Psychogenic Polydidsia Review: Etiology, Differential, and Treatment
ABSTRACT Psychogenic polydipsia (PPD), a clinical disorder characterized by polyuria and polydipsia, is a common occurrence in inpatients with psychiatric disorders. The underlying pathophysiology of this syndrome is unclear, and multiple factors have been implicated, including a hypothalamic defect and adverse medication effects. Hyponatremia in PPD can progress to water intoxication and is characterized by symptoms of confusion, lethargy, and psychosis, and seizures or death. Evaluation of psychiatric patients with polydipsia warrants a comprehensive evaluation for other medical causes of polydipsia, polyuria, hyponatremia, and the syndrome of inappropriate secretion of antidiuretic hormone. The management strategy in psychiatric patients should include fluid restriction and behavioral and pharmacologic modalities.
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- "In normovolemic hyponatremia, the shortlist of diagnostic possibilities includes SIADH, hypothyroidism , adrenal insufficiency, or psychogenic polydipsia. Low urine sodium and low urine osmolality imply psychogenic polydipsia (Dundas et al., 2007). If urine sodium and osmolality are high, then a TSH and cosyntropin stimulation test will evaluate whether thyroid and adrenal function are depressed. "
ABSTRACT: Electrolyte and acid-base disturbances are common occurrences in daily clinical practice. Although these abnormalities can be readily ascertained from routine laboratory findings, only specific clinical correlates may attest as to their significance. Among a wide phenotypic spectrum, acute electrolyte and acid-base disturbances may affect the peripheral nervous system as arreflexic weakness (hypermagnesemia, hyperkalemia, and hypophosphatemia), the central nervous system as epileptic encephalopathies (hypomagnesemia, dysnatremias, and hypocalcemia), or both as a mixture of encephalopathy and weakness or paresthesias (hypocalcemia, alkalosis). Disabling complications may develop not only when these derangements are overlooked and left untreated (e.g., visual loss from intracranial hypertension in respiratory or metabolic acidosis; quadriplegia with respiratory insufficiency in hypermagnesemia) but also when they are inappropriately managed (e.g., central pontine myelinolisis when rapidly correcting hyponatremia; cardiac arrhythmias when aggressively correcting hypo- or hyperkalemia). Therefore prompt identification of the specific neurometabolic syndromes is critical to correct the causative electrolyte or acid-base disturbances and prevent permanent central or peripheral nervous system injury. This chapter reviews the pathophysiology, clinical investigations, clinical phenotypes, and current management strategies in disorders resulting from alterations in the plasma concentration of sodium, potassium, calcium, magnesium, and phosphorus as well as from acidemia and alkalemia.Handbook of Clinical Neurology 01/2014; 119:365-82. DOI:10.1016/B978-0-7020-4086-3.00023-0
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ABSTRACT: Summary form only given. The SABRE accelerator was originally designed to operate as low impedance voltage adder with 40-ohm maximum output impedance in negative polarity operation and approximately 20 ohms in positive polarity. Because of the low impedance and higher that expected energy losses in the pulse forming network, the operating input cavity voltage is of the order of 800 kV which limits the total output voltage to ~8 MV for negative polarity and 5 to 6 MV for positive polarity. The modifications presented here aim to increase the output voltage in both polarities. A new high impedance central electrode was designed capable of operating both in negative and positive polarities, and the number of pulse forming lines feeding the ten inductively isolated cavities was reduced to halfIEEE International Conference on Plasma Science 01/1996; DOI:10.1109/PLASMA.1996.550837
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ABSTRACT: The basic patophysiologic mechanism of the hyponatremic encephalopathy caused by psychogenic polydipsia is the dilution of body fluids and decreasing of plasma osmolality. Psychogenic polydipsia usually occurs among schizophrenic patients. Taking into account that the data describing this syndrome in the standard textbooks of clinical medicine are typically sparse, this article is aimed to review the literature data and report three typical cases of this life-threatening syndrome. In typical cases the clinical presentation of hyponatriemic encephalopathy consist of seizures and prolonged consciousness disturbance. According to the literature review and the analysis of the presented case-reports, the authors suggest that hyponatremic encephalopathy caused by psychogenic polydipsia should always be suspected in patients with hyponatremia and polyuria of diluted urine. The diagnosis is ascertained if the data about previous polydipsia are provided.