Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland.
Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
Clin Endocrinol (Oxf). 2017 Nov;87(5):492-499. doi: 10.1111/cen.13384. Epub 2017 Jul 7.
Hyponatraemia due to excessive fluid intake (ie primary polydipsia [PP]) is common. It may culminate in profound hyponatraemia-carrying considerable risk of morbidity. However, data on patients with PP leading to hyponatraemia are lacking. Herein, we describe the characteristics of polydiptic patients hospitalized with profound hyponatraemia and assess 1-year outcomes.
Substudy of the prospective observational Co-MED Study.
Patients with an episode of profound hyponatraemia (≤125 mmol/L) due to PP in the medical emergency were eligible and classified into psychogenic polydipsia (PsyP), dipsogenic polydipsia (DiP) and beer potomania (BP).
Symptoms, laboratory findings and factors contributing to hyponatraemia (comorbidities, medication and liquid intake) were assessed. A 1-year follow-up was performed to evaluate recurrence of hyponatraemia, readmission rate and mortality.
Twenty-three patients were included (median age 56 years [IQR 50-65], 74% female), seven had PsyP, eight had DiP and eight had BP. Median serum sodium of all patients was 121 mmol/L (IQR 114-123), median urine osmolality 167 mmol/L (IQR 105-184) and median copeptin 3.6 mmol/L (IQR 1.9-5.5). Psychiatric diagnoses, particularly dependency disorder (43%) and depression (35%), were highly prevalent. Factors provoking hyponatraemia were found in all patients (eg acute water load, medication, stress). During the follow-up period, 67% of patients were readmitted, 52% of these with rehyponatraemia, and three patients (38%) with BP died.
Patients with PP are more likely to be female and to have addictive and affective disorders. Given the high recurrence, rehospitalization and mortality rate, careful monitoring and long-term follow-up including controls of serum sodium, education and behavioural therapy are needed.
由于摄入过多液体导致的低钠血症（即原发性多尿症[PP]）很常见。它可能最终导致严重的低钠血症，带来相当大的发病风险。然而，关于导致低钠血症的 PP 患者的数据尚缺乏。在此，我们描述了因严重低钠血症住院的多尿症患者的特征，并评估了 1 年的结果。
前瞻性观察性 Co-MED 研究的子研究。
符合因 PP 导致严重低钠血症（≤125mmol/L）而在急诊就诊的多尿症患者，分为精神性多尿症（PsyP）、渴感性多尿症（DiP）和啤酒狂饮症（BP）。
评估症状、实验室检查结果以及导致低钠血症的因素（合并症、药物和液体摄入）。进行了 1 年的随访，以评估低钠血症的复发、再入院率和死亡率。
共纳入 23 例患者（中位年龄 56 岁[IQR 50-65]，74%为女性），7 例为 PsyP，8 例为 DiP，8 例为 BP。所有患者的血清钠中位数为 121mmol/L（IQR 114-123），尿渗透压中位数为 167mmol/L（IQR 105-184），copeptin 中位数为 3.6mmol/L（IQR 1.9-5.5）。精神科诊断，特别是依赖障碍（43%）和抑郁（35%）非常常见。所有患者都发现了导致低钠血症的因素（例如急性水负荷、药物、压力）。在随访期间，67%的患者再次入院，其中 52%的患者再次出现低钠血症，3 例（38%）BP 患者死亡。
PP 患者更可能为女性，并且存在成瘾和情感障碍。鉴于高复发率、再入院率和死亡率，需要仔细监测并进行长期随访，包括控制血清钠、教育和行为疗法。
