Severe Hyponatremia and Water Intoxication – Diagnostic Challenge in Department of Emergency Medicine

Abstract

Correspondence to: Jure Pupić-Bakrač, Department of Emergency Medicine, University Clinical Hospital Mostar, Bijeli Brijeg bb, 88 000 Mostar, Bosnia and Herzegovina Telephone: +385989764788 E-mail: jureppbkr2@gmail.com Copyright © 2017 KBCSM, Zagreb e-mail: alcoholism.kbcsm@gmail.com • www.http//hrcak.srce.hr/acoholism Abstract Psychogenic polydipsia is a disorder characterized by compulsive drinking of water in a population of psychiatric patients, most often those suffering from chronic psychosis. It can lead to severe dilutional hyponatremia and water intoxication, which is manifested by cerebral edema and associated neurological symptomatology. A 43 years-old patient was admitted to the Department of Emergency Medicine due to convulsions of the right hand and leg, which began one hour before arrival. During the episode, the patient was conscious, vomited once and had urinary incontinence. In the medical history he had epilepsy, chronic psychosis and moderate mental retardation. Vital parameters were stable, and physical examination did not reveal any associated pathological signs. Samples for laboratory analysis were taken and therapy with infusions of Diasepam (20 mg) included, to which patient was resistant. By heteroanamnesis it was acknowledged that in the last few days he spent more time than usual drinking water. Reviewing laboratory results it was found out that sodium concentration was 98 mmol/L. We began the gradual correction of sodium, after which the patient reached the full extent of recovery. Water intoxication is an emergency condition that is in clinical practice often mistaken for other neurological and internal emergency states, because of its non-specific symptomatology. With timely diagnosis and application of adequate treatment, recovery is complete.