Rhabdomyolysis After Correction of Hyponatremia Due to Psychogenic Polydipsia

doi:10.4065/70.5.473

Mayo Clinic Proceedings

Volume 70, Issue 5, May 1995, Pages 473-476

https://doi.org/10.4065/70.5.473 Get rights and content

Severe neurologic complications resulting from correction of hyponatremia are common, but reports of nonneurologic sequelae are scarce. This article describes a patient in whom rhabdomyolysis developed during correction of severe hyponatremia attributable to psychogenic polydipsia. Relevant material about volume regulation in the cell is presented, and a potential mechanism of cell damage is proposed. This case report emphasizes the importance of monitoring for nonneurologic complications during correction of hyponatremia.

Section snippets

Report of Case

A 34-year-old man with paranoid schizophrenia sought medical attention because of an alteration in mental status. The patient's state of health had been as usual until the night of admission. His family noted progressive fatigue and irritability, and the patient complained of mild lightheadedness. He vomited a small amount of bilious material once before the current examination. He had no dry heaves. His parents had noted a substantial increase in his fluid intake during the prior 6 months and

Discussion

Ten published case reports have described rhabdomyolysis associated with water intoxication2, 3, 4, 5, 6, 7, 8, 9, 10, 11 (Table 2), only one of which involved psychogenic polydipsia in a mentally ill patient.⁶ All those reports had various confounding factors; thus, concluding that the hyponatremia, or its correction, was the proximate cause of the muscle damage is difficult. The current case is the only reported one that involves a mentally ill patient with severe hyponatremia attributable to

Conclusion

The current case report associates severe nonneurologic effects with correction of hyponatremia attributable to psychogenic polydipsia. The scope of debate and research must expand to consider these concerns. To my knowledge, this is the first report that associates rhabdomyolysis with the correction of isolated severe hyponatremia due to psychogenic polydipsia in a patient with a psychiatric disorder. Clinicians should be aware of the potential development of rhabdomyolysis during correction

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Cited by (40)

No association between hyponatremia and rhabdomyolysis in rats
2014, Journal of Emergency Medicine
Citation Excerpt :
However, a study by Morita et al., in which patients' files with severe hyponatremia were reviewed for the occurrence of rhabdomyolysis, demonstrated that the initial serum sodium did not show any significant difference between those who eventually developed rhabdomyolysis compared with those who did not (8). A few reports have attributed rhabdomyolysis to the rate of correction of hyponatremia, with the hypothesis that failure in the cell volume regulation caused by the rapid correction of hyponatremia results in membrane fragility and enzyme leakage (9–11). These reports found that the rate of the correction was usually higher than the recommended rate when rhabdomyolysis was associated with hyponatremia (8,9).
Rhabdomyolysis is an uncommon complication of hyponatremia, reported previously only in case reports and small retrospective studies, and its underlying mechanism is controversial. Some studies support the hypothesis that the rapid correction of hyponatremia is responsible for rhabdomyolysis, whereas others emphasize the severity of the hyponatremia as a predisposing factor for rhabdomyolysis.
To test the association between hyponatremia and rhabdomyolysis and to demonstrate a causal association.
Hyponatremia was induced by administration of water and desmopressin acetate in rats during 3 days, followed by its rapid correction, using animal models established for the evaluation of central pontine myelinolysis. The plasma creatine phosphokinase levels, a marker for rhabdomyolysis, were monitored, and hematoxylin and eosin sections of the quadriceps and gastrocnemius muscles were evaluated for signs of rhabdomyolysis.
The induction of hyponatremia and its correction were accompanied by the previously reported neurological sequelae, including signs of central pontine myelinolysis. However, no increase in plasma creatine phosphokinase levels was found, and histopathological examination of the quadriceps and gastrocnemius muscles revealed no sign of rhabdomyolysis.
The present study, which is the first to test the association between hyponatremia and rhabdomyolysis in an animal model, does not support any causal association between hyponatremia and rhabdomyolysis. Thus, other factors might be necessary for an association between hyponatremia and rhabdomyolysis, such as genetic factors or convulsions that are known to be associated with both hyponatremia and rhabdomyolysis. Further research in this important physiologic and clinical question is needed.
About sodium disorders
2010, Medicina Clinica
Risk Factors for Rhabdomyolysis in Self-Induced Water Intoxication (SIWI) Patients
2010, Journal of Emergency Medicine
Citation Excerpt :
Non-neurological symptoms, such as rhabdomyolysis, have been rarely described; however, the mechanism underlying rhabdomyolysis remains controversial. Most of the reports that have investigated rhabdomyolysis have been case reviews (4–9). In the present study, we reviewed 22 SIWI patients retrospectively and presented the complication rate of rhabdomyolysis during their clinical course.
Self-induced water intoxication (SIWI) patients present with various neurological and non-neurological symptoms. However, it is reported that non-neurological manifestations such as rhabdomyolysis are comparatively rare. The mechanism underlying rhabdomyolysis remains controversial. To investigate this further, we evaluated 22 SIWI patients for rhabdomyolysis. We reviewed the records of 22 patients with SIWI and evaluated their clinical characteristics. These patients were divided into the following two groups: Group A with rhabdomyolysis and Group B without it. We compared these groups to study the risk factors underlying the occurrence of rhabdomyolysis. Furthermore, we compared the complications and the duration of hospitalization between the two groups. The maximum serum sodium correction speed per hour, the increase in the serum sodium level in the initial 24 h, and the duration of hospitalization for group A were faster, higher, and longer, respectively, when compared with those in group B. Only group A patients showed complications. The rapid correction of hyponatremia may possibly trigger rhabdomyolysis in SIWI patients.
Recurrent rhabdomyolysis associated with polydipsia-induced hyponatremia - a case report and review of the literature
2007, General Hospital Psychiatry
Citation Excerpt :
These cases have involved patients with hyponatremia due to psychogenic polydipsia [4–7], post-prostatic surgery [8], exercise-induced water intoxication [9], Addison's disease [10], treatment with thiazide diuretics [11], massive ingestion of tea [12] and ecstasy use [13,14]. There are also a few cases in the literature that relate rhabdomyolysis to the correction of hyponatremia [15–17]. All of these patients were on antipsychotic medications, which may have played a role as well.
Rhabdomyolysis involves the breakdown of muscle due to an inciting insult. It has been reported to have many etiologies. Some of the more common causes are trauma and medications. Therapy involves vigorous hydration with a crystalloid or bicarbonate infusion and aims to prevent renal failure caused by the release of myoglobin. This case report describes a patient with a recurrent episode of rhabdomyolysis associated with self-induced water intoxication. He was initially treated with a 3.0% saline infusion, followed by a sodium bicarbonate infusion, with correction of his electrolytes and resolution of the rhabdomyolysis.
A patient using ziprasidone with polydipsia, seizure, hyponatremia and rhabdomyolysis
2006, Progress in Neuro-Psychopharmacology and Biological Psychiatry
We aimed to report a case with rhabdomyolysis related to hyponatremia and/or its correction. A 32–year–old male schizophrenic patient on ziprasidone treatment was admitted to the hospital following a seizure. Patient had primary polydipsia and secondarily developed hyponatremia. After the correction of hyponatremia, due to the high liver enzyme levels, he was diagnosed as rhabdomyolysis. Although the role of antipsychotics in this situation is speculative, development of rhabdomyolysis related to hyponatremia and/or its correction should not be underestimated and should be assesed throughly.
Rhabdomyolysis after severe hyponatremia [2]
2006, Annales Francaises d'Anesthesie et de Reanimation

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Case ReportRhabdomyolysis After Correction of Hyponatremia Due to Psychogenic Polydipsia

Section snippets

Report of Case

Discussion

Conclusion

Am J Kidney Dis

Am J Kidney Dis

J Behav Ther Exp Psychiatry

J Behav Ther Exp Psychiatry

Am J Med

Somatic Findings in patients with psychogenic polydipsia

J Clin Psychiatry

Rhabdomyolysis and myoglobinuria associated with acute water intoxication

West J Med

Hyponatremia and rhabdomyolysis: a possible relationship

South Med J

Case of acute water intoxication developing in a healthy adult

Nippon Naika Gakkai Zasshi

Water intoxication, hyperpyrexia and rhabdomyolysis in a patient with psychogenic polydipsia

NY State J Med