Electrolyte Blood Press.  2013 Jun;11(1):29-32. 10.5049/EBP.2013.11.1.29.

Paranoid Adipsia-induced Severe Hypernatremia and Uremia treated with Hemodialysis

• Choi JH
• Lee HS
• Kim SM
• Kim HY
• Kwon SK

• KMID: 2168398
• DOI: http://doi.org/10.5049/EBP.2013.11.1.29

Abstract

We describe a patient with severe hypernatremia and uremia caused by paranoid adipsia who was treated successfully with hydration and hemodialysis. A previously healthy 40-year-old woman developed the paranoid idea that her water was poisoned, so she refused to drink any water. On admission, her blood urea nitrogen was 208mg/dL, creatinine 4.90mg/dL, serum osmolality 452mOsm/L, serum sodium 172mEq/L, urine specific gravity > or =1.030, urine osmolality 698mOsm/L, and urine sodium/potassium/chloride 34/85.6/8mEq/L. We diagnosed her with uremic encephalopathy and started intravenous dextrose, but the sodium correction was incomplete. She underwent two sessions of hemodialysis to treat the uremic encephalopathy and hypernatremia, and recovered fully without neurological sequelae. Although the standard treatment for severe hypernatremia is hydration, hemodialysis can be an additional treatment in cases of combined uremic encephalopathy.

Keyword

Hypernatremia; Uremia; Hemodialysis; Paranoid

MeSH Terms

Blood Urea Nitrogen
Creatinine
Female
Glucose
Humans
Hypernatremia
Osmolar Concentration
Renal Dialysis
Sodium
Specific Gravity
Uremia
Water
Creatinine
Glucose
Sodium
Water

Figure

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  Fig. 1 Changes of serum sodium and urea nitrogen after treatment. HD: hemodialysis.

Reference

1. Adrogue HJ, Madias NE. Hypernatremia. N Engl J Med. 2000; 342:1493–1499. PMID: 10816188.

2. Farley PC, Lau KY, Suba S. Severe hypernatremia in a patient with psychiatric illness. Arch Intern Med. 1986; 146:1214–1215. PMID: 3718109.

3. Phillips MG, Gabow PA. Psychogenic adipsia in a patient with psychotic depression. Am J Kidney Dis. 1990; 15:592–594. PMID: 2368698.

4. Brouns R, De Deyn PP. Neurological complications in renal failure: a review. Clin Neurol Neurosurg. 2004; 107:1–16. PMID: 15567546.

5. Jana DK, Romano-Jana L. Hypernatremic psychosis in the elderly: case reports. J Am Geriatr Soc. 1973; 21:473–477. PMID: 4729012.

6. Park YJ, Kim YC, Kim MO, Ruy JH, Han SW, Kim HJ. Successful treatment in the patient with serum sodium level greater than 200mEq/L. J Korean Med Sci. 2000; 15:701–703. PMID: 11194198.

7. Yang YF, Wu VC, Huang CC. Successful management of extreme hypernatraemia by haemofiltration in a patient with severe metabolic acidosis and renal failure. Nephrol Dial Transplant. 2005; 20:2013–2014. PMID: 15985507.

8. Yang TY, Chang JW, Tseng MH, Wang HH, Niu DM, Yang LY. Extreme hypernatremia combined with rhabdomyolysis and acute renal failure. J Chin Med Assoc. 2009; 72:555–558. PMID: 19837653.

9. Park HS, Hong YA, Kim HG, Choi SR, Sun IO, Chung BH, Park CW, Yang CW, Kim YS, Choi BS. Usefulness of continuous renal replacement therapy for correcting hypernatremia in a patient with severe congestive heart failure. Hemodial Int. 2012; 16:559–563. PMID: 22515501.

10. Yang CW, Kim YS, Park IS, Chang YS, Yoon YS, Bang BK. Treatment of severe acute hypernatremia and renal failure by hemodialysis. Nephron. 1995; 70:372–373. PMID: 7477631.