- Dilutional Hyponatremia & Mental Illness
- Conditions Causing Dilutional Hyponatremia
- Substance Use Disorder
- Psychogenic Polydipsia
- Dilutional Hyponatremia Symptoms
- Dangers of Dilutional Hyponatremia
- Prevention Of Dilutional Hyponatremia
- Treatment Of Dilutional Hyponatremia
- Hyponatremia: Symptoms, Causes, Treatments
- Who is most at risk for hyponatremia?
- How common is hyponatremia?
- What are the symptoms of hyponatremia?
- What complications are associated with hyponatremia?
Dilutional Hyponatremia & Mental Illness
Water in the human body is comprised of electrolytes and ions, which helps cells to function. The human body is usually adept at keeping fluids and electrolytes in a balanced state, but can become imbalanced under certain conditions.
Dilutional hyponatremia, or water intoxication, occurs when an individual drinks an excessive amount of water without consuming enough electrolytes. This triggers an imbalance, as water enters the body’s cells and causes them to swell.
Dilutional hyponatremia is a serious condition and could potentially be life-threatening.
Individuals with various mental health conditions such as schizophrenia, schizoaffective disorder and bipolar disorder are at higher risk for hyponatremia.
Studies have shown that 3-25% of inpatient psychiatric populations are diagnosed with primary polydipsia, or compulsive water drinking.
People who engage in compulsive behaviors or who are struggling with various addictions are also at a higher risk.
Conditions Causing Dilutional Hyponatremia
Dilutional hyponatremia occurs when sodium levels fall in the blood, disrupting the regulation and balance of body fluids. Dilutional hyponatremia can result from medical conditions, certain medications or from drinking exorbitant amounts of water.
Medical conditions and diseases that impact the heart, kidney or liver can result in the accumulation of body fluids, which can dilute and lower sodium levels.
Serious and chronic diarrhea and vomiting represents another condition that can result in dehydration, causing the body to lose electrolytes.
Diabetes and high blood sugar can cause frequent urination, which can cause dehydration and increased thirst.
Medications that disrupt hormonal and kidney functioning can result in dilutional hyponatremia, as these processes regulate sodium levels. Water pills, pain medications and antidepressants are a few medications that can disrupt the regulation of sodium in the body.
Drinking excessive amounts of water can interfere with the kidney’s ability to remove water. When the kidneys become overwhelmed from excess water intake, low sodium can result.
Dilutional hyponatremia occurs in disorders that are associated with substance use and mental health issues. Individuals that abuse Ecstasy or stimulant drugs can elevate the risk of developing hyponatremia.
People who use alcohol and drugs may drink a lot of water in an effort to remove the drug from their bodies.
Individuals with an eating disorder may attempt to drink inordinate amounts of water to lose weight, or may exercise excessively while rehydrating only with water.
Substance Use Disorder
Dilutional hyponatremia is frequently reported in individuals with chronic substance use disorders. Individuals may develop the condition from abusing stimulants, from drinking beer or from attempting to rapidly detoxify their body of drugs or alcohol.
- Stimulant-induced overhydration: Individuals who take ecstasy can become very thirsty as a result of exertion, body temperature and dehydration. People who take ecstasy overexert themselves and sweat easily, prompting them to drink water for relief. Ecstasy is an antidiuretic, which makes a person retain water, elevating the risk of water intoxication. Stimulant abuse can result in thirst cravings and poor judgment may result in a person drinking excessive amounts of water to fast.
- Drinking beer: Individuals who consume excessive amounts of beer can be at risk of water intoxication. Beer contains a minimal amount of sodium and when combined with unhealthy nutrition, can lead to accelerated sodium loss.
- Rapid drug detoxification: People may attempt to drink an excessive amount of water in order to rid their body of drugs and alcohol. Individuals that abuse substances may try to overhydrate so that they can rapidly flush the substances their system.
Psychogenic polydipsia is also known as compulsive water drinking and results from excessive thirst. The compulsion to seek and drink fluids excessively is frequently displayed in individuals with mental illness.
Self-induced water intoxication can result in hyponatremia. Psychogenic polydipsia hyponatremia is commonly seen in individuals with chronic schizophrenia.
Of those diagnosed with psychogenic polydipsia, 80% also have a diagnosis of schizophrenia.
Other mental health conditions linked with psychogenic polydipsia include schizophrenia, affective disorders, personality disorders, and childhood-onset psychosis and more.
- Personality disorders: People with personality disorders, such as histrionic personality disorder, possess an unmanageable urge to drink water even though it is not necessary or indicated.
- Mood disorders: Psychogenic polydipsia is linked with psychiatric mood disorders, including depression and bipolar disorder. Early indications of sodium deficiency can mimic psychosis or bipolar disorder, as it can intensify symptoms of psychosis.
- Eating disorders: People diagnosed with eating disorders may attempt to lose weight by drinking excessive amounts of water.
- Body dysmorphia & obsessive exercise: Individuals who have body dysmorphia and who engage in obsessive exercising can sweat, become dehydrated and drink an excessive amount of water without electrolytes.
Dilutional Hyponatremia Symptoms
Dilutional hyponatremia symptoms occur as water moves into brain cells, causing them to fill and swell. Dilutional hyponatremia is a potentially life-threatening condition. The severity and duration of symptoms can warrant emergency intervention. Individuals who show severe water intoxication symptoms should seek emergency medical care right away.
Signs of water intoxication can include:
- Decreased energy and fatigue
- Increased mental confusion
- Impaired reflexes
- Slurred speech
- Nausea and vomiting
- Muscle spasms or cramps
Dangers of Dilutional Hyponatremia
Dilutional hyponatremia is often misdiagnosed or goes unrecognized during early stages. Early detection and accurate diagnosis are paramount to prevent severe dilutional hyponatremia, which can result in seizures, brain edema, swelling, coma or death.
Water intoxication deaths occur most often when exorbitant amounts of water are ingested in a short duration of time, but can also occur when water is consumed over a longer period of time. The most frequent deaths from dilutional hyponatremia occur in the psychogenic polydipsia population, comprised of individuals who drink compulsively and who commonly have mental health conditions.
Prevention Of Dilutional Hyponatremia
How to prevent water intoxication is by being mindful and reducing fluid intake. People with medical conditions, such as diabetes or kidney disease should be closely monitored by a physician, especially if excessive thirst develops. While exercising, individuals should consume sports beverages in addition to water and should not drink excessive amounts of water in a short time period.
Treatment Of Dilutional Hyponatremia
The treatment of dilutional hyponatremia is the severity of symptoms along with their origin. Water intoxication treatment is usually determined by the underlying condition that prompted it.
How long water intoxication lasts depends on the level of severity of the condition.
Water intoxication should be treated within hours to avoid complications that can result from leaving it untreated for more than one to two days.
Treatment interventions can include reducing fluid intake, consuming diuretics to elevate urine output, or terminating usage of medications that may be causing the problem. In severe cases, emergency medical care is necessary to regulate sodium levels in a safe manner. A physician may prescribe medication to help a person to manage symptoms of water intoxication.
- SourcesBhatia MS, Goyal A, Saha R, Doval N. “Psychogenic Polydipsia-Management Challenges.” Shanghai Archives of Psychiatry, June 25, 2017. Accessed October 7, 2019.Hutcheon, Donald. “Psychogenic Polydipsia (Excessive Fluid Seeking Behavior.” BC Psychologist, 2013, Accessed October 7, 2019.Iftene, Felicia; et al. “Identification of Primary Polydipsia in a Severe and Persistent Mental Illness Outpatient Population: A Prospective Observational Study.” ScienceDirect, April 11, 2013. Accessed October 7, 2019.Lee, Nicole. “How Does Ecstasy Kill?” Medical Xpress, January 23, 2019. Accessed October 7, 2019.Radcliffe, Shawn and Watson, Stephanie. “Overhydration.” Healthline, June 28, 2017. Accessed October 7, 2019.Toxicology Education Foundation. “Water Intoxication (Dilutional Hyponatremia).” May 28, 2015. Accessed October 7, 2019.
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Hyponatremia: Symptoms, Causes, Treatments
Hyponatremia is usually discovered on laboratory tests as a lower than normal sodium level in the blood. It will appear as sodium or Na+ in your lab results.
Actually, the main problem in the vast number of situations is too much water that dilutes the Na+ value rather than too much sodium. As a result, water moves into body cells, causing them to swell.
This swelling causes the major problem, which is a change in mental status that can progress to seizures or coma.
Hyponatremia can result from multiple diseases that often are affecting the lungs, liver or brain, heart problems congestive heart failure, or medications. Most people recover fully with their doctor’s help.
Who is most at risk for hyponatremia?
Anyone can develop hyponatremia. Hyponatremia is more ly in people living with certain diseases, kidney failure, congestive heart failure, and diseases affecting the lungs, liver or brain. It often occurs with pain after surgery. Also, people taking medications diuretics and some antidepressants are more at risk for this condition.
How common is hyponatremia?
Hyponatremia is very common. Hyponatremia is the most common chemical abnormality seen among patients in the hospital. Rates of hyponatremia are higher among people admitted to inpatient hospital care units or with the medical conditions mentioned above.
In general, too much water in your body is usually the main problem and this dilutes the sodium levels. Much less frequently, hyponatremia is due to significant sodium loss from your body.
Too much water in your body causes your blood to become “watered down.” A good example is people who run in long races or run on hot days. They lose both salt and water in their sweat and often replace these losses with mostly water. This combination can be deadly because it dilutes the remaining sodium in the body.
It’s also possible to lose too much sodium from your body. Medications, diuretics, can cause your kidneys to increase the amount of sodium excreted in urine. Medical problems diarrhea may cause excessive sodium loss if left untreated.
Chronic or binge alcohol consumption can cause people to lose too much sodium through increased urination and vomiting. You can have hyponatremia without feeling dehydrated or volume depleted.
This is most often the case in hospitalized patients.
What are the symptoms of hyponatremia?
Hyponatremia causes neurologic symptoms ranging from confusion to seizures to coma. The severity of the symptoms depends on how low the sodium levels are in the bloodstream and how quickly they fall. In many cases, blood sodium levels fall gradually, producing only mild symptoms as the body has time to make adjustments. Symptoms are more serious when blood sodium levels fall quickly.
Other symptoms of moderate to severe hyponatremia include:
The only way your doctor can know that hyponatremia is present is with blood tests that measure the amount of sodium (Na+) in the bloodstream. Your doctor will also perform a physical examination to detect the severity and cause(s) of hyponatremia.
Treatment for hyponatremia depends on the underlying cause and the severity of your symptoms. If you have mild symptoms, your doctor makes small adjustments to your therapy to correct the problem.
This usually involves restricting water intake, adjusting medications and removing or treating the causes. Therapy may be short-term or long-term. For the short-term, we may restrict water intake, adjust or stop medications, and treat any underlying problems.
For the long-term, we may continue the short-term treatments and add salt to your diet or try some newer medications.
People with moderate to severe hyponatremia require thorough medical evaluation and treatment, usually in the hospital. For the sickest patients, we may replace sodium intravenously (straight into a vein) and really limit water consumption. Certain newer medications, tolvaptan (Samsca®), may be used to correct blood sodium levels.
Treatment to correct any underlying medical problems – congestive heart failure (when poor heart function causes fluid to build up in the body) – is also used to improve hyponatremia.
What complications are associated with hyponatremia?
In many cases, hyponatremia causes extra water to move the bloodstream and into body cells, including brain cells. Severe hyponatremia causes this to occur quickly, resulting in swollen brain tissue. If left untreated, complications can include:
- Mental status changes
If you have certain underlying medical conditions, particularly involving the kidneys, heart, lung, liver or brain, hyponatremia is more ly. You can lower your risk for hyponatremia by following your treatment plan and restricting your water intake to levels recommended by your doctor. Also, notify your doctor of any new symptoms immediately. Monitoring must include blood tests.
With treatment, many people recover fully from hyponatremia. Even long-term hyponatremia can be managed and problems prevented.
If you develop any symptoms of hyponatremia, contact your doctor immediately. Hyponatremia can become an emergency if your sodium level falls too much or too quickly.
Last reviewed by a Cleveland Clinic medical professional on 04/17/2018.