Hyponatremia in Psychiatric Patients: Update on Evaluation and Management

Harvard Medical School and McLean Hospital, Belmont, MA 02478, USA.
Harvard Review of Psychiatry (Impact Factor: 1.73). 01/2008; 16(1):13-24. DOI: 10.1080/10673220801924308
Source: PubMed


Hyponatremia (serum sodium concentration < 136 mEq/L) is a prevalent and potentially dangerous medical comorbidity in psychiatric patients.
MEDLINE was used to identify peer-reviewed publications that described the role of arginine vasopressin (AVP) in the pathogenesis of hyponatremia, the presentation and treatment of hyponatremia in psychiatric patients, and promising new treatment options.
Polydipsia may lead to hyponatremia in patients with schizophrenia, which is mediated, in part, by a reduced osmotic threshold for the release of AVP and by a defect in the osmoregulation of thirst. Acute-onset hyponatremia may require emergent treatment with hypertonic (3%) saline, whereas chronic cases mandate gradual correction to minimize the risk of osmotic demyelination. The AVP-receptor antagonists, including conivaptan, tolvaptan, lixivaptan, and satavaptan, represent a therapeutic advance in the treatment of dilutional hyponatremia.
Based on the role of AVP in the development of hyponatremia, further studies are warranted to determine the efficacy of the AVP-receptor antagonists in psychiatric patients with hyponatremia.

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    • "A number of psychiatric disorders have been linked with psychogenic polydipsia. The most commonly reported psychiatric disorder is chronic schizophrenia, but it may also occur in anorexia nervosa [2] and psychotic depression and bipolar psychosis [7] [8]. A specific link to previous alcohol misuse has been found [9], a diagnosis which, along with bipolar disorder with psychotic symptoms, applies to the patient described in this report. "
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    ABSTRACT: Water intoxication is a rare condition characterised by overconsumption of water. It can occur in athletes engaging in endurance sports, users of MDMA (ecstasy), and patients receiving total parenteral nutrition. This case outlines water intoxication in a patient with psychogenic polydipsia. When the kidney's capacity to compensate for exaggerated water intake is exceeded, hypotonic hyperhydration results. Consequences can involve headaches, behavioural changes, muscular weakness, twitching, vomiting, confusion, irritability, drowsiness, and seizures. Cerebral oedema can lead to brain damage and eventual death. In this case, psychogenic polydipsia led to significant hyponatraemia, cerebral oedema, and tonic-clonic seizures. Differential diagnoses for hyponatraemia are outlined. The aetiology of psychogenic polydipsia is uncertain, but postulated hypotheses are explored. Psychogenic polydipsia occurs in up 20% of psychiatric patients and this case serves to remind us to be cognizant of water overconsumption.
    Full-text · Article · Jan 2015
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    • "Psychogenic polydipsia may be associated with several psychiatric conditions including psychotic depression, manic-depressive psychosis, and most commonly schizophrenia with up to 18% of patients in mental hospitals displaying polydipsic behavior [3,13,14]. The pathogenesis of the polydipsia may be hypersensitivity to vasopressin, an increase in dopamine activity, or a defect in osmoregulation [3,14–16]. "
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    ABSTRACT: Psychogenic polydipsia is prevalent amongst psychiatric patients, but less common in the general population. Generally, hyponatremia ensues with complications of cerebral edema resulting in confusion, seizures, coma, and death. Rapid correction of serum sodium levels can lead to further complications of osmotic demyelination of neurons, e.g. central pontine myelinolysis. We present a case of a 32-year-old male who presented with seizures while being treated at a drug rehabilitation facility. He was discovered to be hyponatremic secondary to suspected psychogenic polydipsia. The patient impressively responded to treatment of fluid restriction and desmopressin and symptoms improved. Among the causes of hyponatremia, psychogenic polydipsia may be more difficult to diagnose especially if an apparent psychiatric condition is not present. Current literature supports cautious correction of hyponatremia to prevent complications. However, rapid corrections may be driven by the physiology of the patient and may not be avoidable. Fortunately, our case illustrates rapid, positive outcomes for the patient.
    Full-text · Article · May 2012 · American Journal of Case Reports
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    • "Hyponatremia is considered a potentially dangerous and prevalent comorbid condition in psychiatric patients (Siegel, 2008). The decrease in the serum sodium level is often asymptomatic or present with symptoms common in psychiatric disorders, such as psychomotor agitation or retardation, fatigue, weakness, and tremor. "
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    ABSTRACT: Hyponatremia at time of inpatient admission is associated with increased severity of illness and mortality in patients hospitalized for treatment of medical conditions. This study was conducted to determine the clinical outcome of psychiatric inpatients with admission hyponatremia. The cohort comprised 1000 adults consecutively admitted to a free-standing psychiatric hospital in 2010. Emergency transfer to a general hospital was used as a proxy marker for poor medical outcome. The point prevalence of hyponatremia (sodium level <136mEq/l) at admission was 6.49%. Older age and a diagnosis of arterial hypertension were independent correlates of admission hyponatremia. Medical deteriorations occurred in 26.7% of hyponatremic patients and 13.1% of those with normal sodium levels. Admission hyponatremia is associated with an increased rate of significant medical deteriorations of psychiatric inpatients and should trigger enhanced clinical monitoring to identify and treat somatic disorders.
    Full-text · Article · Mar 2012
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