Hyponatraemia is recognised as a serious metabolic emergency with varied aetiology. We report an unusual case of hyponatraemia.
A 36 year old woman was admitted following a seizure. Her relationship with her boyfriend had recently ended. She was disorientated with a GCS of 11/15. She was apyrexial and examination was unremarkable. Old notes recorded an interest in complimentary health and 'systemic' candidiasis.
A drug overdose was suspected until plasma biochemistry returned a sodium (Na) of 113mmol/l, potassium 3.3 mmol/l and urea of 2.4 mmol/l. Arterial blood gas analysis, serum cortisol and thyroid function tests were unremarkable. Subsequent CT head and lumbar puncture suggested no structural or infectios cause for her hyponatraemia. Urine osmolality on admission was 72 mosm/kg and she was relatively polyuric.
After 16 hours her Na normalised (132mmol/l, urine output reduced and her urine osmolality was 358 mosm/kg.A diagnosis of psychogenic polydypsia was made. Rapid neurological recovery followed enabling a full history.
She admitted drinking large volumes of water prior to admission as suggested by a homeopathic regimen for 'systemic' candidiasis found on the internet. Subsequent psychiatric review found no evidence of psychosis.
In view of the proliferation of complimentary medical advice available online this case is a salutary warning of the potential harm of such advice.Previous cases of psychogenic polydypsia have focused on chronic schizophrenia and hydration for military exercises. This is the first case of severe hyponatraemia in relation to complimentary health. In view of the increased interest in homeopathy and availability of the internet this case represents an important warning.
24 - 26 Mar 2003
British Endocrine Societies