Compulsive water drinking: a review with report of an additional case

Symptomatic compulsive water drinking is uncommon. The pathophysiology of compulsive water drinking is essentially that of an acute organic brain syndrome from cerebral edema. The syndrome does not occur clinically unless there is an impairment of water excretion, since normal renal function allows up to 20 liters per day excess intake without accumulation. It has been reported that about 80 percent of cases are neurotic middleaged females. In almost all cases there is at least a history of neurotic symptoms or maladaptive symptoms if the history is probed. In most reported cases the patients were psychotic. When symptoms and laboratory aberration are mild, the sole treatment is water restriction. In moderate but very symptomatic cases, treatment includes both intravenous saline and water restriction. In severe cases treatment includes water restriction, intravenous hypertonic saline, diuretics, and anticonvulsants. After the acute phase, patient education may suffice as in the above case, but if psychosis is present, appropriate therapy is indicated accompanined by frequent checks of serum electrolytes to detect early aberration.