Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- busca e ingestão de água
Other diagnostic factors
- agitação
- poliúria
- cefaleia
- náuseas ou vômitos
- letargia ou confusão
- convulsões, delirium ou coma
Risk factors
- transtornos psiquiátricos
- transtornos do neurodesenvolvimento
- tabagismo
- abuso de álcool
Diagnostic tests
1st tests to order
- osmolalidade plasmática
- osmolalidade urinária
- sódio urinário
- sódio sérico
- volume urinário de 24 horas
- urinálise
- ureia sérica
- teste de restrição de água
Tests to consider
- teste de vasopressina
- hormônio antidiurético plasmático
Treatment algorithm
hiponatremia grave (<125 mmol/L [<125 mEq/L]) ou com sintomas neurológicos
hiponatremia (125-130 mmol/L [125-130 mEq/L]) ou com sintomas gastrointestinais
polidipsia crônica
Contributors
Authors
Shilpa Srinivasan, MD, DFAPA, DFAAGP
Vice Chair, Medical Staff Affairs, Behavioral Health Midlands, Prisma Health
Professor of Clinical Psychiatry
Program Director: Geriatric Psychiatry Fellowship
Director: Psychiatry Acting Internship and M4 Clerkship
Department of Neuropsychiatry and Behavioral Science
Prisma Health - University of South Carolina School of Medicine Columbia
Columbia
SC
Disclosures
SS is a board member of the American Association for Geriatric Psychiatry and serves on the Geriatric Psychiatry Exam Committee for the American Board of Psychiatry and Neurology.
Meera Narasimhan, MD, DFAPA
Professor and Chair
Department of Neuropsychiatry and Behavioral Science
Senior Medical Director
Prisma Health
Special Advisor to University of South Carolina President
Health Innovations and Economic Development
University of South Carolina School of Medicine Columbia
Columbia
SC
Disclosures
MN is a member of an advisory board for Alkermes.
Acknowledgements
Dr Shilpa Srinivasan and Dr Meera Narasimhan would like to gratefully acknowledge Dr Emily Williams and Dr Brian Dundas, previous contributors to this topic.
Disclosures
EW declares that she has no competing interests. BD is an author of one of the references for this topic.
Peer reviewers
Branimir Margetić, MD
Neuropsychiatric Hospital "Dr Ivan Barbot"
Popovaca
Croatia
Disclosures
BM is an author of a reference cited in this topic.
Aaron Pinkhasov, MD, DFAPA, FACLP
Chairman
Department Of Psychiatry
NYU Langone Hospital
Professor of Psychiatry and Medicine
NYU Long Island School of Medicine
Long Island
NY
Disclosures
AP declares that he has no competing interests.
Richard C Millson, MD, DTM&H, FRCPC
Associate Professor of Psychiatry
Queen's University
Kingston
Ontario
Canada
Disclosures
RCM declares that he has no competing interests. He is the author of some of the references cited in this topic.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Ahmadi L, Goldman MB. Primary polydipsia: update. Best Pract Res Clin Endocrinol Metab. 2020 Sep;34(5):101469.Full text Abstract
Sterns RH. Disorders of plasma sodium - causes, consequences, and correction. N Engl J Med. 2015 Jan 1;372(1):55-65. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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