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Characteristics and outcomes of patients with profound hyponatraemia due to primary polydipsia
Clara O Sailer1,2, Bettina Winzeler1,2, Nicole Nigro1
1Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland.
Insights
Patients hospitalized with profound hyponatraemia due to primary polydipsia (PP) often have psychiatric disorders and face high readmission rates. Long-term monitoring and behavioral therapy are crucial for managing this condition.
Area of Science:
- Nephrology
- Psychiatry
- Internal Medicine
Background:
- Hyponatraemia resulting from excessive fluid intake, known as primary polydipsia (PP), is a common clinical issue.
- Profound hyponatraemia can lead to significant morbidity, yet data on affected patients are limited.
- This study characterizes patients hospitalized with severe hyponatraemia secondary to PP and evaluates their outcomes.
Purpose of the Study:
- To describe the characteristics of patients hospitalized with profound hyponatraemia due to primary polydipsia.
- To assess the 1-year outcomes, including recurrence, readmission, and mortality, in this patient group.
Main Methods:
- A substudy of the prospective observational Co-MED Study.
- Included patients with profound hyponatraemia (≤125 mmol/L) due to PP, classifying them into psychogenic polydipsia (PsyP), dipsogenic polydipsia (DiP), and beer potomania (BP).
- Assessed symptoms, laboratory findings, contributing factors (comorbidities, medications, fluid intake), and conducted a 1-year follow-up.
Main Results:
- Twenty-three patients (74% female, median age 56) were included: 7 PsyP, 8 DiP, 8 BP.
- Median serum sodium was 121 mmol/L, urine osmolality 167 mmol/L, and copeptin 3.6 mmol/L.
- High prevalence of psychiatric diagnoses (dependency disorder 43%, depression 35%). Factors provoking hyponatraemia were present in all patients. During follow-up, 67% were readmitted, 52% with rehyponatraemia, and 38% of BP patients died.
Conclusions:
- Patients with PP-induced hyponatraemia are frequently female and have addictive/affective disorders.
- The high rates of recurrence, rehospitalization, and mortality necessitate careful monitoring.
- Long-term follow-up, including serum sodium control, education, and behavioral therapy, is recommended.
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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