Journal Article10.1001/ARCHINTE.1980.00330230085018
Hyponatremia in Psychogenic Polydipsia
Mavidi K. Hariprasad,Robert P. Eisinger,Irving M. Nadler,Capecomorin S. Padmanabhan,Bernard D. Nidus +4 more
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TL;DR: Twenty psychotic patients with psychogenic polydipsia had hyponatremia lasting up to 28 months, with headache, hypertension, dementia, seizures, lethargy, and coma, thus suggesting a "reset osmostat" or antidiuretic hormone response to nonosmotic stimuli.
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Abstract: Twenty psychotic patients with psychogenic polydipsia had hyponatremia (98 to 124 mEq/L) lasting up to 28 months, with headache, hypertension, dementia, seizures, lethargy, and coma. Two deaths also may be attributed to this syndrome. Patients drank 7 to 43 L of water daily. Urine was dilute during this water load (37 to 95 mOsm/kg), and free water clearance ranged from 12 to 36 L/day, while plasma osmolality was 236 to 244 mOsm/kg. During fluid deprivation in seven such patients, urinary osmolality exceeded plasma osmolality when plasma concentration had risen to between 242 and 272 mOsm/kg, thus suggesting a "reset osmostat" or antidiuretic hormone response to nonosmotic stimuli. This tended to sustain hyponatremia. Polydipsia should be recognized as a cause of hyponatremia, perhaps with reset osmostat. This ultimately may cause dementia or death, possibly secondary to recurrent cerebral edema. This sequence of events is potentially preventable or correctable. (Arch Intern Med140:1639-1642, 1980)
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Citations
Type D Syndrome of Inappropriate Antidiuretic Hormone Secretion in a Schizophrenia Patient with Polydipsia
Takahira Yamauchi,Manabu Makinodan,Tomohisa Nagashima,Kuniaki Kiuchi,Yoshinobu Noriyama,Toshifumi Kishimoto +5 more
- 20 Apr 2009
TL;DR: The plasma antidiuretic hormone level was consistently low in this patient, and linked to type D syndrome of inappropriate antidiUREtic hormone secretion, designated “hypovasopressinemic antidiuresis”, which should be considered as a pathophysiology for water intoxication in schizophrenia patients.
1
Central Nervous System Complications of Severe Hyponatremia
Richard H. Sterns
- 01 Jan 1991
TL;DR: It has been shown that excessively aggressive correction of chronic hyponatremia may cause delayed neurologic deterioration and brain demyelination — a phenomenon that has been dubbed the “osmotic demYelination syndrome”.
1
Hydrophobia Associated with Severe Hypernatremia, Acute Kidney Injury, and Rhabdomyolysis
Mohammed Almaani,Raymond Kao +1 more
TL;DR: A 33-year-old male was brought to the emergency department by his family with a 10-day history of decreased to no oral intake and a progressive unsteady gait and was noted to be severely dehydrated with dry mucous membranes, a flat jugular venous pressure, mottled skin, and anuria.
References
Effects on the central nervous system of hypernatremic and hyponatremic states
Allen I. Arieff,Raul Guisado +1 more
TL;DR: The purpose of the present paper is to review the clinical, anatomical and biochemical changes in the central nervous system induced by hypo- and hypernatremic states, and to attempt to correlate these changes with the observedcentral nervous system disorders.
308
Sudden Death and Phenothiazines A Current Controversy
Jan E. Leestma,Kenneth L. Koenig +1 more
TL;DR: Most cases reported are young, in apparent good health, on fairly high doses of one or more of the phenothiazine tranquilizing drugs, and often, in spite of the level of administered dose, difficult to control.
127
Psychosis, polydipsia, and water intoxication. Report of a fatal case.
TL;DR: A case of rapidly fatal water intoxication secondary to psychogenic polydipsia in a psychotic woman is reported on and the possible role of neuroendocrine changes in psychosis is discussed and the danger of thiazide diuretics in psychogenic PolyDipsia is emphasized.
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Normal diluting capacity in hyponatremic patients. Reset osmostat or a variant of the syndrome of inappropriate antidiuretic hormone secretion.
TL;DR: Four patients with chronic illnesses and stable hyponatremia and plasma hypotonicity had normal urinary diluting capacity, with excretion of greater than 80% of a standard water load within 4 hours and maintenance of a urine osmolality less than 100 mosmol/kg, during sustained water diuresis, suggesting a true resetting of the osmostat.
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