Severe hyponatremia (serum sodium concentration <120 mEq/L) is a well-known etiology of acute symptomatic seizure. Severe hyponatremia may occur as a rare but clinically important adverse reaction of psychotrophic drugs. Among them, patients with psychogenic polydipsia have especially higher risk of severe hyponatremia. We present a schizophrenic patient with polydipsia who developed severe hyponatremia and symptomatic seizures while receiving olanzapine treatment.
Humans ; Hyponatremia ; Polydipsia ; Polydipsia, Psychogenic ; Seizures ; Sodium

Hyponatremia frequently occurs in patients with chronic schizophrenia and has various causes such as compulsive drinking, neuroleptics, and physical illness. If not corrected immediately, it leads to severe problems such as seizures, change in mental status, and even death. We detected five cases of hyponatremia with neurological symptoms in patients with chronic schizophrenia. One case had a long history of primary polydipsia, whereas the other four cases had no history of polydipsia. We speculated that the cause in these latter four cases was neuroleptics or physical illness. All five cases improved with conservative treatment. Possible implications and the need for future study are discussed.
Antipsychotic Agents ; Drinking ; Humans ; Hyponatremia* ; Polydipsia ; Polydipsia, Psychogenic ; Schizophrenia* ; Seizures

We report three cases of Diabetes insipidus which charactrized by the polyuria and polydipsia. All of the three cases well controlled with oral addministration of chlorpropamide. Two cases were idiopathic and the other was suspected pituitary tumor. A briet review of literature was made.
Chlorpropamide ; Diabetes Insipidus* ; Pituitary Neoplasms ; Polydipsia ; Polyuria

We report a case of immature teratoma arising at the suprasellar region in a 18 year-old-male who presented with bitemporal hemianopsia, nausea and polydipsia. The teratoma is a rare neoplasm consisting of 0.5% to 1.2% of all intracranial tumors. The clinical presentation, radiologic finding, pathology and treatment are briefly described with a review of other cases from the literature in view of clinical features and management.
Chemoradiotherapy ; Hemianopsia ; Nausea ; Pathology ; Polydipsia ; Teratoma*

Polydipsia occurs frequently in chronic schizophrenic patients, some of whom develop hyponatremia. Although the underlying pathophysiology of polydipsia among psychiatric patients, recent reports indicate that clozapine treatment improves polydipsia-hyponatremia in schizophrenia. Two schizophrenic patients with polydipsia, followed for more than two years, showed improvement on clozapine. Case 1 was a patient without history of hyponatremia who improved from polydipsia and psychosis. Case 2 was an inpatient with polydipsia and hyponatremia who showed improvement of polydipsia and did nor recur hyponatremia. The limited information provided by these case reports suggest the need for controlled studies of the clozapine effect on schizophrenic patients with polydipsia.
Clozapine* ; Humans ; Hyponatremia ; Inpatients ; Polydipsia* ; Psychotic Disorders ; Schizophrenia*

Hypotonic hyponatremia by primary polydipsia can cause severe neurologic complications due to cerebral edema. A 10-year-and-4-month-old boy with a psychiatric history of intellectual disability and behavioral disorders who presented with chief complaints of seizure and mental change showed severe hypotonic hyponatremia with low urine osmolality (serum sodium, 101 mmol/L; serum osmolality, 215 mOsm/kg; urine osmolality, 108 mOsm/kg). The patient had been polydipsic for a few months prior, and this had been worse in the previous few days. A diagnosis of hypotonic hyponatremia caused by primary polydipsia was made. The patient was in a coma, and developed respiratory arrest and became brain death shortly after admission, despite the treatment. The initial brain magnetic resonance imaging showed severe brain swelling with tonsillar and uncal herniation, and the patient was declared as brain death. It has been reported that antidiuretic hormone suppression is inadequate in patients with chronic polydipsia, and that this inadequate suppression of antidiuretic hormone is aggravated in patients with acute psychosis. Therefore, hyponatremia by primary polydipsia, although it is rare, can cause serious and life-threatening neurologic complications.
Brain Death* ; Brain Edema ; Brain* ; Child* ; Coma ; Diagnosis ; Humans ; Hyponatremia* ; Intellectual Disability ; Magnetic Resonance Imaging ; Male* ; Osmolar Concentration ; Polydipsia ; Polydipsia, Psychogenic* ; Psychotic Disorders ; Seizures ; Sodium ; Water Intoxication

Primary polydipsia (PP) is marked by an increase in thirst, and most often presents in patients with psychiatric illnesses. Although uncommon in children, we experienced cases of PP in a 15-month-old boy and a 5-year-old girl. Both were admitted to the hospital with symptoms of polydipsia and polyuria that appeared 1–3 months before admission. Brain magnetic resonance imaging in both patients was normal. A water restriction test was performed after hospitalization and showed normal results. The symptoms improved after the parents were instructed to implement water-intake restriction for 2 weeks. Our report provides useful information for the treatment of PP in children.
Brain ; Child ; Child, Preschool ; Diabetes Insipidus ; Female ; Hospitalization ; Humans ; Infant ; Magnetic Resonance Imaging ; Male ; Parents ; Polydipsia ; Polydipsia, Psychogenic ; Polyuria ; Thirst ; Water

Nephrogenic diabetes insipidus is a rare genetic renal disease characterized by insensitivity of the kidney to the anti-diuretic effect of vasopressin in spite of elevated serum anti-diuretic hormone (ADH). Failure of the kidney to respond to ADH results in impaired osmoregulation and water reabsorption of the kidney, therefore, nephrogenic diabetes insipidus presents with a large amount of hypotonic polyuria, polydipsia, and dehydration. We report our experience of two familial cases of nephrogenic diabetes insipidus in brothers both having c.910+1delG in intron 2 of the AVPR2 gene with the brief review of related literatures.
Dehydration ; Diabetes Insipidus, Nephrogenic ; Humans ; Introns ; Kidney ; Polydipsia ; Polyuria ; Siblings ; Vasopressins ; Water ; Water-Electrolyte Balance

We experienced a case of severe hyponatremia complicated by rhabdomyolysis in a schizophrenic patient who had been treated with clozapine and nemonapride. The exact cause of sudden hyponatremia was uncertain, however, the possibility of chronic polydipsia could not be ruled out. Electrolyte imbalance was corrected by isotonic saline infusion, and plasma sodium concentration returned to normal after 24 hours. However, the patient developed severe rhabdomyolysis with myoglobinuria and acute renal failure. After 18 days of treatment, patient's physical and mental condition stabilized without further complication. Possible contribution of clozapine in increasing the risk of rhabdomyolysis after the correction of hyponatremia was briefly discussed.
Acute Kidney Injury ; Clozapine* ; Humans ; Hyponatremia* ; Myoglobinuria ; Plasma ; Polydipsia ; Rhabdomyolysis* ; Sodium

There appeared remarkably common disorder of water balance in psychiatric patients. Approximately 30% of the chronic inpatient population drinks fluids excessively, so called polydipsic, while 5% suffers episodes of water intoxication. Water intoxication is a serious problem characterized by profound hyponatremia and a diverse neurologic signs ranging from ataxia, confusion to death. The cause of polydipsia is even less clear. Although previous studies have suggested that it is related to cognitive dysfunction the possibility of an abnormality in the osmoregulation of thirst has not been investigated. But there is the hypothesis that polydipsic, hyponatremic schizophrenics exhibit increased neuroendocrine and behavioral sensitivity to dopamine in mesolimbic tracts, in proportion to the severity of their osmoregulatory disturbance. In order to provide the optimal clinical management of these common disturbances, the author will review their pathophysiology, assessment, treatment and relationship with mental illness.
Ataxia ; Dopamine ; Humans ; Hyponatremia ; Inpatients ; Neurologic Manifestations ; Osmoregulation ; Polydipsia* ; Psychotic Disorders ; Thirst ; Vasopressins* ; Water Intoxication*