Acute correction of hyponatremia secondary to psychogenic polydipsia

Abstract

SummaryBackground:Psychogenic polydipsia is prevalent amongst psychiatric patients, but less common in the general population. Generally, hyponatremia ensues with complications of cerebral edema resulting in confusion, seizures, coma, and death. Rapid correction of serum sodium levels can lead to further complications of osmotic demyelination of neurons, e.g. central pontine myelinolysis.Case Report:We present a case of a 32-year-old male who presented with seizures while being treated at a drug rehabilitation facility. He was discovered to be hyponatremic secondary to suspected psychogenic polydipsia. The patient impressively responded to treatment of fluid restriction and desmopressin and symptoms improved.Conclusions:Among the causes of hyponatremia, psychogenic polydipsia may be more difficult to diagnose especially if an apparent psychiatric condition is not present. Current literature supports cautious correction of hyponatremia to prevent complications. However, rapid corrections may be driven by the physiology of the patient and may not be avoidable. Fortunately, our case illustrates rapid, positive outcomes for the patient.

Desmopressin to Prevent Rapid Sodium Correction in Severe Hyponatremia: A Systematic Review

“…This is tempered by the fact that osmotic demyelination syndrome can occur even with sNa corrections within the limits recommended for average risk patients. 6,12,13 Some suggest more conservative sNa correction targets of 6-8 mEq/L in the first 24 hours for all patients with severe hyponatremia with the exception of water intoxication or postsurgical hyponatremia. 7,14 The present review suggests that a proactive strategy may be more likely to achieve these stringent sNa correction targets.…”

Psychogenic Polydipsia: The Result, or Cause of, Deteriorating Psychotic Symptoms? A Case Report of the Consequences of Water Intoxication

“…Differential diagnoses for hyponatraemia include SIADH, diabetes insipidus, hyperthyroidism, and excess cortisol. Extreme water consumption, as in the case outlined, is also implicated [ 4 ]. Psychogenic polydipsia is a disorder that can lead to significant morbidity and mortality and occurs in 6% to 20% of psychiatric patients [ 1 , 5 ].…”

Use of Desmopressin in Hyponatremia: Foe and Friend

“…14 This concept has been validated in several subsequent articles and case reports, showing the clinical utility of this therapeutic maneuver. 1 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 This situation is termed a reversed urine osmolality.…”