Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-02T19:46:18.587Z Has data issue: false hasContentIssue false
  • English
  • Français

Hyponatraemia in elderly and adult psychiatric inpatients

Published online by Cambridge University Press:  13 June 2014

Stephen Critchlow
Stephen Critchlow*
Affiliation:
Department of Psychiatry, Lagan Valley Hospital, Hillsborough Road, Lisburn, Co Antrim BT28 1JP, Northern Ireland.
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: The objectives of this paper are to review the presentation of hyponatraemia and diagnose its cause in psychiatric inpatients.

Method: Episodes of significant hyponatraemia (sodium <130mmol/L) were identified from computerised biochemical data and a retrospective review of patients' notes was carried out.

Result. The diagnoses of hyponatraemia reached were different for the two groups of patients studied, adults of over 65 years and under 65 years. Carbamazepine, polydipsia and medical conditions were found as causes in the below 65 age group. Diuretics, medical conditions and lofepramine were identified as causes in the over 65 age group. Inpatients with polydipsia below the age of 65 had lower sodium (p = 0.013) and urea levels (p = 0.00059) than other groups and patients with carbamazepine induced hyponatraemia tended to have episodic hypocalcaemia (p = 0.056). These groups were compared using Fisher's exact test. This study also showed the overall frequency of serum sodium of less than 135mmol/L to be 9.5% in psychiatric inpatients.

Conclusion: Hyponatraemia is a not uncommon finding in psychiatric inpatients. Attention to drug therapy and biochemical findings are helpful in its diagnosis. Accurate diagnosis is usually possible and may vary according to age-group.

Keywords

HyponatraemiaPolydipsiaPsychiatric inpatientsCarbamazepineDiureticsLofepramine.
Type
Original Papers
Information
Irish Journal of Psychological Medicine , Volume 15 , Issue 1 , March 1998 , pp. 6 - 9
Copyright
Copyright © Cambridge University Press 1998

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

1.Ohsawa, H, Kishimoto, T, Hirai, Met al.An epidemiological study on hyponatraemia in psychiatric patients in mental hospitals in Nara Prefecture. Jpn J Psychiatry Neurol 1992; 46(4): 883–9.Google ScholarPubMed
2.de Leon, J, Dadvand, M, Canuso, C, Odom-White, A, Stanilla, J, Simpson, GM. Polydipsia and water intoxication in a long-term psychiatric hospital. Biol Psychiatry 1996; 40(1): 28–34.CrossRefGoogle Scholar
3.Vieweg, V, Pandurangi, A, Levenson, J, Silverman, J. The consulting psychiatrist and the polydipsia-hyponatraemia syndrome in schizophrenia. Int J Psychiatry in Medicine 1994; 24(4): 275–303.CrossRefGoogle Scholar
4.Rowntree, IG. Water intoxication. Arch Intern Med 1923; 32: 157–74.CrossRefGoogle Scholar
5.Korzets, A, Ori, Y, Flora, Set al.Case report: severe hyponatraemia after water intoxication: a potential cause of rhabdomyolysis. Am J Med Sci 1996; 312(2): 92–4.CrossRefGoogle ScholarPubMed
6.Shutty, MS Jr, Leadbetter, RA. Case report: recurrent pseudocyesis in a male patient with psychosis, intermittent hyponatraemia. and polydipsia. Psychosom Med 1993; 55(2): 146–8.CrossRefGoogle Scholar
7.McColl, P, Kelly, C. A misleading case of entral pontine myelinolysis. Risk factors for psychiatric patients. Br J Psychiatry 1992; 160: 550–2.CrossRefGoogle Scholar
8.Vieweg, V, Rowe, W, David, Jet al.Hyposthenuria as a marker for self-induced water intoxication and schizophrenic disorders. Am J Psychiatry 1984; 141: 1258–60.Google ScholarPubMed
9.Naccarato, R, Rizzo, A, Sirigu, Fet al.Renal histologic and ultrastructural findings in psychogenic polydipsia and diabetes insipidus. Nephron 1976; 16: 226–35.CrossRefGoogle ScholarPubMed
10.Harrison, RB, Ramchandani, P, Allen, JT. Psychogenic polydipsia: unusual cause for hydronephrosis. AJR 1979; 133: 327–8.CrossRefGoogle ScholarPubMed
11.Blum, A, Friedland, GW. Urinary tract abnormalities due to chronic psychogenic polydipsia. Am J Psychiatry 1983; 140: 915–16.Google ScholarPubMed
12.Hobson, JA, English, JT. Self-induced water intoxication. Ann Intern Med 1963; 58: 324–332.CrossRefGoogle ScholarPubMed
13.Emsley, R, Roberts, M, Smith, R, Spangenberg, J, Chalton, D. Disordered water homeostasis in schizophrenia and cerebral ventricular size. Br J Psychiatry 1995; 166(4): 501–6.CrossRefGoogle ScholarPubMed
14.Peterson, DT, Marshall, WH. Polydipsia and inappropriate secretion of antidiuretic hormone associated with hydrocephalus. Ann Intern Med 1975; 83: 675–6.CrossRefGoogle ScholarPubMed
15.Shen, WW, Sata, LS. Hypothalamic dopamine receptor supersensitivity? A pilot study of self induced water intoxication. Psychiatr J Univ Ottawa 1983; 8: 154–8.Google ScholarPubMed
16.Smith, WO, Clark, ML. Self-induced water intoxication in schizophrenic patients. Am J Psychiatry 1980; 137: 1055–60.Google ScholarPubMed
17.Alexander, ER, Crow, TJ, Hamilton, SM. Water intoxication in relation to acute psychotic disorder. BMJ 1973; 1: 89.CrossRefGoogle ScholarPubMed
18.Emery, R. Water intoxication. BMJ 1959; 2: 190.CrossRefGoogle Scholar
19.Silber, TJ. Seizures, water intoxication in anorexia nervosa. Psychosomatics 1984: 25: 705–6.CrossRefGoogle ScholarPubMed
20.Schwartz, WB, Bennett, W, Curelop, S. A syndrome of renal sodium loss and hyponatraemia probably resulting from inappropriate secretion of antidiuretic hormone. Am J Med 1957; 23: 529–42.CrossRefGoogle ScholarPubMed
21.Bartter, FC, Schwartz, WB. The syndrome of inappropriate secretion of antidiuretic hormone. Am J Med 1967; 42: 790–806.CrossRefGoogle ScholarPubMed
22.Moses, AM, Miller, M. Drug-induced dilutional hyponatraemia. N Engl J Med 1974; 291: 1234–9.CrossRefGoogle Scholar
23.Blum, A. The possible role of tobacco cigarette smoking in hyponatraemia of long-term psychiatric patients. JAMA 1984; 252: 2864–5.CrossRefGoogle ScholarPubMed
24.Chin, WW, Cooper, DS, Crapo, Let al.Water intoxication caused by smoking in a compulsive water drinker (abstract). Clin Res 1976; 24: 625A.Google Scholar
25.Ellinas, PA, Rosner, F, Jaume, JC. Symptomatic hyponatraemia associated with psychosis, medications and smoking. J Nat Med Assoc 1993; 85(2) 135–41.Google ScholarPubMed
26.Vieweg, WVRKarp, BI. Treatment strategies in the polydipsia-hyponatraemia syndrome. J Clin Psychiatry 1994; 55: 154–60.Google Scholar
27.Greer, RA, Stewart, RB. Hyponatraemia and ECT. Am J Psychiatry 1993; 150: 1272.Google ScholarPubMed
28.Spears, NM, Leadbetter, RA, Shutty, MS Jr. Clozapine treatment in polydipsia and intermittent hyponatraemia. J Clin Psychiatry 1996; 57: 3123–7.Google Scholar
29.Goldman, MB, Luchins, DJ. Effect of demeclocycline on serum sodium in hyponatraemic chronic schizophrenics. Biol Psychiatry 1985; 20: 1149–55.CrossRefGoogle Scholar