Abstract
Over a 3-year period, 15 patients with severe hyponatremia were referred to our emergency room from a nearby psychiatric institution. This article reports on 36 episodes of symptomatic hyponatremia in those 15 patients. All but two of the patients were receiving antipsychotic medications; one patient was taking a nonsteroidal anti-inflammatory drug, and one patient was taking an oral hypoglycemic agent. Thirteen patients were chronic schizophrenics, one had a bipolar depressive disorder with psychotic features, and one patient had no psychiatric disorder. Patients presented with seizures, change in mental status, and vegetative symptoms (nausea, vomiting, and diarrhea) associated with hyponatremia and water intoxication. Exacerbation of the patients' underlying illness, psychogenic polydipsia, compulsive smoking, alcoholic cirrhosis, drug abuse, and neuroleptic and other medications are thought to be the major causes of acute hyponatremia in these patients.
Full text
PDFSelected References
These references are in PubMed. This may not be the complete list of references from this article.
- BARLOW E. D., DE WARDENER H. E. Compulsive water drinking. Q J Med. 1959 Apr;28(110):235–258. [PubMed] [Google Scholar]
- BARLOW E. D., DE WARDENER H. E. Compulsive water drinking. Q J Med. 1959 Apr;28(110):235–258. [PubMed] [Google Scholar]
- Blum A. The possible role of tobacco cigarette smoking in hyponatremia of long-term psychiatric patients. JAMA. 1984 Nov 23;252(20):2864–2865. [PubMed] [Google Scholar]
- Burnell G. M., Foster T. A. Psychosis with low sodium syndrome. Am J Psychiatry. 1972 Apr;128(10):1313–1314. doi: 10.1176/ajp.128.10.1313. [DOI] [PubMed] [Google Scholar]
- DODGE P. R., CRAWFORD J. D., PROBST T. H. Studies in experimental water intoxication. Arch Neurol. 1960 Nov;3:513–529. doi: 10.1001/archneur.1960.00450050033005. [DOI] [PubMed] [Google Scholar]
- Dourish C. T. Dopaminergic involvement in the control of drinking behaviour: a brief review. Prog Neuropsychopharmacol Biol Psychiatry. 1983;7(4-6):487–493. doi: 10.1016/0278-5846(83)90015-5. [DOI] [PubMed] [Google Scholar]
- Dubovsky S. L., Grabon S., Berl T., Schrier R. W. Syndrome of inappropriate secretion of antidiuretic hormone with exacerbated psychosis. Ann Intern Med. 1973 Oct;79(4):551–554. doi: 10.7326/0003-4819-79-4-551. [DOI] [PubMed] [Google Scholar]
- Forrest J. N., Jr, Cox M., Hong C., Morrison G., Bia M., Singer I. Superiority of demeclocycline over lithium in the treatment of chronic syndrome of inappropriate secretion of antidiuretic hormone. N Engl J Med. 1978 Jan 26;298(4):173–177. doi: 10.1056/NEJM197801262980401. [DOI] [PubMed] [Google Scholar]
- Gabow P. A., Kaehny W. D., Kelleher S. P. The spectrum of rhabdomyolysis. Medicine (Baltimore) 1982 May;61(3):141–152. doi: 10.1097/00005792-198205000-00002. [DOI] [PubMed] [Google Scholar]
- HOBSON J. A., ENGLISH J. T. Self-induced water intoxication; case study of a chronically schizophrenic patient with physiological evidence of water retention due to inappropriate release of antidiuretic hormone. Ann Intern Med. 1963 Feb;58:324–332. doi: 10.7326/0003-4819-58-2-324. [DOI] [PubMed] [Google Scholar]
- Jos C. J., Evenson R. C., Mallya A. R. Self-induced water intoxication: a comparison of 34 cases with matched controls. J Clin Psychiatry. 1986 Jul;47(7):368–370. [PubMed] [Google Scholar]
- Jose C. J., Barton J. L., Perez-Cruet J. Hyponatremic seizures in psychiatric patients. Biol Psychiatry. 1979 Oct;14(5):839–843. [PubMed] [Google Scholar]
- Jose C. J., Evenson R. C. Antecedents of self-induced water intoxication. A preliminary report. J Nerv Ment Dis. 1980 Aug;168(8):498–500. doi: 10.1097/00005053-198008000-00009. [DOI] [PubMed] [Google Scholar]
- Jose C. J., Perez-Cruet J. Incidence and morbidity of self-induced water intoxication in state mental hospital patients. Am J Psychiatry. 1979 Feb;136(2):221–222. doi: 10.1176/ajp.136.2.221. [DOI] [PubMed] [Google Scholar]
- Kirch D. G., Bigelow L. B., Weinberger D. R., Lawson W. B., Wyatt R. J. Polydipsia and chronic hyponatremia in schizophrenic inpatients. J Clin Psychiatry. 1985 May;46(5):179–181. [PubMed] [Google Scholar]
- LANGGARD H., SMITH W. O. Self-induced water intoxication without predisposing illness. N Engl J Med. 1962 Feb 22;266:378–381. doi: 10.1056/NEJM196202222660803. [DOI] [PubMed] [Google Scholar]
- Lawson W. B., Karson C. N., Bigelow L. B. Increased urine volume in chronic schizophrenic patients. Psychiatry Res. 1985 Apr;14(4):323–331. doi: 10.1016/0165-1781(85)90100-3. [DOI] [PubMed] [Google Scholar]
- MANDELL A. J., MERSOL-SABBOT I., MANDELL M. P. PSYCHOLOGICAL DISTURBANCE AND WATER RETENTION. Arch Gen Psychiatry. 1964 May;10:513–518. doi: 10.1001/archpsyc.1964.01720230075008. [DOI] [PubMed] [Google Scholar]
- Marshall J. F., Richardson J. S., Teitelbaum P. Nigrostriatal bundle damage and the lateral hypothalamic syndrome. J Comp Physiol Psychol. 1974 Nov;87(5):808–830. doi: 10.1037/h0037223. [DOI] [PubMed] [Google Scholar]
- Moses A. M., Miller M. Drug-induced dilutional hyponatremia. N Engl J Med. 1974 Dec 5;291(23):1234–1239. doi: 10.1056/NEJM197412052912307. [DOI] [PubMed] [Google Scholar]
- Nixon R. A., Rothman J. S., Chin W. Demeclocycline in the prophylaxis of self-induced water intoxication. Am J Psychiatry. 1982 Jun;139(6):828–830. doi: 10.1176/ajp.139.6.828. [DOI] [PubMed] [Google Scholar]
- Peterson D. T., Marshall W. H. Letter: Polydipsia and inappropriate secretion of antidiuretic hormone associated with hydrocephalus. Ann Intern Med. 1975 Nov;83(5):675–676. doi: 10.7326/0003-4819-83-5-675_2. [DOI] [PubMed] [Google Scholar]
- Raskind M. A., Orenstein H., Christopher T. G. Acute psychosis, increased water ingestion, and inappropriate antidiuretic hormone secretion. Am J Psychiatry. 1975 Sep;132(9):907–910. doi: 10.1176/ajp.132.9.907. [DOI] [PubMed] [Google Scholar]
- Rosenbaum J. F., Rothman J. S., Murray G. B. Psychosis and water intoxication. J Clin Psychiatry. 1979 Jul;40(7):287–291. [PubMed] [Google Scholar]
- Sandifer M. G. Hyponatremia due to psychotropic drugs. J Clin Psychiatry. 1983 Aug;44(8):301–303. [PubMed] [Google Scholar]
- Santy P. A., Schwartz M. B. Hyponatremia disguised as an acute manic episode. Hosp Community Psychiatry. 1983 Dec;34(12):1156–1157. doi: 10.1176/ps.34.12.1156. [DOI] [PubMed] [Google Scholar]
- Shen W. W., Sata L. S. Hypothalamic dopamine receptor supersensitivity? A pilot study of self-induced water intoxication. Psychiatr J Univ Ott. 1983 Sep;8(3):154–158. [PubMed] [Google Scholar]
- Sklar A. H., Schrier R. W. Central nervous system mediators of vasopressin release. Physiol Rev. 1983 Oct;63(4):1243–1280. doi: 10.1152/physrev.1983.63.4.1243. [DOI] [PubMed] [Google Scholar]
- Vieweg V., Rowe W., David J., Spradlin W. Hyposthenuria as a marker for self-induced water intoxication and schizophrenic disorders. Am J Psychiatry. 1984 Oct;141(10):1258–1260. doi: 10.1176/ajp.141.10.1258. [DOI] [PubMed] [Google Scholar]
- Vieweg W. V., David J. J., Rowe W. T., Peach M. J., Veldhuis J. D., Kaiser D. L., Spradlin W. W. Psychogenic polydipsia and water intoxication--concepts that have failed. Biol Psychiatry. 1985 Dec;20(12):1308–1320. doi: 10.1016/0006-3223(85)90116-7. [DOI] [PubMed] [Google Scholar]
- Vieweg W. V., David J. J., Rowe W. T., Wampler G. J., Burns W. J., Spradlin W. W. Death from self-induced water intoxication among patients with schizophrenic disorders. J Nerv Ment Dis. 1985 Mar;173(3):161–165. doi: 10.1097/00005053-198503000-00005. [DOI] [PubMed] [Google Scholar]
- Vieweg W. V., Rowe W. T., David J. J., Sutker L. H., Spradlin W. W. Evaluation of patients with self-induced water intoxication and schizophrenic disorders (SIWIS). J Nerv Ment Dis. 1984 Sep;172(9):552–555. doi: 10.1097/00005053-198409000-00008. [DOI] [PubMed] [Google Scholar]
- Weitzel W. D., Shraberg D., Work J. Inappropriate ADH secretion: the role of drug re-challenge. Psychosomatics. 1980 Sep;21(9):771–779. doi: 10.1016/S0033-3182(80)73622-8. [DOI] [PubMed] [Google Scholar]
- Zubenko G. S., Altesman R. I., Cassidy J. W., Barreira P. J. Disturbances of thirst and water homeostasis in patients with affective illness. Am J Psychiatry. 1984 Mar;141(3):436–437. doi: 10.1176/ajp.141.3.436. [DOI] [PubMed] [Google Scholar]