Non-Psychogenic Polydipsia With Hyponatremia

摘要

Polydipsia with hyponatremia in patients is well-known in the literature. Descriptive terms for such patients include, "compulsive water drinking",1 "self-induced water intoxication",2,3 "self-induced water intoxication and psychosis",4 "psychogenic polydipsia", "primary polydipsia", and "psychosis-intermittent hyponatremia-polydipsia (PIP) syndrome".5 Non-psychogenic polydipsia with hyponatremia (individuals without identifiable psychiatric, brain, or endocrine disorder) is a rare entity. Reported herein is the course of a woman who had been drinking up to 8 liters of water a day, and was subsequently started on a diuretic for hypertension. Non-psychogenic polydipsia with hyponatremia is reviewed after a MEDLINE database search for articles, dates ranging from 1954-2004, under the terms "psychogenic and polydipsia", "polydipsia and hyponatremia", and "psychogenic hyponatremia". Articles describing polydipsic patients with endocrine, organic brain, personality or psychiatric disorders were excluded, and additional cases were evaluated after careful review of the relevant articles and their references. Non-psychogenic polydipsia with hyponatremia is categorized. Background Several categories of non-psychogenic polydipsia with hyponatremia have been reported including: individuals voluntarily drinking excessive fluid ± low solute intake, those iatrogenically infused with excessive hypotonic fluid or advised to "drink plenty", children that are fed excessive fluid, by intention or na?ve caretakers, or any of the above with concomitant use of a substance impairing free water excretion. Table I. includes well-documented cases of non-psychogenic polydipsia with hyponatremia, excluding individuals iatrogenically infused with excessive fluid and children that were fed excessive fluid.6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30 All cases in Table I. received medical evaluation. Acute water intoxication occurred within a few hours to days in all individuals but those with a long history of non-psychogenic polydipsia prescribed a medication associated with the syndrome of inappropriate anti-diuretic hormone release (SIADH, discussed later).