Schizophrenia and fatal self-induced water intoxication with appropriately-diluted urine.
A 31-year-old woman with untreated chronic schizophrenia developed extreme polydipsia which rapidly led to coma and death due to cerebral edema. Hyponatremia (120 mEq/liter) and serum hypo-osmolality (260 mOsm/kg) were associated with marked polyuria (up to 1850 ml/hour) and appropriately low urinary osmolality (90 mOsm/kg) which responded to treatment. This case and few qualifying previous reports which are reviewed support the possibility that pure self-induced water intoxication with no major contribution of inadequate release of antidiuretic hormone may occur, and that extreme polydipsia can sometimes overwhelm normal renal diluting capacity in psychotic patients.
Kushnir
M
M
Department of Medicine C, Kaplan Hospital Rehovot, Israel.
Schattner
A
A
Ezri
T
T
Konichezky
S
S
D000328:Adult; D004326:Drinking; D005260:Female; D006801:Humans; D009994:Osmolar Concentration; D012559:Schizophrenia / Q000150:complications*; D014667:Vasopressins / Q000378:metabolism; D014869:Water Intoxication / Q000209:etiology* / Q000652:urine
D014667:Vasopressins