Hyponatremia and rhabdomyolysis from excessive water intake for ureteral stone expulsion in a patient with mental disorder: A case report.

RATIONALE

Primary polydipsia refers to excessive water intake due to psychogenic or non-psychogenic causes without being secondary to conditions such as hyperglycemia or renal dysfunction. Most cases of primary polydipsia are psychogenic in nature, with few cases of non-psychogenic primary polydipsia reported in the literature. In this case, the patient's excessive water intake appeared to be influenced by both psychogenic and non-psychogenic factors.

PATIENT CONCERNS

A 43-year-old male patient with a history of psychiatric illness was diagnosed with ureteral stones and was engaged in excessive water intake in an attempt to facilitate stone passage. Subsequently, he developed facial and bilateral lower extremity edema. On physical examination, the patient appeared anxious, exhibited a depressed mood, and demonstrated poor speech, but remained fully conscious. Physical examination revealed facial and bilateral lower extremity edema with tenderness and percussion pain in the left renal region. Neurological examination and other systemic evaluation revealed no significant abnormalities. Laboratory tests revealed hyponatremia, hypokalemia, and markedly elevated creatine kinase levels.

DIAGNOSES

The diagnosis of hypervolemic hypotonic hyponatremia complicated by rhabdomyolysis was established based on the patient's clinical manifestations and laboratory findings.

INTERVENTIONS

Furosemide was initiated on day 2 for diuresis and transitioned to continuous micropump infusion for precise dosing. Persistent edema prompted albumin administration (day 4) to address hypoalbuminemia and low-dose dopamine for administration renal perfusion. The psychiatric symptoms were managed with quetiapine and sertraline. Urine culture on day 6 confirmed urinary tract infection, prompting cefoperazone therapy. By day 10, the edema had resolved, and ureteroscopic lithotripsy was performed.

OUTCOMES

Following therapeutic interventions, the patient demonstrated marked improvement in hyponatremia and rhabdomyolysis, culminating in discharge on the twelfth hospital day.

LESSONS

Physicians should maintain a high index of suspicion for excessive water intake in patients with urolithiasis who exhibit anxiety, fear, or a history of psychiatric disorders because such behavior can lead to life-threatening electrolyte imbalances and associated complications. Such behaviors may be mitigated or prevented by appropriate medical advice and psychological interventions.