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Hyponatremia in psychogenic polydipsia

M K Hariprasad, R P Eisinger, I M Nadler

    Archives of Internal Medicine
    |December 1, 1980
    PubMed
    Summary

    Psychotic patients with psychogenic polydipsia can develop severe hyponatremia. This condition, characterized by excessive water intake, may lead to serious neurological symptoms and is potentially preventable.

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    Area of Science:

    • Nephrology
    • Psychiatry
    • Endocrinology

    Background:

    • Psychogenic polydipsia is a condition characterized by compulsive water drinking.
    • Hyponatremia, a low sodium concentration in the blood, can have serious consequences.

    Purpose of the Study:

    • To investigate the relationship between psychogenic polydipsia and hyponatremia in psychotic patients.
    • To explore the underlying mechanisms of hyponatremia in this patient population.

    Main Methods:

    • Studied twenty psychotic patients with psychogenic polydipsia and hyponatremia.
    • Monitored water intake, urine output, and plasma/urine osmolality.
    • Assessed antidiuretic hormone response during fluid deprivation.

    Main Results:

    • Patients consumed excessive water (7-43 L/day), leading to dilute urine and low plasma osmolality.
    • Evidence suggested a 'reset osmostat' or altered antidiuretic hormone response, sustaining hyponatremia.
    • Symptoms included headache, hypertension, dementia, seizures, lethargy, coma, and two deaths.

    Conclusions:

    • Psychogenic polydipsia is a significant cause of hyponatremia in psychotic patients.
    • A 'reset osmostat' may contribute to the persistence of hyponatremia.
    • The condition can lead to severe neurological impairment and mortality, but is potentially preventable or correctable.

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