Inappropriate antidiuretic state in long-term psychiatric inpatients

To investigate the occurrence of an inappropriate antidiuretic state in a long-term psychiatric inpatient population, 690 patients underwent serum sodium determination. Forty-four patients (6.4%) had levels less than 133 mmol/l. Fifteen of these patients could be investigated further and the biochemical findings in all were consistent with an inappropriate antidiuretic state. Evidence of previous episodes of water intoxication was found in 80% of these patients. Although more than one possible cause was present in most patients, the two factors most strongly incriminated in the pathogenesis of the inappropriate antidiuretic state were the drugs carbamazepine and hydrochlorothiazide.