The parathyroid glands and vitamin D
S.S. Nussey, S.A. Whitehead in Endocrinology, 2001
Multiple symptoms arise when disease leads to hyper-or hypocalcemia and Clinical Case 5.1 illustrates features of hypercalcemia. Clinical Case 5.1 is a middle-aged woman suffering from the consequences of marked hypercalcemia, presenting with symptoms of polydipsia and polyuria. These, together with the weight loss, made her primary care physician suspect DM. However, this patient had anorexia whilst DM is much more commonly associated with a good appetite, despite weight loss. The polyuria resulted from the effects of hypercalcemia antagonizing the action of arginine vasopressin on the distal tubule and collecting ducts of the kidney (see Box 7.42). The resulting diuresis stimulated thirst and led to polydipsia. Her anorexia was due to the effects of hypercalcemia acting on the brain to reduce appetite.
Case 78: Dysarthric, Dysphagic and Polyuric
Layne Kerry in 100 Diagnostic Dilemmas in Clinical Medicine, 2017
A 49-year-old man was referred from the local psychiatric unit with a deteriorating Glasgow Coma Scale (GCS). He had been admitted to the unit 4 weeks earlier after neighbours reported that he appeared unkempt and disorientated. Since admission, the psychiatry team noted that the patient had become increasingly dysarthric, dysphagic, polyuric with urinary incontinence and agitated with new visual hallucinations. He complained of cough, weight loss and profound polydipsia. His past history included bipolar affective disorder, for which he took regular aripiprazole, diazepam and sodium valproate. Until several days earlier, he had been on lithium, quetiapine and procyclidine. He lived alone and was previously independent, smoked 12.5 g tobacco daily and did not drink alcohol.
Endocrinology and diabetes Case 15: A thirsty boy
Ronny Cheung, Aubrey Cunnington, Simon Drysdale, Joseph Raine, Joanna Walker in 100 Cases in Paediatrics, 2017
History Steven is a 4-year-old boy seen in the paediatric day unit with a 2-week history of polydipsia and polyuria. Having been dry at night for some time, he has also started wetting the bed. His mother thinks that he has lost some weight. He has been less cheerful than usual and has not wanted to go to school – his mother has put this down to tiredness at the end of his first term. She and Steven’s grandmother have hypothyroidism. There is no significant past medical history and he is fully immunized. He has a 2-year-old brother who is well.
A fatal case of polydipsia in a male with intellectual disability
Published in Journal of Intellectual and Developmental Disability, 1996
Polydipsia could be detected among 6.6% to 17.5% of the population in the state mental hospitals in the USA (see review by de Leon, Verghese, Tracey, Josiassen, & Simpson, 1994). However, the problem of polydipsia among the intellectually disabled population has only recently been highlighted. So far two reports of prevalence of polydipsia among adults with intellectual disability have been published. Bremner and Regan (1991) polydipsia in 3.5%, and Deb, Bramble, Drybala, Boyle, & Bruce (1994) found in 6.2% of the adults with intellectual disability who lived in institutions. Although fatality associated with polydipsia is relatively rare, a few cases have been reported among schizophrenic patients (Peh, Devan, & Low, 1990) but none in people with intellectual disability. It appears that a rapid drop in serum sodium level below 125 mmol/l in less than 24 hours increases the risk of mortality and brain damage (Arieff & Guisado, 1976).
Clozapine Treatment of Polydipsia
Published in Annals of Clinical Psychiatry, 1994
A patient with refractory chronic schizophrenia having severe polydipsia and hyponatremia was treated with clozapine. There followed a dramatic improvement in the polydipsia and correction of the hyponatremia. This improvement has been sustained throughout a 6-month follow-up.
Disordered water homeostasis in Asian patients with schizophrenia
Published in Australian and New Zealand Journal of Psychiatry, 1997
Siow-Ann Chong, Lay-Ling Tan, Mun-Chong Wong, Siew-Choo Woo, Chay-Hoon Tan, Li-Ling Ng
Objective: The aim of this study was to determine the prevalence of polydipsia-hyponatremia among patients with schizophrenia in an Asian mental hospital. Method: Seven hundred and twenty-eight inpatients with schizophrenia were assessed for polydipsia-hyponatremia using case notes reviews, specific gravity of urine, normalised diurnal weight gain, and serum sodium levels. Results: One hundred and three (13.8%) patients had polydipsia, 30 (4.1%) had polydipsia-hyponatremia and 14 (13%) had a history of water intoxication. Eight of the 30 patients were receiving carbamazepine, three were on tricyclic antidepres-sants and two had diabetes mellitus and were on sulfonylureas. Conclusion: The prevalence of water intoxication among polydipsic patients was low compared to Western studies. This could be due to different methods of assessing polyuria, or ethnic differences and/or the prohibition of smoking in our patients. Certain medications might have also contributed to hyponatremia.
Related Knowledge Centers
- Water Intoxication
- Polyuria
- Diabetes Insipidus
- Pathology
- Diabetes Mellitus
- Hyponatremia
- Schizophrenia