Psychosis-related polydipsia and chronic hyponatremia – A case report

2016 ◽  
Vol 33 (S1) ◽  
pp. S578-S578
Author(s):  
F. Gonçalves Godinho ◽  
A.L. Melo ◽  
S. Marques ◽  
D. Barrocas
Keyword(s):  
Case Report ◽  
Water Intake ◽  
High Water ◽  
Psychotic Symptoms ◽  
Water Restriction ◽  
Psychogenic Polydipsia ◽  
Behavioral Measures ◽  
Severe Hyponatremia ◽  
High Water Intake ◽  
Competing Interest

IntroductionPsychogenic polydipsia has an estimated prevalence of 6–20% in psychiatric population. Although first described in the 1930s, there are few studies addressing this problem and its management. The high water intake can lead to severe hyponatremia with a mortality rate high enough to merit clinical concern.AimsReport a case of a schizophrenic patient with psychogenic polydipsia and hyponatremia.MethodsRetrospective review of the clinical file and literature research on this topic.ResultsA 41-year-old man with a long-term schizophrenia presented to the emergency room (ER) with exacerbation of psychotic symptoms. In the prior 24 months, he had stopped medication and began excessive water intake (5 to 10 L/day). He presented with auditory hallucinations, passivity phenomena and persecutory and other delusional thoughts that justified this behavior – “The water will end; I have to stock it, like camels do”. Presently he had an asymptomatic hyponatremia (128 mg/dL), but 6 months before he had been admitted in the ER with vomiting, altered state of consciousness and convulsions secondary to severe hyponatremia (108 mg/dL). During the present hospitalization, organic causes of hyponatremia were excluded and he was started on behavioral measures and antipsychotics. The psychotic symptoms improved and there was no need for water restriction after the first week, with restored natremia values on discharge.ConclusionsWith this case report we intended to raise awareness on this potentially fatal condition that despite its prevalence has no defined diagnostic criteria, nor established controlled trials concerning the effectiveness of treatments.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Central infusion of the AT1 receptor antagonist losartan inhibits thirst but not sodium appetite in cattle

1997 ◽  
Vol 272 (6) ◽  
pp. R1940-R1945 ◽  
Author(s):  
J. R. Blair-West ◽  
D. A. Denton ◽  
M. J. McKinley ◽  
R. S. Weisinger
Keyword(s):  
Water Intake ◽  
Salt Intake ◽  
Sodium Intake ◽  
High Water ◽  
Salt Appetite ◽  
Ang Ii ◽  
Sodium Depletion ◽  
Water Restriction ◽  
Sodium Appetite ◽  
High Water Intake

Experiments in cattle compared the effects of intracerebroventricular (i.c.v.) infusions of losartan and PD-123319 on water intake caused by water restriction, i.c.v. infusion of hypertonic NaCl, or i.c.v. infusion of angiotensin II (ANG II). The effects of these receptor antagonists on sodium intake caused by sodium depletion were also examined. Losartan infusion caused dose-dependent inhibition of the high water intake caused by the physiological stimulus of water restriction or by ANG II infusion but did not affect salt appetite. PD-123319 infused at equimolar or greater (in ANG II experiments) doses did not affect water intake or salt intake due to sodium depletion. The results of these i.c.v. infusion experiments confirm our earlier proposal that the physiological regulation of water intake in cattle may be mediated by ANG II acting centrally via AT1 receptors. The dose of losartan that inhibited thirst in cattle did not inhibit sodium appetite, nor did an equimolar dose of PD-123319.

scholarly journals High water vs. ad libitum water intake for autosomal dominant polycystic kidney disease: a randomized controlled feasibility trial

QJM ◽  
2019 ◽  
Vol 113 (4) ◽  
pp. 258-265 ◽  
Author(s):  
R El-Damanawi ◽  
M Lee ◽  
T Harris ◽  
L B Cowley ◽  
S Bond ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Polycystic Kidney Disease ◽  
Water Intake ◽  
Autosomal Dominant ◽  
High Water ◽  
Feasibility Trial ◽  
Polycystic Kidney ◽  
High Water Intake ◽  
Ad Libitum ◽  
Autosomal Dominant Polycystic Kidney

Abstract Background Vasopressin stimulates cyst growth in autosomal dominant polycystic kidney disease (ADPKD) and is a key therapeutic target. Evaluation of high water intake as an alternative to pharmacological vasopressin blockade is supported by patients. However feasibility, safety and adherence-promoting strategies required to deliver this remain unknown. Aims Assess the feasibility of a definitive randomized high water intake trial in ADPKD. Methods In this prospective open-label randomized trial, adult ADPKD patients with eGFR ≥ 20 ml/min/1.73 m2 were randomized to prescribed high water (HW) intake targeting urine osmolality (UOsm) ≤270 mOsm/kg, or ad libitum (AW) intake (UOsm >300 mOsm/kg). Self-management strategies including home-monitoring of urine-specific gravity (USG) were employed to promote adherence. Results We enrolled 42 participants, baseline median eGFR (HW 68.4 [interquartile range (IQR) 35.9–107.2] vs. AW 75.8 [IQR 59.0–111.0 ml/min/1.73 m2, P = 0.22) and UOsm (HW 353 [IQR 190–438] vs. AW 350 [IQR 240–452] mOsm/kg, P = 0.71) were similar between groups. After 8 weeks, 67% in the HW vs. 24% in AW group achieved UOsm ≤270 mOsm/kg, P = 0.001. HW group achieved lower UOsm (194 [IQR 190–438] vs. 379 [IQR 235–503] mOsm/kg, P = 0.01) and higher urine volumes (3155 [IQR 2270–4295] vs. 1920 [IQR 1670–2960] ml/day, P = 0.02). Two cases of hyponatraemia occurred in HW group. No acute GFR effects were detected. In total 79% (519/672) of USG were submitted and 90% (468/519) were within target. Overall, 17% withdrew during the study. Conclusion DRINK demonstrated successful recruitment and adherence leading to separation between treatment arms in primary outcomes. These findings suggest a definitive trial assessing the impact of high water on kidney disease progression in ADPKD is feasible.

Value of fluid and electrolyte supplements in subarctic survival situations

1964 ◽  
Vol 19 (4) ◽  
pp. 580-582 ◽  
Author(s):  
Terence A. Rogers ◽  
James A. Setliff
Keyword(s):  
Water Intake ◽  
Fluid Balance ◽  
Cold Exposure ◽  
High Water ◽  
The Other ◽  
Standard Diet ◽  
High Water Intake ◽  
Ad Libitum

After 48 hr on a standard diet indoors, 30 men were subjected to cold and starvation in the winter subarctic. During the fast, ten men got 230 mEq NaCl each, ten got 115 mEq NaCl plus 115 mEq NaHCO3, and the other ten got a placebo. Of each group of ten, five had water ad libitum and the other five each had a “forced” intake of 1,920 ml. In each electrolyte-supplemented group, those with the high water intake dehydrated to the same extent as those drinking ad libitum. Those getting NaCl or NaCl plus NaHCO3 lost a mean of about 1 kg less weight than those in the placebo groups. The NaHCO3 did not diminish the fasting acidosis. cold exposure; fasting; fluid balance; starvation Submitted on January 22, 1964

Body temperature responses to exercise in man on restricted food and water intake

1959 ◽  
Vol 14 (2) ◽  
pp. 194-198 ◽  
Author(s):  
F. Grande ◽  
J. E. Monagle ◽  
E. R. Buskirk ◽  
H. L. Taylor
Keyword(s):  
Water Intake ◽  
Sweat Rate ◽  
Control Level ◽  
High Water ◽  
Progressive Increase ◽  
Important Change ◽  
Water Restriction ◽  
Water Group ◽  
Adequate Food ◽  
Ad Libitum

Rectal temperatures (TR) of 12 clinically healthy soldiers were measured in a room at 25.5°C and 40–45% relative humidity during a 1-hour walk on a motor driven treadmill at 3.5 mph and 10% grade, during control with adequate food intake and water ad libitum, and during a period of food and water restriction. The daily water intake during the water restriction period was 900 ml for six of the men, Low Water group (L.W.), and 1800 ml for the other six, High Water group (H.W.). The restriction of water began at the same time as the restriction of food and lasted 5 full days for the L.W. group and 10 full days for the H.W. group. Food was restricted to 1000 calories from carbohydrate, 4.5 gm of NaCl and a multivitamin pill/day for 16 days. Water ad libitum was given throughout the experiment except for the period of water restriction. The L.W. group showed a progressive increase of TR at the end of the walk during the water restriction period with average TR 1.51℃, higher at peak dehydration than in control. In the H.W. group the greatest average increase, 0.46℃, was observed on day 5 of restriction. Administration of water ad libitum brought the work TR back to the control level in the L.W. group, but failed to produce any important change in the H.W. group. The relationship between dehydration, elevation of TR during work and changes in sweat rate is discussed. Submitted on July 24, 1958

Culture and mental disorders

2017 ◽  
Vol 41 (S1) ◽  
pp. S517-S517
Author(s):  
A. Adrián ◽  
C. Noval Canga ◽  
H. Rebeca ◽  
S. Isabel ◽  
G. Sofía ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Mental Disorders ◽  
Psychiatric Diagnosis ◽  
Emergency Service ◽  
Psychotic Symptoms ◽  
Sociocultural Factors ◽  
Psychiatric History ◽  
Sexual Content ◽  
Competing Interest

ObjectivesShow with a case report how psychiatric pathology may face differential diagnosis problems when sociocultural aspects are involved.Methods and materialsSeventy-three year old man, born in Colombia. During the last two months, he had come many times to the emergency service due to behavioural changes. He does not have previous psychiatric history. His daughter refers that one of the patient's sisters has been diagnosed of “mystical madness”. The previous days he abandoned his medical treatment saying that he “gets in touch with his wife and that he wants to meet her”. Since his wife's dead, he had presented an excessively adapted behaviour, without grief symptoms. The first hospitalization day he said we wanted to get married with one of his daughters, with a sexual content speech, being able to get emotional when he spoke about his dead wife. Now the patient is under frequent reviews, and it is thought the differential diagnosis of depression with psychotic symptoms, due to the lack of symptoms remission.ConclusionWhenever we face different psychiatric diagnosis we don’t keep in mind some sociocultural factors, which could be masked and raise different doubts. It is important to keep in mind that each country or ethnical have their own cultural habits which are going to deeply influence patient's personality.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Severe Hyponatremia Precipitated by Acute Urinary Retention in a Patient with Psychogenic Polydipsia

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
C. M. H. Hilton ◽  
L. Boesby ◽  
K. E. Nelveg-Kristensen
Keyword(s):  
Acute Kidney Injury ◽  
Urinary Retention ◽  
Acute Urinary Retention ◽  
Kidney Injury ◽  
Sodium Concentration ◽  
Water Intoxication ◽  
Water Restriction ◽  
Psychogenic Polydipsia ◽  
Severe Hyponatremia ◽  
Electrolyte Homeostasis

A woman in her late sixties presented with severe hyponatremia and acute kidney injury (AKI) as consequence of psychogenic polydipsia and acute urinary retention due to urinary tract infection. Urinary catheterization promptly drained 5.5 L of urine with resulting polyuria, leading to an initial swift raise in plasma (P) sodium concentration, disregarding the course of fluid resuscitation. After the polyuric phase, normal range P-sodium levels were reestablished by oral water restriction. Treatment with psychoactive drugs, e.g., zuclopentixol, may have contributed to the severity of the condition. There are few published reports regarding water intoxication and urinary retention, but none reflecting severe hyponatremia precipitated by acute urinary retention in a patient with polydipsia. By this report, we illustrate the detrimental consequences on water and electrolyte homeostasis of urinary retention and polydipsia resulting in acute water intoxication. The purpose of presenting this case is firstly to draw attention to the potentially fatal combination of polydipsia and postrenal acute kidney injury, where the kidneys are unable to correct the enormous excess water, then to focus on the difficulty in correcting hypervolemic hyponatraemia in the context of polyuria after relief of urinary retention, and finally, to point out that patients in treatment with antipsychotics may have further worsening of electrolyte derangement.

4.P.19 Decrease in arteriolar and medium-size arterial tone during subchronic high water intake in humans

1997 ◽  
Vol 134 (1-2) ◽  
pp. 299-300
Author(s):  
R. Joannidès ◽  
N. Moore ◽  
El.H. Bakkali ◽  
C. Schoenmakers-Smits ◽  
V. de la Guerronière ◽  
...  
Keyword(s):  
Water Intake ◽  
High Water ◽  
Medium Size ◽  
High Water Intake ◽  
Arterial Tone

Antipsychotics-induced leukopenia and neutropenia: A case report and review of literature

2016 ◽  
Vol 33 (S1) ◽  
pp. S546-S546 ◽  
Author(s):  
H. Maatallah ◽  
H. Ben Ammar ◽  
M. Said ◽  
A. Aissa
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Atypical Antipsychotics ◽  
Antipsychotic Drugs ◽  
Psychotic Symptoms ◽  
Review Of Literature ◽  
Blood Cell Count ◽  
Life Threatening ◽  
Dsm Iv ◽  
Competing Interest

IntroductionAntipsychotic drugs effectively control psychotic symptoms, but may cause important side effects, significantly increasing morbidity and mortality. Hematologic abnormalities are frequent and may be life-threatening in some patients. Many prospective investigations confirmed neutropenia as a frequent occurrence with virtually all atypical antipsychotics.Objective and methodsDefine epidemiological, clinical and therapeutic characteristics of antipsychotics – induced leukopenia and neutropenia through a case report and a review of literature.Case reportPatient 28 years old native of Tunis, with family history: brother who suffer of undifferentiated schizophrenia. Since the age of 16 years he has been followed for disorganized schizophrenia (DSM IV). He was initially put under Haldol Decanoate (2 months), fluphenazine (2 months), amisulpride (3 months), sulpride (2 months), olanzapine (3 months), Rispreridone (1 month), aripiprazole (5 months) leukopenia/neutropenia is occurring during treatment with each molecule and which promptly resolved after discontinuation. Reduced white blood cell count has also been reported after addition of lithium. Actually an ECT is proposed for this patient.ConclusionThis case report shows the importance of hematological monitoring during the course of typical or atypical treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Obsessive symptoms in schizophrenia: A case report

2016 ◽  
Vol 33 (S1) ◽  
pp. S573-S574 ◽  
Author(s):  
S. Benavente López ◽  
N. Salgado Borrego ◽  
M.I. de la Hera Cabero ◽  
I. Oñoro Carrascal ◽  
L. Flores ◽  
...  
Keyword(s):  
Case Report ◽  
Effective Dose ◽  
Mood State ◽  
Physical Restraint ◽  
Psychotic Symptoms ◽  
Minimum Effective Dose ◽  
Obsessive Compulsive ◽  
Behavioral Disturbances ◽  
Compulsive Disorder ◽  
Competing Interest

IntroductionSchizophrenia could be presented with obsessive thoughts or an obsessive-compulsive disorder. It is known that some antipsychotics like clozapine could cause obsessive symptoms or worsen them.Case ReportWe report the case of a 53-year-old male who was diagnosed of schizophrenia. The patient was admitted into a long-stay psychiatric unit due to the impossibility of outpatient treatment. He presented a chronic psychosis consisted in delusions of reference, grandiose religious delusions, and auditory pseudohallucinations. He often presented behavioral disturbances consisted in auto and heteroaggressive behavior, being needed the physical restraint. Various treatments were used, including clozapine, but obsessive and ruminative thoughts went worse. Because of that, clozapine dose was lowed, and it was prescribed sertraline and clomipramine. With this treatment the patient presented a considerable improvement of his symptoms, ceasing the auto and heteroaggressive behavior, presenting a better mood state, and being possible the coexistence with other patients. Psychotic symptoms did not disappeared, but the emotional and behavioral impact caused by them was lower.DiscussionThis case report shows how a patient with schizophrenia could present severe behavioral disturbances due to obsessive symptoms. If obsessive symptoms are presented, clozapine must be at the minimum effective dose and antidepressants with a good antiobsessive profile.ConclusionsObsessive symptoms could be presented as a part of schizophrenia. Clozapine could worsen this symptoms and it is necessary to adjust its dose to the minimum effective dose.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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