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Polydipsia and intermittent hyponatremia

Published online by Cambridge University Press:  23 March 2020

M.J. Gordillo
Affiliation:
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
C. Caballero
Affiliation:
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
S. Latorre
Affiliation:
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
S.V. Boned
Affiliation:
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
G. Miriam
Affiliation:
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
P. Torres
Affiliation:
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
M. De Almuedo
Affiliation:
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
M.T. Sanchez
Affiliation:
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
E. Contreras
Affiliation:
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
E. Gomez
Affiliation:
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
E. Sanchez
Affiliation:
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
M. Segura
Affiliation:
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
C. Torres
Affiliation:
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
G. Gemma
Affiliation:
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
M. Tur
Affiliation:
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
A. Fernandez
Affiliation:
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain
C. Merino
Affiliation:
Psychiatry Unit, Can Misses Hospital, Psychiatry, Ibiza, Spain

Abstract

Introduction

Hyponatraemia occurs in 4% of schizophrenic patients. Dilutional hyponatraemia, due to inappropriate retention of water and excretion of sodium, occurs with different psychotropic medications and could lead to hippocampal dysfunction. This complication is usually asymptomatic but can cause severe problems, as lethargy and confusion, difficult to diagnose in mentally ill patients.

Objectives

To describe a case of a patient with psychotropic poli-therapy, admitted three times due to hyponatremia and the pharmacological changes that improved his condition.

Aims

To broadcast the intermittent hyponatraemia and polydipsia (PIP), a not rare condition, suffered by treated schizophrenic patients and discuss its physiopathology and treatment thorough a case report.

Methods

A 56-year schizophrenic male was admitted for presenting disorganized behavior, agitation, auditory hallucinations, disorientation, ataxia, vomits and urinary retention. He was on clomipramine, haloperidol and clotiapine (recently added), quetiapine, fluphenazine and clonazepam. After water restriction his symptoms improved and he was discharged. Twenty-five days later, he was readmitted for presenting the same symptoms and after water restriction, he was discharged. Five days later, he was again admitted and transferred to the psychiatric ward.

Results

Haloperidol, fluphenazine and clomipramine were replaced by clozapine. These changes lead him to normalize the hypoosmolality and reduce his water-voracity. Endocrinology team did not label this episode of SIADH due to its borderline blood and urine parameters.

Conclusions

Hyponatremia is frequent in schizophrenic patients and may have severe consequences. Therefore, a prompt recognition and treatment is warranted.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Type
e-Poster viewing: Consultation liaison psychiatry and psychosomatics
Copyright
Copyright © European Psychiatric Association 2017
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