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PubMed1992

Early detection of water intoxication.

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.

Adult↗

PubMed1985

Water intoxication in psychiatric patients.

Compulsive water drinking is associated with a broad spectrum of psychopathology, from mild neurosis to psychosis. Since the normal kidney is capable of excreting large volumes of fluid rapidly, water intoxication requires both a pathological basis and a psychiatric explanation of why so much water is being taken. Excessive water consumption can be dangerous, so that the fluid intake of patients with a history of polyuria together with a low urinary specific gravity should be closely observed. Four cases of water intoxication resulting from psychogenic polydipsia are described, three of them in chronic schizophrenics, where inappropriate ADH secretion might represent part of the psychosis.

Adult↗

PubMed1990

The water-intoxicated patient.

In a long-term psychiatric setting, self-induced water intoxication may be a life-threatening situation. At first glance, the symptoms or behaviors of self-induced water intoxication are similar to schizophrenia, i.e., inappropriate behavior, delusions, hallucinations, confusion, and disorientation. In some cases, the symptoms of water intoxication mimic schizophrenia and thus, are disguised as a part of the psychoses. Affected individuals develop polydipsia, which is accompanied by overhydration and dilutional hyponatremia. If untreated, the symptoms may progress from mild confusion to acute delirium, seizures, coma, or death (Ripley, Millson, & Koczapski, 1989). Under normal circumstances there is a delicate balance of water requirement and water intake. If the balance of water is altered, electrolyte imbalance can occur. The recognition of water intoxication or self-induced water intoxication and psychosis among chronic, institutionalized patients may prevent their death or the development of neurological damage (Arieff, 1985). Because self-induced water intoxication often goes unrecognized in its early stages and may have irreversible or fatal complications, early detection is crucial. This article will discuss the etiology, nursing assessment, and interventions associated with patients suffering from self-induced water intoxication.

Adult↗

PubMed1984

Evaluation of patients with self-induced water intoxication and schizophrenic disorders (SIWIS).

The complications of water intoxication are well documented in the medical literature. Less well appreciated is the frequent appearance of self-induced water intoxication in patients with schizophrenic disorders. Six such patients are described and compared with the findings in the literature. Nonedematous, nonhypovolemic hyponatremia is the invariable biochemical abnormality in this syndrome and its multiple causes are discussed, including the syndrome of inappropriate antidiuresis. Severe hyposthenuria (urinary specific gravity 1.003 or less) is the silent biological marker that always antedates the complications of self-induced water intoxication and schizophrenic disorders (SIWIS). While recognizing that all patients with polydipsia do not go on to develop water intoxication, this biological marker provides the means to detect patients who may be destined to develop SIWIS; early recognition may prevent the major complications of this syndrome.

Adult↗

PubMed1997

Cyclophosphamide induced water intoxication in a woman with Sjögren's syndrome.

Water intoxication is a well described complication of high dose intravenous (i.v.) cyclophosphamide therapy combined with forced hydration. Less well known is that water intoxication can develop even after low dose iv cyclophosphamide. To draw attention to this potentially life threatening complication, we describe a woman who developed acute water intoxication after treatment with low dose iv cyclophosphamide for a sensory neuropathy secondary to Sjögren's syndrome. Rheumatologists should be aware of this serious adverse effect of iv cyclophosphamide because this drug is being used increasingly for treatment of a variety of rheumatological diseases. The pathogenesis, clinical characteristics, treatment, and methods for prevention of cyclophosphamide induced water intoxication are discussed.

Antirheumatic Agents↗

PubMedDate not supplied

[Prevalence of polydipsia and water intoxication in psychiatric inpatients].

INTRODUCTION: The prevalence of polydipsia and water intoxication among psychiatric inpatients has been described in different countries, however few studies have been conducted in Europe. The present study was aimed at evaluating the prevalence of polydipsia and water intoxication in an European Psychiatric Hospital. METHODS: SPGU (Specific Gravity of Urine) and Normalised Diurnal Weight Gain (NDWG) were evaluated among 201 inpatients. RESULTS: Risk of polydipsia and water intoxication were found among 51% of all patients. Risk of primary polydipsia was present in 25% of patients, and primary polydipsia and risk of water intoxication among 25% of all patients. CONCLUSIONS: This is one of the unique studies of polydipsia and water intoxication in psychiatric inpatients in Europe, and the first one conducted in Spain. The development of specific preventative and clinical programmes in psychiatric patients is suggested due to the clinical relevance and high prevalence of this pathology.

Adult↗

PubMed1980

Fatal water intoxication in a case of psychogenic polydipsia.

The term "water intoxication" is used to describe a condition of agitation, delirium, convulsion, and coma brought on by excessive intake of water, resulting in severe hyponatremia. Psychogenic polydipsia (compulsive water drinking) has until recently been considered a relatively benign process. Since 1974, however, three fatal cases of water intoxication, resulting from psychogenic polydipsia, have been reported. All three individuals died while hospitalized, thereby permitting performance of blood electrolyte determinations and documentation of the associated electrolyte imbalance. In the authors' case, there was a well-documented prior episode of water intoxication in which serum electrolytes showed a pattern typical of this entity. Death, however, occurred at home, thus preventing valid serum electrolyte determinations to be performed. Analysis of the vitreous humor revealed a severe hyponatremia, thus substantiating the diagnosis of fatal water intoxication. This case, once again, points out the usefulness of electrolyte analyses on the vitreous humor as an aid to establishing a cause of death.

Chlorides↗

PubMed1995

[Water intoxication following preparation for barium enema].

BACKGROUND: Induction of water intoxication from tap water enemas was reported a few years ago. Its treatment is still debated. CASE REPORT: A 4 1/2 year-old boy was admitted because he suffered from coma grade I. A barium enema had been prescribed for fecal incontinence and the patient had been given orally about 4 liters of water during the 24 hours preceding this investigation. Blood examination showed;: Na 122 mEq/l; K 3 mEq/l; Cl 87 mEq/l. Brain CT scan was normal. The patient was placed under restriction of fluid and was given i.v. 5.8% NaCl solution (2 mM/kg) for 3 hours. Convulsions appeared despite this treatment requiring intubation and ventilation plus increasing doses of NaCl: 20% solution (2 mM/kg) for 30 minutes followed by 2 mM/kg for 3 hours, associated with mannitol and furosemide infusion. CONCLUSION: Use of hypertonic saline solutions in the treatment of water intoxication is discussed. Acute hyponatremia must be rapidly corrected using hypertonic saline solution plus restriction of fluid and diuretic.

Barium Sulfate↗

PubMed1984

Water intoxication in a psychotic patient with normal renal water excretion.

A psychotic patient with hyponatremia and obtundation following short-term ingestion of large amounts of water was found to have maximally dilute urine, and underwent brisk diuresis until the serum osmolality returned to normal. This is the first report of normal renal diluting capacity as documented by measurement of urine osmolality in a water-intoxicated, schizophrenic patient, and demonstrates that normal renal diluting mechanisms may on occasion be overwhelmed by massive water ingestion.

Adult↗

PubMed1995

Patient perceptions of self-induced water intoxication.

This study comprehensively examines self-induced water intoxication (SIWI) from a patient perspective including demographics, reasons for seeking fluids, patterns/behaviors of fluid seeking, and symptoms frequently experienced while in a state of SIWI. The subjects were 45 of an original convenience sample of 62 individuals with a serious mental illness (SMI), hospitalized in a long-term state psychiatric facility, who engaged in self-induced water intoxication. All participants were interviewed in a structured format to complete a 40-item Likert-type questionnaire developed for the study, titled the Self-induced Water Intoxication Questionnaire (SIWIQ). In the study, the majority of participants were smokers, and reported no past problem with alcohol. SIWI occurred more in males than females, and was more predominant in those participants who had longer hospital stays. Anger and vomiting were found to be the two most predominant symptoms experienced when excess fluid consumption occurred. Behaviors of drinking from the shower, the toilet, and one's own urine are consistent with findings of previous studies and illustrate the difficulty in keeping individuals with SIWI from fluids. Data show that participants with SIWI experience considerable anxiety and cognitive difficulties and express these as reasons for engaging in excess fluid consumption. Boredom, obtaining a high, and sad mood were also predominant reasons identified for excess fluid drinking. Significant relationships were found and discussed. The findings provide support for the position that SIWI represents an attempt at treatment by the dysfunctional individual and is pursued for anxiolytic effects and alleviation of boredom. The data support the idea of approaching the problem from a dysfunctional coping framework, realizing that SIWI is a very complex problem, needing examination and intervention at multiple levels, beyond exclusive focus on fluid control.

Adaptation, Psychological↗

PubMed1990

Water intoxication in psychiatric patients in Singapore.

The syndrome of water intoxication may occur in psychiatric patients and various hypotheses regarding its aetiology have been postulated. Twenty-seven patients in Woodbridge Hospital were found to have this syndrome. The aim of the study was to describe the clinical and biochemical findings of this group of patients. 70.4% had schizophrenia, 25.9% had mental retardation and 3.7% had a history of alcohol dependence. Many of them were on antipsychotic medication. The symptoms of water intoxication included polyuria, nausea, tremors, weight gain, disorientation, coma and fits. A majority of the patients had hyponatraemia during the acute stages and the osmolality of urine and plasma were correspondingly low. A few patients had abnormalities in electroencephalogram and computerised axial tomography of brain. The management of patients with water intoxication is discussed briefly.

Adult↗

PubMed1986

Perspective on carbamazepine-induced water intoxication: reversal by demeclocycline.

Carbamazepine (CBZ)-induced water intoxication occasionally limits its usefulness in refractory seizures and trigeminal neuralgia. Fluid restriction, CBZ dose reduction, or concomitant phenytoin therapy may be impractical or ineffective. Demeclocycline (7-chloro-6 demethyl tetracycline) (DMC) corrected the CBZ-induced water intoxication in a 51-year-old man with refractory complex partial seizures and a normal antidiuretic hormone (ADH) level. DMC inhibits ADH-sensitive adenylate cyclase activity in the renal collecting duct and may be useful in correcting the ADH-like or renal antidiuretic effect of CBZ.

Carbamazepine↗

PubMedDate not supplied

Diurnal variation in water homeostasis among schizophrenic patients subject to water intoxication.

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.

Adult↗

PubMed1976

Self-induced water intoxication in a schizophrenic patient.

Water intoxication occurred in a 53-year-old woman with chronic simple schizophrenia and poorly controlled diabetes. For several years she had had a compulsive habit of drinking excessive amounts of water. Coma, fever, convulsions and other neurologic signs appeared suddenly, and she had severe hyponatremia. Her condition improved rapidly when the electrolyte abnormality was corrected.

Drinking↗

PubMed1994

Polydipsia and water intoxication in psychiatric patients: a review of the epidemiological literature.

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.

Chronic Disease↗

PubMed2000

Sex-dependent changes in blood-brain barrier permeability and brain NA(+),K(+) ATPase activity in rats following acute water intoxication.

To understand the increased susceptibility of the development of serious complications to hypoosmotic hyponatremia in young females, we examined the resistance of blood brain barrier (BBB) permeability to water along with the synaptosomal Na(+),K(+)ATPase activity in both sexes of rats during acute water intoxication. Four groups of rats were used: Group I and II were normal female and male rats injected with only Evans-blue. Group III and IV were water intoxicated female and male rats respectively. BBB permeability in female rats was found to be increased following acute water intoxication. In contrast, synaptosomal Na(+),K(+)ATPase activities in both water intoxicated male and female rats were found significantly lower than those in control rats. But inhibition in enzyme activity in synaptosomes from water intoxicated female rats was more pronounced than those of corresponding male rats. Our results concluded that female sex steroids may be responsible for the highly significant decrease in synaptosomal Na(+),K(+)ATPase activity and increased BBB permeability in female rats following water intoxication.

Acute Disease↗

PubMed1985

Patterns of urinary excretion among patients with self-induced water intoxication and psychosis.

Parameters of water metabolism were measured serially in nine patients with the syndrome of self-induced water intoxication and psychosis (SIWIP). Clinical and laboratory findings indicated that SIWIP patients are type A of the syndrome of inappropriate antidiuresis. Estimated 24-hour urinary excretion of creatinine and early morning urinary creatinine concentration measurements were used to calculate 24-hour urine volumes. Polyuria was considered present for male patients when excretion was estimated to be greater than 2,600 ml of urine/24 hours or early morning urinary specific gravity was less than or equal to 1.003. Male patients with a specific gravity of less than or equal to 1.003 predictably excreted 28,000 ml of urine/day. Severe hyposthenuria may be a biological marker for a population at risk to develop complications of SIWIP, including seizures, coma, and death.

Adult↗

PubMed1991

Acute water intoxication as a complication of urine drug testing in the workplace.

Urine drug testing is now mandatory in many industries. We report the first case, to our knowledge, of an adverse consequence of drug testing in the workplace: acute water intoxication. We discuss normal water metabolism and the adverse effects of water loading and impaired renal function on free water clearance. We present a literature review of seven other cases of acute voluntary water intoxication in patients without chronic psychiatric or neurologic illness. For workers undergoing urine drug testing we conclude that risk factors for acute water intoxication include (1) intake of more than 1 L of water and (2) impaired urine dilution. In a recently drug-tested worker, symptoms of cerebral dysfunction should suggest the possibility of water intoxication.

Acute Disease↗