Psychogenic polydipsia — An unusual cause of hyponatremic coma and seizure
✍ Scribed by Raymond Roberge; Joel Gernsheimer; Robert Sparano; Randy Tartakoff; Mary Jo Morgenstern; Kenneth Rubin; Doris Senekjian; Ruben Andrade; Varghese Matthew
- Publisher
- Elsevier Science
- Year
- 1984
- Tongue
- English
- Weight
- 315 KB
- Volume
- 13
- Category
- Article
- ISSN
- 1097-6760
No coin nor oath required. For personal study only.
✦ Synopsis
CASE PRESENTATION
Robert Sparano, MD: A 38-year-old man presented to the emergency department after having been found unconscious at home. Paramedics responding at the scene reported witnessing a grand-real-type seizure lasting approximately one minute. The patient was reported to respond to noxious stimuli by withdrawal of all extremities. The paramedics placed an oral airway, administered oxygen by nasal cannula, and transported the patient.
Prior medical history, as provided by family members, revealed that the patient was a psychiatric outpatient with a longstanding diagnosis of schizophrenia. There was also a long history of intravenous drug abuse and alcohol abuse. Medications included Cogentin (benztropine) on a daily basis, and Prolixin (fluphenazine) 25 mg intramuscularly on a biweekly basis. Admission vital signs were as follows: pulse, 88 beats per minute; blood pressure, 180/120 mm Hg; respirations, 28/min; and temperature, 37.3 C. Shortly after admission, the patient sustained a second grand-mal-type seizure. He was intubated and was administered 5 mg diazepam intravenously, with resultant termination of the seizure. The patient received one ampule (50 cc) of 50% dextrose solution, four ampules (1.6 mg) naloxone, and 100 mg thiamine, without apparent response. Physostigmine, 2 rag, was administered to counteract the possibility of phenothiazine toxicity, again without apparent response. An Ewald tube was passed nasally and the stomach was aspirated of approximately 200 cc of a brownish sludge that was sent for toxicology screening and subsequently was found to be negative. A charcoal slurry was instilled into the stomach and a cathartic was administered.
Physical examination revealed some nuchal rigidity. Pupils were equal and reactive. Deep tendon reflexes were equal and symmetrical. Plantar reflexes were downgoing. The chest was clear to auscultation, and the heart examination was normal. The abdomen was soft and non-distended, and hypoactive bowel sounds were present. Rectal examination revealed good sphincter tone, no masses, and guaiac-negative stool. The chest film was negative, and the electrocardiogram revealed no acute changes.
Lumbar puncture was negative. Toxicology screen was negative for alcohol, phenothiazines, benzodiazepines, and barbiturates; salicylates were 3.4 mg%. The urinalysis revealed a specific gravity of 1.005, 1 to 3 WBCs, 3 to 6 RBCs, and a pH of 6.0. The CBC revealed a WBC of 18,100; hemoglobin, 13.1; and hematocrit, 37. The serum electrolytes were as follows: