Published online Dec 22, 2014. doi: 10.5498/wjp.v4.i4.150
Peer-review started: June 23, 2014
First decision: July 10, 2014
Revised: November 10, 2014
Accepted: November 17, 2014
Article in press: November 19, 2014
Published online: December 22, 2014
Processing time: 183 Days and 18.5 Hours
The prevalence of polydipsia among patients with schizophrenia is 6%-20%. Around 10%-20% of patients with polydipsia may develop hyponatremia and even complicated with rhabdomyolysis. Here we presented a 40-year-old man with schizophrenia, who had received paliperidone 15 mg/d for more than one year, and polydipsia was noted. In Jan, 2014, he developed hyponatremia (Na 113 mEq/L) with consciousness disturbance. After 3% NaCl (500 cc/d) intravenous supplement for three days, the hyponatremia was corrected, but rhabdomyolysis developed with a substantial elevation in the level of creatine kinase (CK) to 30505 U/L. After hydration, the CK level gradually decreased to 212 U/L. Both the hyponatremia itself and quick supplementation of NaCl can cause rhabdomyolysis. If rhabdomyolysis is not recognized, insufficient hydration or water restriction for polydipsia may further exacerbate the rhabdomyolysis with a lethal risk. In this case, we highlight the possible complication of rhabdomyolysis with polydipsia-induced hyponatremia. In addition to monitoring the serum sodium level, the monitoring of CK is also important; and switching of antipsychotic may improve the polydipsia.
Core tip: We present a 40-year-old man with schizophrenia who had polydipsia for more than one year and later had hyponatremia related consciousness disturbance. Though the association of polydipsia with schizophrenia and/or neuroleptic treatment is already discussed in the literature, there were no articles as detailed as our article. It reviewed the possible mechanism associated with hyponatremia and rhabdomyolysis, the choice of antipsychotics, and the reasons of polydipsia in schizophrenia patient at a time.