Makino Eriko, Hashimoto Takahide, Sako Akahito, Nanasawa Hideki, Enomoto Tetsuro, Hayakawa Tatsuro, Hamasaki Hidetaka, Yanai Hidekatsu
Department of Internal Medicine, Kohnodai Hospital National Center for Global Health and Medicine Ichikawa Chiba Japan.
Department of Psychiatry, Kohnodai Hospital National Center for Global Health and Medicine Ichikawa Chiba Japan.
PCN Rep. 2023 Jan 26;2(1):e77. doi: 10.1002/pcn5.77. eCollection 2023 Mar.
Hyponatremia is a common electrolyte disorder. The severe hyponatremia has a mortality rate of 4%-40%. Psychiatric patients are likely to develop the condition because of polydipsia or the adverse effects of antipsychotics. We investigated the characteristics of patients with and without psychiatric diseases who developed severe hyponatremia.
We retrospectively investigated cases admitted to our hospital (all departments) between October 2012 and November 2015 with a serum sodium concentration of ≤125 mmol/l on admission. We compared patient characteristics, etiology, and clinical course between psychiatric and nonpsychiatric patients.
In total, 123 cases (62 female) were analyzed. Psychiatric disorders were present in 69 cases (56%), including schizophrenia ( = 19), anorexia ( = 16), mood disorders ( = 14), and organic mental disorders ( = 9). The mean patient age was 63 years. The mean serum sodium concentration on admission was 119 mmol/l, and the main causes of hyponatremia were polydipsia (20%), insufficient sodium intake (18%), and syndrome of inappropriate antidiuretic hormone secretion (16%). Compared with the nonpsychiatric group, the psychiatric group was significantly younger (55 vs. 74 years), was more likely to have polydipsia (30% vs. 6%), and had a lower in-hospital mortality (0% vs. 17%).
Our study found differences in the clinical picture between psychiatric and nonpsychiatric patients with severe hyponatremia. Clinicians need to monitor serum sodium because the symptoms of hyponatremia can mimic those of psychiatric diseases.
低钠血症是一种常见的电解质紊乱。严重低钠血症的死亡率为4% - 40%。精神科患者由于烦渴或抗精神病药物的不良反应，很可能会出现这种情况。我们调查了发生严重低钠血症的有精神疾病和无精神疾病患者的特征。
我们回顾性调查了2012年10月至2015年11月期间我院（所有科室）收治的入院时血清钠浓度≤125 mmol/L的病例。我们比较了精神科和非精神科患者的患者特征、病因及临床病程。
共分析了123例病例（62例女性）。69例（56%）存在精神障碍，包括精神分裂症（n = 19）、厌食症（n = 16）、情绪障碍（n = 14）和器质性精神障碍（n = 9）。患者平均年龄为63岁。入院时平均血清钠浓度为119 mmol/L，低钠血症的主要原因是烦渴（20%）、钠摄入不足（18%）和抗利尿激素分泌不当综合征（16%）。与非精神科组相比，精神科组明显更年轻（55岁对74岁），更易出现烦渴（30%对6%），且院内死亡率更低（0%对17%）。
我们的研究发现严重低钠血症的精神科和非精神科患者临床表现存在差异。临床医生需要监测血清钠，因为低钠血症的症状可能与精神疾病的症状相似。
