteristics of polydiptic patients hospitalized with profound hyponatraemia and assess 1-year outcomes. DESIGN Substudy of the prospective observational Co-MED Study. PATIENTS Patients with an episode of profound hyponatraemia (≤125 mmol/L) due to PP in the medical emergency were eligible and classified into psychogenic polydipsia (PsyP), dipsogenic polydipsia (DiP) and beer potomania (BP). MEASUREMENTS Symptoms, laboratory findings and factors contributing to hyponatraemia (comorbidities, medication and liquid intake) were assessed. A 1-year follow-up was performed to evaluate recurrence of hyponatraemia, readmission rate and mortality. RESULTS Twenty-three patients were included (median age 56 years [IQR 50-65], 74% female), seven had PsyP, eight had DiP and eight had BP. Median serum sodium of all patients was 121 mmol/L (IQR 114-123), median urine osmolality 167 mmol/L (IQR 105-184) and median copeptin 3.6 mmol/L (IQR 1.9-5.5). Psychiatric diagnoses, particularly dependency disorder (43%) and depression (35%), were highly prevalent. Factors provoking hyponatraemia were found in all patients (eg acute water load, medication, stress). During the follow-up period, 67% of patients were readmitted, 52% of these with rehyponatraemia, and three patients (38%) with BP died. CONCLUSION Patients with PP are more likely to be female and to have addictive and affective disorders. Given the high recurrence, rehospitalization and mortality rate, careful monitoring and long-term follow-up including controls of serum sodium, education and behavioural therapy are needed.
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Affiliation(s)
- Clara O Sailer
- Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Bettina Winzeler
- Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Nicole Nigro
- Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
| | - Isabelle Suter-Widmer
- Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Birsen Arici
- Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
| | - Martina Bally
- Division of Endocrinology, Diabetology and Metabolism, Medical University Department, Kantonsspital, Aarau, Switzerland
| | - Philipp Schuetz
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- Division of Endocrinology, Diabetology and Metabolism, Medical University Department, Kantonsspital, Aarau, Switzerland
| | - Beat Mueller
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- Division of Endocrinology, Diabetology and Metabolism, Medical University Department, Kantonsspital, Aarau, Switzerland
| | - Mirjam Christ-Crain
- Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
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Abstract
We are reporting a case of psychogenic polydipsia from a State of Ohio psychiatric hospital. The patient has a known five-year history of psychogenic polydipsia with recurrent hyponatremia and has been diagnosed with schizoaffective disorder bipolar type 1, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria, for the past two decades. There was a marked improvement with the use of acetazolamide, resulting in a decreased compulsion to drink fluid and improvement of his hyponatremia. The patient was observed for six months. We evaluated the water balance of the patient with diurnal weight measurements (DWG) and a weekly comprehensive metabolic panel (CMP) to monitor Na⁺ levels. His symptoms and hyponatremia were improved with acetazolamide. The treatment was well tolerated without any adverse effects and improved his quality of life.
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Affiliation(s)
- Syed E Ahmed
- Heartland Behavioral Healthcare, Department of Mental Health and Addiction, State of Ohio, Northeast Ohio Medical University
| | - Afaque H Khan
- Psychiatry, Heartland Behavioral Healthcare, Department of Mental Health and Addiction, State of Ohio, Northeast Ohio Medical University
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de Fost M, Oussaada SM, Endert E, Linthorst GE, Serlie MJ, Soeters MR, DeVries JH, Bisschop PH, Fliers E. The water deprivation test and a potential role for the arginine vasopressin precursor copeptin to differentiate diabetes insipidus from primary polydipsia. Endocr Connect 2015; 4:86-91. [PMID: 25712898 PMCID: PMC4401105 DOI: 10.1530/ec-14-0113] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 02/23/2015] [Indexed: 11/29/2022]
Abstract
The water deprivation test is the gold standard test to differentiate central or nephrogenic diabetes insipidus (DI) from primary polydipsia (PP) in patients with polyuria and polydipsia. Few studies have addressed the diagnostic performance of this test. The aim of this retrospective cohort study was to evaluate the diagnostic performance of the standard water deprivation test, including plasma arginine vasopressin (AVP) measurements, in 40 consecutive patients with polyuria. We compared initial test results with the final clinical diagnosis, i.e., no DI, central DI, or nephrogenic DI. The median length of follow-up was 8 years. In a subset of ten patients, the novel marker copeptin (CP) was measured in plasma. Using the final diagnosis as a gold standard, a threshold for urine osmolality of >800 mOsmol/kg after water deprivation yielded a sensitivity and specificity of 96 and 100%, respectively, for diagnosing PP. Sensitivity increased to 100% if the cut-off value for urine osmolality was set at 680 mOsmol/kg. Plasma AVP levels did not differ between patient groups and did not differentiate among central DI, nephrogenic DI, or PP. In all three patients with central DI, plasma CP was <2.5 pmol/l with plasma osmolality >290 mOsmol/kg, and >2.5 pmol/l in patients without DI. The optimal cut-off value for differentiating PP from DI during a water deprivation test was urine osmolality >680 mOsmol/kg. Differentiating between central and nephrogenic DI should be based on clinical judgment as AVP levels did not discriminate.
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Affiliation(s)
- M de Fost
- Department of Endocrinology and MetabolismRoom F5-164Laboratory of EndocrinologyDepartment of Clinical Chemistry, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - S M Oussaada
- Department of Endocrinology and MetabolismRoom F5-164Laboratory of EndocrinologyDepartment of Clinical Chemistry, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - E Endert
- Department of Endocrinology and MetabolismRoom F5-164Laboratory of EndocrinologyDepartment of Clinical Chemistry, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - G E Linthorst
- Department of Endocrinology and MetabolismRoom F5-164Laboratory of EndocrinologyDepartment of Clinical Chemistry, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - M J Serlie
- Department of Endocrinology and MetabolismRoom F5-164Laboratory of EndocrinologyDepartment of Clinical Chemistry, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - M R Soeters
- Department of Endocrinology and MetabolismRoom F5-164Laboratory of EndocrinologyDepartment of Clinical Chemistry, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - J H DeVries
- Department of Endocrinology and MetabolismRoom F5-164Laboratory of EndocrinologyDepartment of Clinical Chemistry, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - P H Bisschop
- Department of Endocrinology and MetabolismRoom F5-164Laboratory of EndocrinologyDepartment of Clinical Chemistry, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - E Fliers
- Department of Endocrinology and MetabolismRoom F5-164Laboratory of EndocrinologyDepartment of Clinical Chemistry, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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11
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Abstract
Psychogenic polydipsia, in its most severe form, can lead to acute water intoxication by way of extreme hyponatremia. This results in cerebral edema, mental status deterioration and can lead to life threatening intracranial hypertension if not identified and treated urgently. However, this treatment rarely involves surgical intervention. Herein, we describe a 47-year-old man who presented to our emergency department who was found down with a decline in mental status and generalized tonic clonic seizures. He was comatose with glasgow coma score of 5. His exam was notable for sluggishly reactive pupils, absence of corneal reflexes, decorticate posturing, and globally increased tone and hyper-reflexia with upgoing toes bilaterally. Lab work revealed sodium of 107 mmol/L. CT scan of the head showed global cerebral edema with sulcal effacement. A ventriculostomy was placed with an opening pressure of 35-cm H(2)O, and cerebrospinal fluid was drained to maintain normal intracranial pressure. Fluid restriction and hypertonic saline were used to carefully correct the hyponatremia. The patient improved and at day five was neurologically intact. His history later revealed schizophrenia and a predilection for drinking greater than 8 L of diet cola daily.
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Affiliation(s)
- Vanessa M Gleason
- Department of Pharmacy, Division of Acute Care Surgery, Thomas Jefferson University, Philadelphia, PA, USA
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Quinn CJ, Iyegha UP, Beilman GJ, Cerra FB. Acute correction of hyponatremia secondary to psychogenic polydipsia. Am J Case Rep 2012; 13:69-71. [PMID: 23569492 PMCID: PMC3616165 DOI: 10.12659/ajcr.882772] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 05/10/2012] [Indexed: 11/24/2022]
Abstract
Background: Psychogenic polydipsia is prevalent amongst psychiatric patients, but less common in the general population. Generally, hyponatremia ensues with complications of cerebral edema resulting in confusion, seizures, coma, and death. Rapid correction of serum sodium levels can lead to further complications of osmotic demyelination of neurons, e.g. central pontine myelinolysis. Case Report: We present a case of a 32-year-old male who presented with seizures while being treated at a drug rehabilitation facility. He was discovered to be hyponatremic secondary to suspected psychogenic polydipsia. The patient impressively responded to treatment of fluid restriction and desmopressin and symptoms improved. Conclusions: Among the causes of hyponatremia, psychogenic polydipsia may be more difficult to diagnose especially if an apparent psychiatric condition is not present. Current literature supports cautious correction of hyponatremia to prevent complications. However, rapid corrections may be driven by the physiology of the patient and may not be avoidable. Fortunately, our case illustrates rapid, positive outcomes for the patient.
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Affiliation(s)
- Coridon J Quinn
- Department of Surgery, University of Minnesota, Minneapolis, MN, U.S.A
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13
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Abstract
To the best of our knowledge psychogenic polydipsia has not been reported in an Indian journal. We are reporting one such case, which was diagnosed as having depression according to ICD 10 R criteria. Fully investigated patient had some reversible changes in the urinary tract. There was no antidiuretic hormone-related abnormality as indicated by absence of hyponatremia. The patient recovered with antidepressant drugs. The followup was done for 6 months.
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Affiliation(s)
- Ajay Kohli
- Department of Psychiatry, Era's Lucknow Medical College, Lucknow, Uttar Pradesh, India
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