Polydipsia-induced hyponatremia and status epilepticus in a schizophrenia patient: A case report from the emergency department

Ching-Kuo Lin^{a, b}, Yu-Tung Feng^c

^a Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
^b Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
^c Graduate Institute of Healthcare Administration, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan

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Abstract
Related to severe hyponatremia, various symptoms, such as confusion, vomiting, changes in mental state, status epilepticus, and a variety of conscious disturbances are sometimes seen in the emergency department (ED) but seldom recognized as water intoxication in the early stages. Status epilepticus is an emergent and life-threatening condition if not diagnosed and managed promptly and efficiently. The authors reported a case of a 31-year-old woman with history of schizophrenia with poor drug compliance. The compulsive drinking of more than 15,000 mL of water per day for 4 days resulted in intermittent episodes of vomiting and seizures and she was sent to our ED by ambulance. Water intoxication with severe hyponatremia ([Na+] = 112 mEq/L) was diagnosed and hypertonic sodium supplements and airway protection were then offered. Detailed history taking and early detection of hyponatremia is crucial to prevent fatal complications of water intoxication. Emergency physicians should be suspicious of hyponatremia from water intoxication in psychiatric patients with neurologic symptoms during the observation period in the ED.

Keywords
Hyponatremia; Polydipsia; Seizure; Status epilepticus; Water intoxication