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Prediction of serum sodium based on diurnal weight gain among schizophrenics subject to water intoxication. ACTA ACUST UNITED AC 2020. [DOI: 10.1017/s0767399x00003114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
SummaryWe related normalized diurnal weight gain (NDWG) to a decrease in serum sodium concentration (DSOD) among 8 schizophrenics subject to water intoxication. DSOD = 0.422 + 1.675 × NDWG (n = 8, r = 0.864, P = 0.006). We used this relationship to interdict drinking and, thus, prevent severe hyponatremia.
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Gerhant A, Słotwiński M, Hołownia O, Stelmach E, Olajossy M. Hiponatremia in the practice of a psychiatrist. Part 2: psychogenic polydipsia. CURRENT PROBLEMS OF PSYCHIATRY 2017. [DOI: 10.1515/cpp-2017-0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objective. The study is the second part of the literature review on hyponatremia in patients with diagnosed mental disorders. This article focuses on psychogenic polydipsia as, along with the SIADH, one of the two most common causes of hyponatremia in the mentioned group of patients.
Method: The literature review was based on searching the Medline, the Google Scholar and the Ebsco databases in Polish and English by entering the following phrases: psychogenic polydipsia, the psychosis – intermittent hyponatremia – polydipsia syndrome, water intoxication.
Discussion: Psychogenic polydipsia occurs in up to 25% of patients treated for mental disorders. It most frequently concerns patients with schizophrenia. 30% of patients with psychogenic polydipsia suffer from hyponatremia with or without symptoms of water intoxication. In the etiology of psychogenic polydipsia, the influence of dopaminergic and noradrenergic neurotransmission has been considered, as well as angiotensin, which is claimed to have dipsogenic properties. In order to reduce the severity of the disorder, attempts have been made to administer the following groups of medications: β-blockers, opioid receptor antagonists, angiotensin convertase inhibitors and angiotensin receptor antagonists. Other methods include replacing classic antipsychotic drugs with clozapine. There are also reports of a reduced severity of polydipsia with hyponatremia after introducing risperidone and olanzapine. Preventing episodes of water intoxication in patients with psychogenic polydipsia requires the monitoring of their body weight and a suitable reduction of fluid intake by them.
Results: Mentally ill patients, especially those with chronic schizophrenia, should be monitored for psychogenic polydipsia and the concomitant hyponatremia.
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Affiliation(s)
- Aneta Gerhant
- 2 Department of Psychiatry and Psychiatric Rehabilitation , Medical University of Lublin , Poland
| | - Maciej Słotwiński
- 2 Department of Psychiatry and Psychiatric Rehabilitation , Medical University of Lublin , Poland
| | - Olga Hołownia
- 2 Department of Psychiatry and Psychiatric Rehabilitation , Medical University of Lublin , Poland
| | - Ewa Stelmach
- 2 Department of Psychiatry and Psychiatric Rehabilitation , Medical University of Lublin , Poland
| | - Marcin Olajossy
- 2 Department of Psychiatry and Psychiatric Rehabilitation , Medical University of Lublin , Poland
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Spasovski G, Vanholder R, Allolio B, Annane D, Ball S, Bichet D, Decaux G, Fenske W, Hoorn EJ, Ichai C, Joannidis M, Soupart A, Zietse R, Haller M, van der Veer S, Van Biesen W, Nagler E. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Eur J Endocrinol 2014; 170:G1-47. [PMID: 24569125 DOI: 10.1530/eje-13-1020] [Citation(s) in RCA: 439] [Impact Index Per Article: 43.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hyponatraemia, defined as a serum sodium concentration <135 mmol/l, is the most common disorder of body fluid and electrolyte balance encountered in clinical practice. It can lead to a wide spectrum of clinical symptoms, from subtle to severe or even life threatening, and is associated with increased mortality, morbidity and length of hospital stay in patients presenting with a range of conditions. Despite this, the management of patients remains problematic. The prevalence of hyponatraemia in widely different conditions and the fact that hyponatraemia is managed by clinicians with a broad variety of backgrounds have fostered diverse institution- and speciality-based approaches to diagnosis and treatment. To obtain a common and holistic view, the European Society of Intensive Care Medicine (ESICM), the European Society of Endocrinology (ESE) and the European Renal Association - European Dialysis and Transplant Association (ERA-EDTA), represented by European Renal Best Practice (ERBP), have developed the Clinical Practice Guideline on the diagnostic approach and treatment of hyponatraemia as a joint venture of three societies representing specialists with a natural interest in hyponatraemia. In addition to a rigorous approach to methodology and evaluation, we were keen to ensure that the document focused on patient-important outcomes and included utility for clinicians involved in everyday practice.
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Spasovski G, Vanholder R, Allolio B, Annane D, Ball S, Bichet D, Decaux G, Fenske W, Hoorn EJ, Ichai C, Joannidis M, Soupart A, Zietse R, Haller M, van der Veer S, Van Biesen W, Nagler E. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Nephrol Dial Transplant 2014; 29 Suppl 2:i1-i39. [PMID: 24569496 DOI: 10.1093/ndt/gfu040] [Citation(s) in RCA: 322] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Hyponatraemia, defined as a serum sodium concentration <135 mmol/l, is the most common disorder of body fluid and electrolyte balance encountered in clinical practice. It can lead to a wide spectrum of clinical symptoms, from subtle to severe or even life threatening, and is associated with increased mortality, morbidity and length of hospital stay in patients presenting with a range of conditions. Despite this, the management of patients remains problematic. The prevalence of hyponatraemia in widely different conditions and the fact that hyponatraemia is managed by clinicians with a broad variety of backgrounds have fostered diverse institution- and speciality-based approaches to diagnosis and treatment. To obtain a common and holistic view, the European Society of Intensive Care Medicine (ESICM), the European Society of Endocrinology (ESE) and the European Renal Association - European Dialysis and Transplant Association (ERA-EDTA), represented by European Renal Best Practice (ERBP), have developed the Clinical Practice Guideline on the diagnostic approach and treatment of hyponatraemia as a joint venture of three societies representing specialists with a natural interest in hyponatraemia. In addition to a rigorous approach to methodology and evaluation, we were keen to ensure that the document focused on patient-important outcomes and included utility for clinicians involved in everyday practice.
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6
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Abstract
A prior study in a US state hospital suggested that schizophrenia, smoking and long hospitalization were associated with polydipsia. This study, in another US hospital, attempts to (1) replicate that schizophrenia and smoking are associated with polydipsia, and (2) rule out that this relationship is partly explained by alcohol and drug use. Both studies have similar methodologies. The second sample included 588 inpatients. Models of variables associated with polydipsia were developed using logistic regression. In the second study, after correcting for other factors, the association between polydipsia and schizophrenia showed a borderline significance, while polydipsia and smoking displayed a significant association. Neither organic brain lesions, nor alcohol or drug use, were associated with polydipsia. An analysis combining both samples showed that: (1) schizophrenia, long hospitalization, smoking and heavy smoking were significantly associated with polydipsia, and (2) male gender and Caucasian race (but not smoking) increased the risk of developing water intoxication in polydipsic patients. These two studies in severely mentally ill patients suggest that the association of polydipsia with schizophrenia, smoking and chronicity is consistent and independent from the definition of polydipsia (by staff, a biological method or the combination of both). Psychiatric medications do not appear to explain most cases of polydipsia in these patients.
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Affiliation(s)
- Jose de Leon
- Mental Health Research Center at Eastern State Hospital, 627 West Fourth St., Lexington, KY 40508, USA.
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7
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Thoma JL, Howe J, Gaudet A, Brantley PJ. Behavioral treatment of chronic psychogenic polydipsia with hyponatremia: a unique case of polydipsia in a primary care patient with intractable hiccups. J Behav Ther Exp Psychiatry 2001; 32:241-50. [PMID: 12102585 DOI: 10.1016/s0005-7916(02)00007-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Psychogenic polydipsia is recognized as a dangerous and potentially life threatening disorder. Few studies have focused on the treatment of polydipsia presenting in the outpatient setting. A review of the behavioral treatment literature pertaining to psychogenic polydipsia is presented. This review is followed by a case illustration of an outpatient behavioral approach to the treatment of psychogenic polydipsia in a non-psychiatric, primary car, adult, male patient suffering from intractable hiccup. An ABA single-case design was used, with sodium concentration as the dependent variable. This behavioral method appears promising in settings where restriction of fluid intake is not practical.
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Affiliation(s)
- J L Thoma
- Mayo Clinic, Nicotine Dependence Center, Rochester, MN 55905, USA.
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8
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Abbasi QA, Carbonell FE, Koczapski AB, Vieweg WV. Measuring and estimating daily urine volume in psychiatric patients: strengths and weaknesses. Schizophr Res 1997; 28:87-93. [PMID: 9428067 DOI: 10.1016/s0920-9964(97)00086-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We collected daily urine volumes (DUV) from 24 nonpolydipsic psychiatric patients and eight polydipsic schizophrenic patients. At 7 AM and 4 PM, we collected spot urine samples and measured urine creatinine concentration (UCr). Using morning weight and the UCr measurements, we compared actual DUV with estimated DUV using 3 methods to estimate DUV currently available in the literature. Each method of estimating DUV was superior among the polydipsic patients compared with the nonpolydipsic patients. We discuss the strengths and weaknesses of trying to estimate DUV in psychiatric patients. One method was simple but less accurate. The two remaining methods gave similar results but one method was substantially easier to use than the other.
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Affiliation(s)
- Q A Abbasi
- Psychiatry Service, McGuire Veterans Affairs Medical Center, Richmond, Virginia, USA
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10
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Ribble DJ, Thelander B. Patients With Disordered Water Balance: Innovative Psychiatric Nursing Intervention Strategies. J Psychosoc Nurs Ment Health Serv 1994; 32:35-42. [PMID: 7844768 DOI: 10.3928/0279-3695-19941001-09] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
1. Patients with disordered water balance (DWB) have difficulty with fluid intake/output and osmoregulation. These difficulties are characterized by polydipsia, polyuria, significant variation in pattern of excretion, abnormal diurnal weight gain, and behavioral changes. 2. Therapeutic milieu-management strategies for patients experiencing acute and chronic phases of DWB are the cornerstone of long-term management of these patients. 3. Implementation of the intervention and milieu-management strategies described in this article resulted in a reduction of patients requiring acute medical treatment subsequent to an acute phase of DWB.
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Affiliation(s)
- D J Ribble
- Middletown Psychiatric Center, New York 10940
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11
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Abstract
We report our experience treating 14 elderly psychiatric patients with altered sodium states. Hypernatremia occurs more commonly among elderly psychiatric patients than among their younger counterparts, and elderly hypernatremic psychiatric patients suffer most commonly from dementia. Dilutional hyponatremia is less common and less severe among elderly schizophrenic patients compared with younger patients with schizophrenia. Central nervous system changes induced by altered sodium states among elderly psychiatric patients are sufficiently similar whether hyper- or hyponatremia is present; therefore, the clinician must not wait for specific features to develop, but must quickly measure serum sodium concentration in elderly psychiatric patients with altered mental states. Treatment of hypernatremia involves rehydration with normal saline or hypotonic solutions, and treatment of dilutional hyponatremia largely involves fluid restriction.
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Affiliation(s)
- V Vieweg
- Piedmont Geriatric Hospital, Department of Mental Health, Commonwealth of Virginia, Burkeville
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12
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de Leon J, Verghese C, Tracy JI, Josiassen RC, Simpson GM. Polydipsia and water intoxication in psychiatric patients: a review of the epidemiological literature. Biol Psychiatry 1994; 35:408-19. [PMID: 8018788 DOI: 10.1016/0006-3223(94)90008-6] [Citation(s) in RCA: 174] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Polydipsia among chronic psychiatric patients is poorly understood and underdiagnosed. It may have three stages: simple polydipsia, polydipsia with water intoxication, and physical complications. Epidemiological surveys have used staff reports and polyuria measures to identify polydipsic patients. Water intoxication has been screened by chart review, weight, or serum sodium data. According to these surveys, polydipsia, not explained by medically induced polyuria, may be present in more than 20% of chronic inpatients. Up to 5% of chronic inpatients had episodes of water intoxication although mild cases may have been missed. Single time point surveys show that 29% of polydipsic patients had presented water intoxication. Methodologically limited clinical studies suggest that polydipsia with water intoxication rather than simple polydipsia may be associated with poor prognosis in schizophrenia. Epidemiological surveys found polydipsia with water intoxication to be associated with chronicity, schizophrenia, smoking, some medications, male gender, and white race. New pathophysiological models need to elucidate these findings.
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Affiliation(s)
- J de Leon
- Medical College of Pennsylvania, Eastern Pennsylvania Psychiatric Institute, Philadelphia 19129
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13
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Vieweg V, Pandurangi A, Levenson J, Silverman J. The consulting psychiatrist and the polydipsia-hyponatremia syndrome in schizophrenia. Int J Psychiatry Med 1994; 24:275-303. [PMID: 7737786 DOI: 10.2190/5wg5-vv1v-bxad-805k] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The authors seek to extend understanding and treatment of hospitalized schizophrenics presenting with complications of polydipsia and dilutional hyponatremia. Attending physicians may ask the consultation/liaison psychiatrist to see schizophrenics with hyponatremically-induced delirium or other psychiatric syndromes. The referring physician may or may not have identified polydipsia and dilutional hyponatremia and their complications. This article will help the consultation/liaison psychiatrist recognize early evidence of water imbalance, describe evaluation, and provide somatic and behavioral treatment approaches to this life-threatening syndrome. METHOD Over the past ten years, the authors have treated more than 100 patients with the polydipsia-hyponatremia syndrome. The authors discuss their and others' experience with drugs that help and hinder patients suffering from dilutional hyponatremia. They review current key articles from the polydipsia-hyponatremia syndrome literature including articles identified via Medline search 1985-94. RESULTS Schizophrenics with the polydipsia-hyponatremia syndrome most commonly present with polydipsia, polyuria, urinary incontinence, cognitive, affective, and behavioral changes, seizures, or coma. Quantitating polydipsia, hyponatremia, and diurnal changes in body weight facilitate therapeutic interventions. Treatment include patient and caregiver education, drug therapies to better treat psychosis and better treat osmotic dysregulation, behavioral interventions to interdict polydipsia, and diurnal weight monitoring. CONCLUSIONS Once recognized, acute, subacute, and chronic complications of the polydipsia-hyponatremia syndrome are readily treatable. Besides treating the patient, consultation/liaison psychiatrists can teach their medical colleagues about this syndrome. In so doing, they will enhance the quality of their patients' lives and help the internist and surgeon feel more comfortable when working with schizophrenics.
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Affiliation(s)
- V Vieweg
- Department of Psychiatry, Medical College of Virginia, Richmond 23298-0710, USA
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14
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15
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Abstract
1. It has been estimated that between 3% and 6% of patients in psychiatric treatment settings are affected by water intoxication. Water intoxication with consequent hyponatremia can result in disturbing clinical conditions. 2. Early detection is an important factor because of the insidious nature and rapid development of this syndrome. 3. A risk analysis for the early detection of this serious condition has been developed. It is easily administered and effective in categorizing a patient's level of risk.
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Affiliation(s)
- C Bugle
- Choate Mental Health and Developmental Center, Anna, IL 62906
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16
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Yank GR, Spradlin WW, Porterfield PB. General systems approaches in mental health administration : developing state-university collaboration programs. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 1992; 16:59-71. [PMID: 24443151 DOI: 10.1007/bf03341371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Developing state-university collaboration is the process of creating mechanisms to couple two systems for mutual benefit. Collaboration requires setting new organizational boundaries for both the state agency and the university and developing new patterns of information flow within and between the organizations. Each organization's homeostatic properties resist change; this resistance must be balanced by leaders' attention to the organization's developmental needs. The impact of collaboration increases tremendously after key thresholds of involvement are attained and a "critical mass" of faculty exerts a synergistic effect that shifts both the state agency and the university department to new functional states.
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Affiliation(s)
- G R Yank
- Western State Hospital, Staunton, USA
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17
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Pavalonis D, Shutty M, Hundley P, Leadbetter R, Vieweg V, Downs M. Behavioral intervention to reduce water intake in the syndrome of psychosis, intermittent hyponatremia, and polydipsia. J Behav Ther Exp Psychiatry 1992; 23:51-7. [PMID: 1430251 DOI: 10.1016/0005-7916(92)90025-e] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We describe a non-intensive behavioral intervention using an A-B design with extended follow-up on an open psychiatric unit to reduce water intake in a 52-year-old man with the syndrome of psychosis, intermittent hyponatremia, and polydipsia. A reinforcement schedule contingent upon weight gain secondary to water intake was employed. Mean diurnal weight gain was 7.1 pounds during a 23-week baseline which dropped to 4.1 pounds following 23 weeks of treatment and at a 1-year follow-up. Estimated fluid consumption dropped from 10 liters to 4 liters daily and incidents of hyponatremia decreased by 62%.
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18
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Alexander RC, Karp BI, Thompson S, Khot V, Kirch DG. A double blind, placebo-controlled trial of demeclocycline treatment of polydipsia-hyponatremia in chronically psychotic patients. Biol Psychiatry 1991; 30:417-20. [PMID: 1912134 DOI: 10.1016/0006-3223(91)90300-b] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- R C Alexander
- Neuropsychiatry Branches, National Institute of Mental Health, Washington, DC
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19
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Snider K, Boyd MA. When They Drink Too Much Nursing Interventions for Patients with DISORDERED WATER BALANCE. J Psychosoc Nurs Ment Health Serv 1991; 29:10-6. [PMID: 1875307 DOI: 10.3928/0279-3695-19910701-04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Disordered water balance affects as many as 60% of severely psychiatrically disabled persons. Most patients do not progress to the point of a medical emergency, but are in a state of mild chronic intoxication, making them unavailable for treatment and requiring nursing care to treat the effects of the chronic intoxicated state. Interventions depend on the severity of the disordered water balance and vary from teaching fluid intake control to controlling all patient access to fluids. Nursing management of water intoxication is a trial and error approach. Through a thorough assessment and close observation of the patient, the nurse can determine which interventions would be most appropriate for the patient.
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Affiliation(s)
- K Snider
- Veterans Administration Medical Center, St. Louis, Missouri
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20
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Riggs AT, Dysken MW, Kim SW, Opsahl JA. A review of disorders of water homeostasis in psychiatric patients. PSYCHOSOMATICS 1991; 32:133-48. [PMID: 2027935 DOI: 10.1016/s0033-3182(91)72084-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Disorders of water homeostasis are common in psychiatric patients and include compulsive water drinking, the syndrome of inappropriate antidiuretic hormone secretion (SIADH), and the syndrome of self-induced water intoxication (SIWI). Although water intoxication was recognized nearly 70 years ago, the physiological basis of these disorders of water metabolism still remains elusive. This review will provide a historical overview, critique current studies on compulsive water drinking and SIWI, discuss possible etiologies, and present current approaches to treatment of these disorders. Because of the complexity of the subject, a review of normal water homeostasis and the SIADH will be included.
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Affiliation(s)
- A T Riggs
- Department of Medicine, University of Minnesota, Minneapolis
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21
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Delva NJ, Crammer JL, Lawson JS, Lightman SL, Sribney M, Weier BJ. Vasopressin in chronic psychiatric patients with primary polydipsia. Br J Psychiatry 1990; 157:703-12. [PMID: 2279208 DOI: 10.1192/bjp.157.5.703] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Twelve chronic in-patients with primary polydipsia were studied, during free drinking and after fasting, by concurrent measurements of plasma AVP, serum sodium and osmolality, and urine volume, AVP, osmolality, and creatinine. A majority of the patients showed inappropriately high levels of AVP: plasma AVP estimations demonstrated that seven had Type I SIADH and two had Type II SIADH. Urinary AVP estimations confirmed inappropriately raised AVP in seven of the subjects tested, and there was a significant agreement between the plasma and urine diagnoses. Although able to concentrate their urine in response to fluid deprivation, the patients showed a decreased renal sensitivity to AVP. Despite the mitigating effect of decreased renal sensitivity to AVP, the SIADH seen in these patients appears to contribute to the development of water intoxication caused by polydipsia.
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Affiliation(s)
- N J Delva
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
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Abstract
Polydipsia, or excessive intake of water, is reviewed in the chronically mentally ill from a nursing perspective. The purpose of this article is to review research related to excessive water ingestion, the magnitude and types of problems that these patients experience, and the treatment interventions reported. Future research and practice should focus on understanding the patient's experience of polydipsia and how it relates to the patient's level of functioning, testing assessment tools, and determining appropriate interventions.
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Affiliation(s)
- M A Boyd
- School of Nursing, Southern Illinois University, Edwardsville 62026-1066
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24
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Vieweg WV, Harrington DP, Westerman PS, McKelway RB, Hundley PL, Yank GR. Seasonal stability of water balance among schizophrenic patients subject to water intoxication. Prog Neuropsychopharmacol Biol Psychiatry 1990; 14:215-22. [PMID: 2309037 DOI: 10.1016/0278-5846(90)90102-m] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
1. Diurnal weight gain, afternoon hyponatremia, and polyuria were assessed for one year among eight male schizophrenics subject to water intoxication. 2. The authors normalized the diurnal weight gain (NDWG) as a percentage by subtracting the 7 a.m. weight from the 4 p.m. Weight, multiplying the difference by 100, and then dividing the result by the 7 a.m. weight. 3. NDWG ranged between 2.69 +/- .99 and 3.34 +/- 1.32 percent (F [3, 5] = .885, p = .509) during the four seasons of the year. 4. The seasonal decrease in afternoon serum sodium compared to its morning counterpart ranged between 4.23 +/- 1.96 and 6.14 +/- 2.82 mmol/l (F [3, 5] = 2.212, p = .205). 5. Seasonal polyuria ranged between 8.2 +/- 3.5 and 8.8 +/- 3.2 liters (F [3, 5] = .228, p = .873). 6. Among schizophrenics subject to water intoxication, the seasonal stability in our three parameters of water imbalance suggest they may be used to follow patients with altered water homeostasis over time. This finding has both clinical and research implications.
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Affiliation(s)
- W V Vieweg
- Western State Hospital, Department of Mental Health, Staunton, Virginia
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26
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Vieweg WV, Godleski LS, Mitchell M, Hundley PL, Yank GR. Abnormal diurnal weight gain among chronically psychotic patients contrasted with acutely psychotic patients and normals. Psychol Med 1989; 19:105-109. [PMID: 2727200 DOI: 10.1017/s0033291700011065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We found diurnal weight gain to be abnormal among 28 institutionalized chronically psychotic patients. They were weighed daily for 15 days at 7 a.m. and 4 p.m. We normalized the diurnal weight gain (NDWG) as a percentage by subtracting the 7 a.m. weight from the 4 p.m. weight, multiplying the difference by 100, and then dividing the result by the 7 a.m. weight. NDWG was 2.8 +/- 1.3% for the 28 study patients, 0.631 +/- 0.405% for 16 acutely psychotic controls, and 0.511 +/- 0.351% for 29 normals. Ninety-three per cent of the study sample had NDWG values above the upper limit of normal. Sex, diagnosis, smoking, baseline weight, blood pressure, and pulse did not explain these observations. NDWG related (N = 28, r = 0.552, P = 0.002) to antipsychotic drug dose. The implications of our findings are discussed.
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Affiliation(s)
- W V Vieweg
- Clinical Evaluation Service, Western State Hospital, Stauton, VA 24401
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27
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Vieweg WV, Godleski LS, Hundley PL, Yank GR. Failure of antipsychotic drug dose to explain abnormal diurnal weight gain among 129 chronically psychotic inpatients. Prog Neuropsychopharmacol Biol Psychiatry 1989; 13:709-23. [PMID: 2571178 DOI: 10.1016/0278-5846(89)90059-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
1. The diurnal weight gain was found to be abnormal among 129 chronically psychotic inpatients. 2. The patients were weighed at 7 a.m. and 4 p.m. weekly for three weeks. We normalized the diurnal weight gain (NDWG) as a percentage by subtracting the 7 a.m. weight from the 4 p.m. weight, multiplying the difference by 100, and then dividing the result by the 7 a.m. weight. 3. NDWG was 2.2 +/- 1.5 percent for 87 male patients compared (p less than .0001) with .53 +/- .41 for 14 male controls. 4. NDWG was 1.8 +/- 1.0 percent for 42 female patients compared (p less than .0001) with .49 +/- .30 for 15 female controls. 5. Seventy percent of male and female patients had NDWG values greater than two standard deviations above the mean values of controls. 6. Differences in age, sex, morning weight, antipsychotic drugs, lithium, carbamazepine, phenytoin, blood pressure, and pulse did not explain these findings.
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Affiliation(s)
- W V Vieweg
- Western State Hospital, Department of Mental Health and Mental Retardation, Commonwealth of Virginia, Staunton 24401
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Vieweg WV, Hundley PL, Godleski LS, Tisdelle DA, Pruzinsky T, Yank GR. Diurnal weight gain as a predictor of serum sodium concentration in patients with psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome). Psychiatry Res 1988; 26:305-12. [PMID: 3222395 DOI: 10.1016/0165-1781(88)90125-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Ten male patients (mean age 37.3 +/- 6.4 years) with psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome) underwent measurement of weight, sitting and standing blood pressure, and serum sodium concentration at 7 a.m. and 4 p.m. weekly for 8 consecutive weeks. Blood pressure was higher in the afternoon than in the morning. The diurnal decrease in serum sodium (141.4 +/- 2.8 to 134.2 +/- 4.8 mEq/l) was associated with a diurnal increase in weight (78.4 +/- 9.7 to 80.0 +/- 10.3 kg). When the weight increase was normalized by dividing by 7 a.m. weight (NDWG), the following relationship evolved: diurnal serum sodium decrease = 3.060 + [201.728 x NDWG]. Therefore, NDWG accounted for 63.1% of the variability of serum sodium. Using the known relationship of plasma water, total body water, and total body weight, we calculated that antidiuresis (afternoon weight gain) accounted for 62.5% of afternoon hyponatremia. Thus, two separate methods of calculating the relationship between antidiuresis and hyponatremia provided remarkably similar findings. We derived a table to predict 4 p.m. serum sodium values based on 7 a.m. weight, 7 a.m. serum sodium, and 4 p.m. weight.
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Affiliation(s)
- W V Vieweg
- Western State Hospital, Department of Health and Mental Retardation, Commonwealth of Virginia, Staunton 24401
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Abstract
We evaluated diurnal weight gain and polyuria among 31 institutionalized chronically psychotic patients receiving lithium and 42 controls not receiving this drug. The patients were weighed weekly for three weeks at 7 a.m. and 4 p.m. We normalized the diurnal weight gain (NDWG) as a percentage by subtracting the 7 a.m. weight from the 4 p.m. weight, multiplying the difference by 100, and then dividing the result by the 7 a.m. weight. Polyuria was assessed using mean urine creatinine concentration (MUCR). NDWG was abnormal among study patients (1.9 +/- 1.2%) and controls (1.6 +/- 1.5%) independent of lithium treatment. The variation in MUCR explained about 20% of the variation in NDWG in both groups.
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Affiliation(s)
- W V Vieweg
- Western State Hospital, Department of Mental Health and Mental Retardation, Virginia
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Vieweg WV, Robertson GL, Godleski LS, Yank GR. Diurnal variation in water homeostasis among schizophrenic patients subject to water intoxication. Schizophr Res 1988; 1:351-7. [PMID: 3154522 DOI: 10.1016/0920-9964(88)90048-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Among seven schizophrenic patients subject to water intoxication (six men and one woman, mean age 39.1 +/- 6.9 years), we measured serum sodium, plasma arginine vasopressin, and urine osmolality at 7 a.m. and 4 p.m. on eight consecutive Thursdays. On the days of greatest diurnal change in serum sodium, the 7 a.m. serum sodium was 141.1 +/- 1.8 mEq/l and the 4 p.m. value was 129.9 +/- 3.2 mEq/l. Plasma vasopressin also tended to be lower at 4 p.m. but, in many cases, was inadequately suppressed for the level of hyponatremia. The urine was dilute at both 7 a.m. and 4 p.m. and mean urine osmolality did not differ at the two times. In three patients, urine osmolality was consistently subnormal relative to plasma vasopressin at both 7 a.m. and 4 p.m. This abnormality was consistent with nephrogenic diabetes insipidus secondary to lithium and, possibly, phenytoin which the patients received to protect them against hyponatremia. We conclude that the combination of polydipsia and abnormal osmoregulation of vasopressin secretion contributes importantly to the afternoon hyponatremia found in schizophrenic patients subject to water intoxication.
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Affiliation(s)
- W V Vieweg
- Western State Hospital, Department of Mental Health and Mental Retardation, Staunton, VA 24401
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Vieweg WV, Godleski LS, Goldman F, Burtner BA, Hundley PL, Yank GR. Abnormal diurnal weight gain among chronically psychotic patients compared to a control population. Acta Psychiatr Scand 1988; 78:169-71. [PMID: 3223314 DOI: 10.1111/j.1600-0447.1988.tb06317.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We report inappropriate antidiuresis as manifested by abnormal diurnal weight gain among 29 male and female chronically psychotic patients compared to a control population. Abnormal diurnal weight gain may be a new metabolic marker for chronically psychotic patients.
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Affiliation(s)
- W V Vieweg
- Clinical Evaluation Service, Western State Hospital, Charlottesville, Virginia
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Vieweg WV, Godleski LS. Psychosis, body weight and plasma sodium. Br J Psychiatry 1988; 153:122-3. [PMID: 3224238 DOI: 10.1192/bjp.153.1.122b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Vieweg WV, Wilkinson EC, David JJ, Rowe WT, Hobbs WB, Spradlin WW. The use of demeclocycline in the treatment of patients with psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome). Psychiatr Q 1988; 59:62-8. [PMID: 3131788 DOI: 10.1007/bf01064293] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Eight patients (7 men and 1 woman, mean age 43.1 +/- 8.9 years) with psychosis, intermittent hyponatremia, and polydipsia (PIP syndrome) underwent treatment with demeclocycline in an effort to normalize serum sodium levels and thereby protect the PIP patients against complications including hyponatremic seizures and coma. There tended to be an improvement (p = .080) in early morning serum sodium following treatment with demeclocycline (baseline 132.6 +/- SD 3.3 and treatment serum sodium 134.8 +/- SD 3.3 mEq/1). At the same time, there was an increase (p = .043) in urinary specific gravity following treatment with demeclocycline (baseline 1.0047 +/- SD .0029 and treatment urinary specific gravity 1.0063 +/- SD .0026). Clinical indications for and potential mechanisms of action of demeclocycline treatment in the PIP syndrome are discussed.
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Affiliation(s)
- W V Vieweg
- Western State Hospital, Department of Mental Health and Mental Retardation, Staunton, VA 24401
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