Abstract: PUB104
A Case of Singultus, Polydipsia, and Severe Hyponatremia
Session Information
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Patel, Niel, University of California San Diego, La Jolla, California, United States
- Khanian, Matan, University of California San Diego, La Jolla, California, United States
- Karl, Bethany E., University of California San Diego, La Jolla, California, United States
- Park, Janice, University of California San Diego, La Jolla, California, United States
Introduction
Hyponatremia occurs when excessive water intake exceeds the kidneys’ capacity for free water excretion. Primary polydipsia is an uncommon cause of hyponatremia, however more prevalent in certain patients. We report a case of severe hyponatremia due to primary polydipsia as an attempt to treat hiccups.
Case Description
A 62-year-old man with hypertension, polysubstance use, and chronic hiccups presented with singultus and was found to have severe hyponatremia. He had prior admissions for hypotonic hyponatremia thought to be due to primary polydipsia in the setting of hiccups refractory to medications and phrenic nerve blocks. He reported cocaine use to provide temporary relief. To reduce cocaine use, he reported high fluid intake of 20 liters daily. See Table 1 for labs and Figure 1 for hospital course. Behavior modification including fluid restriction were advised. Singultus improved as sodium improved. Psychiatry was consulted and he was given additional medications for hiccups.
Discussion
Hyponatremia from primary polydipsia can be caused by 4 to 5 liters of fluid intake daily. Fluid restriction alone is an effective treatment. This is a unique case as the patient’s excessive fluid intake was to self-treat intractable hiccups. Polydipsia can be seen as an obsessive behavior and was previously referred to as psychogenic; however, other issues, such as singultus, can also cause excess intake. Severe hyponatremia may worsen hiccups, leading to a cycle of excess drinking. In this case, the patient was readmitted 2 months later for hyponatremia due to repeat increased intake. He again improved with fluid restriction. Behavioral correction, psychotherapy, and sodium monitoring are key to ensure adherence to fluid restriction. Unfortunately, this is challenging as patients may have repeat admissions and require repeat counseling that any fluids contribute to this process due to relative hypotonicity as seen here.
Lab Findings on Initial Admission
| Sodium | 113 mmoL/L |
| Urine Osmolality | 77 mOsm/Kg |
| Urine Sodium | <20 mmol/L |