What is polydipsia
Polydipsia means is increased thirst and excessive fluid intake, greater than 3L per day, which is an abnormal feeling of always needing to drink fluids. Drinking lots of water is healthy in most cases. However, the urge to drink too much may be the result of a physical or emotional disease. As many as 20% of people with schizophrenia have polydipsia and approximately 3.5% – 5% of all schizophrenic patients develop a more serious symptom of self-induced water intoxication.
Polydipsia (excessive thirst) may also be a symptom of high blood sugar (hyperglycemia), which may help in detecting diabetes.
Polydipsia is often the reaction to fluid loss during exercise or to eating salty foods.
Polydipsia causes may include:
- A recent salty or spicy meal
- Bleeding enough to cause a large decrease in blood volume
- Diabetes mellitus
- Diabetes insipidus
- Medicines such as anticholinergics, demeclocycline, diuretics, phenothiazines
- Loss of body fluids from the bloodstream into the tissues due to conditions such as severe infections (sepsis) or burns, or heart, liver, or kidney failure
- Psychogenic polydipsia (a mental disorder)
Psychogenic polydipsia is a well-described phenomenon in those with a diagnosed psychiatric disorder such as schizophrenia and anxiety disorders. The compulsion to seek out and over drink any/all fluids and is a type of polydipsia exhibited by patients with mental illness and/or the developmentally disabled. Polydipsia is also present in a subset of schizophrenics. These individuals, often chronic schizophrenics with a long history of mental illness, frequently exhibit enlarged ventricles and shrunken cortex on MRI, making the physiological mechanism difficult to isolate from the psychogenic. Psychogenic polydipsia is a serious disorder that often leads to institutionalization as it can be very difficult to manage outside the inpatient setting. It should be taken very seriously and can be life-threatening, as serum sodium is diluted (hyponatremia) to an extent that seizures and cardiac arrest can occur. Those individuals afflicted with psychogenic polydipsia have been known to seek fluids from any source possible.
Psychogenic polydipsia patient drinks large amounts of any/all fluids, which raises the pressure of the extracellular space. As a side effect, the antidiuretic hormone (ADH) level is lowered. The urine produced by these patients will have a low electrolyte concentration, and it will be produced in large quantities (i.e., polyuria). If the individual is institutionalized, close monitoring by staff is necessary to control fluid intake. In extreme episodes, the patient’s kidneys will be unable to deal with fluid overload and weight gain will be noted.
Individuals diagnosed with ”psychogenic polydipsia” — of which 80% are diagnosed with schizophrenia — have a fluid intake that is usually 4 to 10L/day, some drink up to 22L/day! Hyponatremia is a low serum sodium level below 130mmol/L (normal range 135 – 1 45 mmol/L).
Polyuria is urine output in excess of 3L/day. In the psychiatric population, polyuria exists as a compensatory mechanism for polydipsia; 25% of polydipsia patients have acute development of hyponatremia where there is a precipitous drop in serum sodium. This occurs sporadically and unpredictably and results in the syndrome of water intoxication
Clozapine is an atypical antipsychotic medication, which, in low doses, is the most common pharmacological intervention in the treatment of self-induced water intoxication. The restriction of fluid intake appears to have little or no influence on the excessive urge to drink by patients diagnosed with psychogenic polydipsia. As a result, doctors have turned to pharmacological interventions to treat either the polydipsia itself or the hyponatremia. Of note: clozapine has well-known side effects, including orthostatic hypotension, lowering of seizure threshold, anti-cholinergic toxicity, and significant incidence of agranulocytosis (1% – 2%). Many patients with polydipsia or hyponatremia may have multiple physical illnesses that could preclude the use of clozapine.
Behavioral strategies include limiting the daily water intake when indicated, initiating fluid restriction when there is a significant weight increase, taking a “serum sodium levels” count if signs and symptoms of intoxication start to appear, providing constant attention for the patient which can include locking the individual in seclusion for their own safety. Behavioral management programs should be mandatory.
Psychosocial rehabilitation programs for individuals diagnosed with psychogenic polydipsia, requiring tertiary care, should be guided by the principles of psychosocial rehabilitation, with sophisticated medication management and behavioral interventions.
Polydipsia means excessive thirst, which is an abnormal feeling of always needing to drink fluids.
Your doctor will get your medical history and perform a physical exam.
Your doctor may ask you questions such as:
- How long have you been aware of having increased thirst? Did it develop suddenly or slowly?
- Does your thirst stay the same all day?
- Did you change your diet? Are you eating more salty or spicy foods?
- Have you noticed an increased appetite?
- Have you lost weight or gained weight without trying?
- Has your activity level increased?
- What other symptoms are happening at the same time?
- Have you recently suffered a burn or other injury?
- Are you urinating more or less frequently than usual? Are you producing more or less urine than usual? Have you noticed any bleeding?
- Are you sweating more than usual?
- Is there any swelling in your body?
- Do you have a fever?
Tests that may be ordered include the following:
- Blood glucose level
- Complete blood count (CBC) and white blood cell differential
- Serum calcium
- Serum osmolality
- Serum sodium
- Urine osmolality
Your doctor will recommend treatment if needed based on your exam and tests. For example, if tests show you have diabetes, you will need to get treated.
A very strong, constant urge to drink may be the sign of a psychological problem. You may need a psychological evaluation if the doctor suspects this is a cause. Your fluid intake and output will be closely watched.
Polydipsia may occur in almost any psychiatric disorder (e.g., Histrionic Personality Disorder). However, most cases (about 80%) of psychogenic polydipsia with self-induced water intoxication, occur with clients with a psychotic illness, usually of the schizophrenic type. The prevalence of compulsive water drinking in state psychiatric hospitals in the United States has been estimated between 7% – 18% and about half of this population suffer from the complications of self-induced water intoxication. Although there is some agreement in common areas of diagnosis and treatment interventions (i.e., Clozapine, behavior modification, psychosocial rehabilitation), a consistent treatment approach throughout the years has emphasized psychosocial rehabilitation strategies such as psycho — education, which has been implemented in various tertiary care settings.
The psychosocial rehabilitation approach to service delivery is based upon the following fundamental and interconnected concepts:
- Psychosocial rehabilitation programs emphasize the need for individually tailored interventions;
- Psychosocial rehabilitation programs emphasize a flexibility, either the individual’s capacities be adapted to environmental realities or the environment be changed to suit the capacities of the person;
- Psychosocial rehabilitation programs are oriented to exploitation of people’s strengths;
- Psychosocial rehabilitation programs aim at the restoration of hope;
- Psychosocial rehabilitation programs emphasize the vocational potential of mentally ill individuals;
- Psychosocial rehabilitation programs extend beyond work activities to encompass a full array of social and recreational life concerns;
- Recipients of psychosocial rehabilitation programs are actively involved in their own care;
- The psychosocial rehabilitation program is an ongoing process.