Fulminant crural compartment syndrome preceded by psychogenic polydipsia

Ulstrup, Anton; Ugleholdt, Randi; Rasmussen, Jeppe Vejlgaard

doi:10.1136/bcr-2014-208603

Cited by 6 publications

(5 citation statements)

References 21 publications

(15 reference statements)

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“…Compartment syndrome isolated to the anterior compartment and from a medically induced aetiology is very rare. Our review found only five published cases [1][2][3][4][5]. Four cases were secondary to psychogenic polydipsia, and one case attributed to severe primary hypothyroidism and adrenal insufficiency.…”

Section: Discussionmentioning

confidence: 92%

“…All of the published cases similar to the one described in this case report resulted in permanent disability due to delays in recognising the diagnosis. Drop foot and loss of sensation in the dorsal foot is the likely outcome for a patient with delayed release of the anterior compartment [1,3,4]. This is due to necrosis of the muscles in the anterior compartment and/or compression of the deep peroneal nerve as it passes through the compartment, supplying the muscles before giving sensation to the 1st webspace on the dorsum of the foot.…”

Section: Discussionmentioning

confidence: 99%

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Bilateral anterior compartment syndrome secondary to psychogenic polydipsia

et al. 2022

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Compartment syndrome is a surgical emergency requiring urgent release of the muscular compartments to prevent ischaemia and tissue death. Unusual presentation patterns or aetiological factors may be confusing, delaying the diagnosis and prompt management. We report a rare case of bilateral anterior compartment syndrome, secondary to psychogenic polydipsia. Compartment pressures were measured using a manometer. The patient was expedited to theatre for exploration. A literature review was performed to search for similar cases. In our case, a 42-year-old male presented confused and agitated with bilateral lower limb pain unresponsive to opiates. He had a past medical history of schizophrenia with psychogenic polydipsia, consuming 10 L of cola soft drink per day prior to presentation. Blood tests showed sodium of 112 mmol/L and a peak creatinine kinase of 13,417 U/L. On examination, he had tense and swollen bilateral anterior legs; posterior calves were soft. Left and right anterior compartment pressures were measured at 60 mmHg and 90 mmHg respectively (normal limit < 30 mmHg). At operation, bilateral fasciotomies of the anterior compartments were performed and bulging muscles were found. Reported cases similar to this resulted in permanent disability due to delays in recognising the diagnosis. Follow-up of this patient showed return of normal sensation and movement of the muscles of the anterior compartment. Hyponatraemia as a result of psychogenic polydipsia is well recognised, but isolated anterior compartment syndrome is a rare complication of hyponatraemia. This case report highlights the need to consider non-traumatic causes of compartment syndrome.Level of evidence: Level V, Diagnostic study

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Bilateral anterior compartment syndrome secondary to psychogenic polydipsia

et al. 2022

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“…The underlying pathophysiology of this condition has not been elucidated, but one hypothesis is that increased intracellular calcium followed by decreased ion exchange could lead to muscle cell death. Another theory is that fluctuations in extracellular osmolarity could alter transmembrane potentials, resulting in muscle cell death [ 6 ]. Although the causes of water-intoxication-related rhabdomyolysis seem multifactorial, rapid correction of serum sodium has been proposed as a risk factor in several studies [ 10 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

A Sudden Fluctuation in Creatinine Kinase: Water Intoxication and Rhabdomyolysis

Ito

2020

Cureus

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Water intoxication often causes hyponatremia. Acute hyponatremia and its rapid correction have been reported to cause rhabdomyolysis. However, little is known about the clinical course of water-intoxication-related rhabdomyolysis. We report a case of self-induced water intoxication resulting in rhabdomyolysis, in which serum creatinine kinase surged rapidly. The appropriate selection of fluid therapy was difficult because of the differences in the standard treatments for each complication. Water restriction is used to treat water intoxication, while the opposite, fluid resuscitation, is used to treat rhabdomyolysis. Close monitoring of serum creatinine kinase was useful in determining fluid management in such a situation.

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“…Psychogenic polydipsia though commonly found with patients of schizophrenia can be a potentially fatal condition. There have been reports of life threatening conditions such as seizure, rhabdomyolysis, aspiration pneumonia, and crural compartment syndrome associated with psychogenic polydipsia [7–9]. There are also reports of death secondary to self-induced water intoxication in patients with schizophrenia [10].…”

Section: Discussionmentioning

confidence: 99%

Psychogenic Polydipsia Complicated to Hyponatremia Induced Seizure in Schizophrenia: A Case Report from Nepal

Sharma

Shah

Sangroula³

et al. 2019

Case Reports in Psychiatry

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Psychogenic polydipsia is one of the common cooccurrences with Schizophrenia and if not addressed can lead to fatal consequences. There are some evidences for pharmacological management of this condition but nonpharmacological management starting from psycho-education to behavioural modification therapy involving family members can be a very effective strategy. We report a case from Nepal where psychogenic polydipsia was complicated to hyponatremia and lead to seizure episodes. We emphasize on asking a routine question about polydipsia in every patient of Schizophrenia in clinics.

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Fulminant crural compartment syndrome preceded by psychogenic polydipsia

Cited by 6 publications

References 21 publications

Bilateral anterior compartment syndrome secondary to psychogenic polydipsia

Bilateral anterior compartment syndrome secondary to psychogenic polydipsia

A Sudden Fluctuation in Creatinine Kinase: Water Intoxication and Rhabdomyolysis

Psychogenic Polydipsia Complicated to Hyponatremia Induced Seizure in Schizophrenia: A Case Report from Nepal

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