Pini Stefano, Raia Accursio, Carpita Barbara, Nardi Bendetta, Benvenuti Matteo, Scatena Andrea, Di Paolo Marco
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, ITA.
Department of Medicine, Surgery, Neuroscience, and Forensic Medicine, University of Siena, Siena, ITA.
Cureus. 2025 Feb 28;17(2):e79813. doi: 10.7759/cureus.79813. eCollection 2025 Feb.
Self-induced water intoxication is a life-threatening condition caused by excessive water intake that surpasses renal excretion capacity, resulting in hypotonic hyponatremia. This acute imbalance leads to cerebral and pulmonary edema, neurological deterioration, and potentially fatal outcomes. Psychiatric disorders such as schizophrenia and postpartum psychosis are significant contributors, often driving these behaviors through unique psychopathological mechanisms exacerbated by inadequate patient supervision. This study presents two fatal cases. The first involves a 42-year-old woman with chronic schizophrenia and psychogenic polydipsia, whose condition progressed gradually, allowing partial therapeutic intervention. The second describes a 28-year-old woman with postpartum psychosis and compulsive water drinking linked to religious delusions, whose condition deteriorated rapidly, leading to cardiopulmonary arrest shortly after admission. Both cases highlight the connection between psychiatric disorders and severe hyponatremia (<120 mmol/L), resulting in irreversible brain damage and sudden death. Autopsy findings revealed diffuse cerebral edema, pulmonary congestion, and diffuse axonal injury with reactive astrogliosis, demonstrating the severe impact of electrolyte imbalances on neuronal damage. Neuropathological findings, such as ubiquitin-positive axonal swellings and astrocytic activation, underscore the critical role of ionic homeostasis disruption in bridging clinical and autopsy observations. These cases highlight the importance of early recognition of psychogenic polydipsia and compulsive water-drinking behaviors, particularly in high-risk psychiatric patients. Preventative strategies should include routine electrolyte monitoring, caregiver education, and proactive management of psychiatric disorders. Critically, water intoxication must always be considered among the possible causes of unexplained coma or sudden death in psychiatric patients, stressing the need for clinical vigilance and accurate postmortem assessment to improve prevention.
自我诱导性水中毒是一种危及生命的状况，由过量饮水超过肾脏排泄能力所致，会导致低渗性低钠血症。这种急性失衡会引发脑和肺水肿、神经功能恶化，并可能导致致命后果。精神分裂症和产后精神病等精神障碍是重要因素，常常通过独特的精神病理机制驱使这些行为，而患者监管不足会加剧这些机制。本研究呈现了两例致命病例。第一例涉及一名42岁患有慢性精神分裂症和精神性烦渴的女性，其病情逐渐发展，得以进行部分治疗干预。第二例描述了一名28岁患有产后精神病且因宗教妄想而强迫饮水的女性，其病情迅速恶化，入院后不久即导致心肺骤停。两例病例均凸显了精神障碍与严重低钠血症（<120 mmol/L）之间的关联，导致不可逆转的脑损伤和猝死。尸检结果显示弥漫性脑水肿、肺充血以及伴有反应性星形胶质细胞增生的弥漫性轴索损伤，表明电解质失衡对神经元损伤的严重影响。神经病理学发现，如泛素阳性轴索肿胀和星形胶质细胞活化，强调了离子稳态破坏在连接临床和尸检观察结果方面的关键作用。这些病例凸显了早期识别精神性烦渴和强迫饮水行为的重要性，尤其是在高危精神科患者中。预防策略应包括常规电解质监测、护理人员教育以及对精神障碍的积极管理。至关重要的是，对于精神科患者不明原因昏迷或猝死的可能原因，必须始终考虑水中毒，强调临床警惕性和准确的死后评估对于改善预防的必要性。
