Psychogenic polydipsia and hyponatremia: clinical implications and importance of diagnosis
DOI:
https://doi.org/10.25118/2763-9037.2018.v8.315Keywords:
Psychiatry, psychogenic polydipsia, schizophrenia, hyponatremia, clozapinaAbstract
Regarding the psychiatric disorders, schizophrenia is the one that shows the most prevalence of psychogenic polydipsia, defi ned as an excessive thirst or an increase in the water intake without having a physiological or organic predisposing and the main complicati on is the water intoxicati on leading to hyponatremia. In this case report, a pati ent with paranoid schizophrenia diagnosis for twelve years, referred from PSAC (Psychosocial Att enti on Center), was hospitalized due to acute relapse of chronic psychosis and uncontrolled water intake. His psychiatric conditi on of base was categorized due to loss of personal autonomy, unorganized behavior, slurred speech, soliloquies and non-structured delirium, and had a sati sfactory response aft er starti ng the use of clozapine. Approximately four months before this admission, without triggering event, he started to refuse medicati on of daily use and started to ingest water excessively, drinking about 5 to 6 liters per day. There were two weeks with sharp worsening of the conditi on. It presented itself very restless, irritated, speaking and gesturing by himself, with auditory hallucinati ons and delirious speeches with persecutory and grandeurcontent. During hospitalization, clozapine was the antipsychotic of choice due to the approach being in compliance with the literature related to polydipsia, with partial improvement of polydipsia after four weeks of hospitalization. Discharged and received orientations to care and guidance. The choice of the described case highlights the importance of discarding organic causes initially to explain the hyponatremia and polydipsia, including in chronic psychotic patients. The clinical stabilization and sodium serum correction must be done to avoid grave complications of the hyponatremia such as convulsions and in critical states, cardiac arrest. Furthermore, it shows an option of treatment of psychogenic polydipsia in euvolemic patients and without comorbidities, through the use of Clozapine.
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Macías Robles M, López Fonti ciella MP, Maciá Bobés M, Fernández San Martí n A. [Severe and acute hyponatremia in a schizophrenic pati ent with potomania]. An Sist Sanit Navar. 2009;32:117-20.
Verbalis JG, Goldsmith SR, Greenberg A, Korzelius C, Schrier RW, Sterns RH, et al. Diagnosis, evaluati on, and treatment of hyponatremia: expert panel recommendati ons. Am J Med. 2013;126:S1-42.
Verghese C, de Leon J, Josiassen RC. Problems and progress in the diagnosis and treatment of polydipsia and hyponatremia. Schizophr Bull. 1996;22:455-64.
Illowsky BP, Kirch DG. Polydipsia and hyponatremia in psychiatric pati ents. Am J Psychiatry. 1988;145:675-83.
de Leon J, Verghese C, Stanilla JK, Lawrence T, Simpson GM. Treatment of polydipsia and hyponatremia in psychiatric pati ents. Can clozapine be a new opti on? Neuropsychopharmacology. 1995;12:133-8.
Gupta S, Baker P. Clozapine treatment of polydipsia. Ann Clin Psychiatry. 1994;6:135-7.
Lee HS, Kwon KY, Alphs LD, Meltzer HY. Eff ect of clozapine on psychogenic polydipsia in chronic schizophrenia. J Clin Psychopharmacol. 1991;11:222-3.
Munn NA. Resoluti on of polydipsia and hyponatremia in schizophrenic pati ents aft er clozapine treatment. J Clin Psychiatry. 1993;54:439.
Spears NM, Leadbett er RA, Shutt y MS Jr. Clozapine treatment in polydipsia and intermitt ent hyponatremia. J Clin Psychiatry. 1996;57:123-8.
Wakefi eld T, Colls I. Clozapine treatment of a schizophrenic pati ent with polydipsia and hyponatremia. Am J Psychiatry. 1996;153:445-6.
Patel JK. Polydipsia, hyponatremia, and water intoxicati on among psychiatric pati ents. Hosp Community Psychiatry. 1994;45:1073-4.
Torres IJ, Keedy S, Marlow-O’Connor M, Beenken B, Goldman MB. Neuropsychological impairment in pati ents with schizophrenia and evidence of hyponatremia and polydipsia. Neuropsychology. 2009;23:307-14.
Siegel AJ. Hyponatremia in psychiatric pati ents: update on evaluati on and management. Harv Rev Psychiatry. 2008;16:13-24.
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