Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-30T18:51:50.207Z Has data issue: false hasContentIssue false

Rapid development of hyponatraemic seizures in a psychotic patient

Published online by Cambridge University Press:  09 July 2009

David N. Grainger*
Affiliation:
St Nicholas Hospital, Newcastle-upon-Tyne
*
1Address for correspondence: Dr David N. Grainger, 48, Mountwood, Greystoke Gardens, Jesmond Vale, Newcastle-upon-Tyne NE2 1PY.

Synopsis

A 60-year-old woman with a history of recurrent psychotic illness developed severe hyponatraemia after a short period of compulsive water drinking. The case provides a rare illustration of the rapidity of development of dangerously low levels of serum sodium. On discovery of mild hyponatraemia it is essential to repeat measurement of the serum sodium level should the patient's clinical condition change, in order to detect any further deterioration of serum osmolality which may result in severe and possibly fatal cerebral symptoms.

Type
Case Report
Copyright
Copyright © Cambridge University Press 1992

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Barrter, F. C. & Schwartz, W. B. (1967). The syndrome of inappropriate antidiuretic hormone. American Journal of Medicine 42, 790806.CrossRefGoogle Scholar
Blotcky, M. J., Grossman, I. & Looney, J. G. (1980). Psychogenic water intoxication: a fatality. Texan Medicine 76, 5859.Google ScholarPubMed
Blum, A. & Friedland, G. W. (1983). Urinary tract abnormalities due to chronic psychogenic polydipsia. American Journal of Psychiatry 140, 915916.Google ScholarPubMed
Blum, A. J., Tempey, F. W. & Lynch, W. J. (1983). Somatic findings in patients with psychogenic polydipsia. Journal of Clinical Psychiatry 44, 5556.Google ScholarPubMed
Burnell, G. M. & Foster, T. A. (1972). Psychosis with low sodium syndrome. American Journal of Psychiatry 128, 13131314.CrossRefGoogle ScholarPubMed
Cooke, R. E. (1960). The problem of water intoxication in paediatrics and surgery. Journal of the Oklahoma Medical Association 53, 314319.Google ScholarPubMed
Ferrier, I. N. (1985). Water intoxication in patients with psychiatric illness. British Medical Journal 291, 15941596.CrossRefGoogle ScholarPubMed
Goldman, M. B. & Luchins, D. J. (1987). Prevention of episodic water intoxication with target weight procedure. American Journal of Psychiatry 144, 365366.Google ScholarPubMed
Hariprasad, M. K., Eisinger, R. P., Nalder, I. M.Padmanabhan, C. S. & Nidus, B. D. (1980). Hyponatraemia in psychogenic polydipsia. Archives of Internal Medicine 140, 16391642.CrossRefGoogle ScholarPubMed
Hobson, J. A. & English, J. T. (1963). Self-induced water intoxication. Annals of Internal Medicine 58, 324332.CrossRefGoogle ScholarPubMed
Hwang, A. S. & Magraw, R. M. (1989). Syndrome of inappropriate secretion of antidiuretic hormone due to fluoxetine. American Journal of Psychiatry 146, 399.Google ScholarPubMed
Illowsky, B. P. & Kirch, D. G. (1988). Polydipsia and hyponatraemia in psychiatric patients. American Journal of Psychiatry 145, 675683.Google ScholarPubMed
Jose, C. J. (1984). Generalized seizures from self-induced water intoxication. Psychosomatics 25, 153157.CrossRefGoogle Scholar
Jose, C. J. & Perez-Cruet, J. (1979). Incidence and morbidity of self-induced water intoxication in state mental hospital patients. American Journal of Psychiatry 136, 221222.Google ScholarPubMed
Jose, C. J., Barton, J. L. & Perez-Cruet, J. (1979). Hyponatraemic seizures in psychiatric patients. Biological Psychiatry 14, 839843.Google ScholarPubMed
Khamnei, A. K. (1984). Psychosis, inappropriate antidiuretic hormone secretion, and water intoxication. Lancet i, 963.CrossRefGoogle Scholar
Koczapski, A. B., Ibraheem, S., Ashby, Y. T., Paredes, J., Jones, B. D. & Ancill, R. (1987). Early diagnosis of water intoxication by monitoring diurnal variations in body weight. American Journal of Psychiatry 144, 1626.Google ScholarPubMed
Levinsky, N. G. (1987). Fluid and electrolytes. In Harrison's Principles of Internal Medicine, 11th edn (ed. Braunwald, E., Petersdorf, R. G., Wilson, J. D., Martin, J. B. and Fauci, A. S.), pp. 198208. McGraw-Hill: New York.Google Scholar
Miller, M. G. (1989). Tricyclics as a possible cause of hyponatraemia in psychiatric patients. American Journal of Psychiatry 146, 807.Google ScholarPubMed
Nixon, R. A., Rothman, J. S. & Chin, W. (1982). Demeclocycline in the prophylaxis of self-induced water intoxication. American Journal of Psychiatry 139, 828830.Google ScholarPubMed
Pledger, D R. & Mathew, H. (1989). Hyponatraemia and clomipramine therapy. British Journal of Psychiatry 154, 263264.CrossRefGoogle ScholarPubMed
Raskind, M. (1974). Psychosis, polydipsia and water intoxication – report of a fatal case. Archives of General Psychiatry 30, 112114.CrossRefGoogle ScholarPubMed
Raskind, M. A., Orenstein, H. & Christopher, T. G. (1975). Acute psychosis, increased water ingestion, and inappropriate antidiuretic hormone secretion. American Journal of Psychiatry 132, 907910.Google ScholarPubMed
Rendell, M., McGrane, D. & Cuesta, M. (1978). Fatal compulsive water drinking. Journal of American Medical Association 240, 25572559.CrossRefGoogle ScholarPubMed
Robertson, G. L., Shelton, R. L. & Athar, S. (1976). The osmoregulation of vasopressin. Kidney International 10, 2537.CrossRefGoogle ScholarPubMed
Sandifer, M. G. (1983). Hyponatraemia due to psychotropic drugs. Journal of Clinical Psychiatry 44, 301303.Google ScholarPubMed
Santy, P. A & Schwartz, M. B. (1983). Hyponatraemia disguised as an acute manic episode. Hospital and Community Psychiatry 34, 11561157.Google ScholarPubMed
Schwartz, W. B., Bennett, W. & Curelop, S. (1957). A syndrome of renal sodium loss and hyponatraemia probably resulting from inappropriate secretion of antidiuretic hormone. American Journal of Medicine 23, 529542.CrossRefGoogle ScholarPubMed
Smith, W. O. & Clark, M. L. (1980). Self-induced water intoxication in schizophrenic patients. American Journal of Psychiatry 137, 10551060.Google ScholarPubMed
Sterns, R. H., Riggs, J. E. & Schochet, S. S. (1986). Osmotic demyelination syndrome following correction of hyponatraemia. New England Journal of Medicine 314, 15351542.CrossRefGoogle Scholar
Vieweg, W. V. R., David, J. J., Rowe, W. T., Wampler, G. J., Burns, W. J. & Spradlin, W. W. (1985). Death from self-induced water intoxication among patients with schizophrenic disorders. Journal of Nervous and Mental Disease 173, 161165.CrossRefGoogle ScholarPubMed
Zubenko, G. S. (1987). Water homeostasis in psychiatric patients. Biological Psychiatry 22, 121125.CrossRefGoogle ScholarPubMed
Zubenko, G. S., Altesman, R. I., Cassidy, J. W. & Barriera, P. J. (1984). Disturbances of thirst and water homestasis in patients with affective illness. American Journal of Psychiatry 141, 436437.Google Scholar