When in "Deep Waters"! Psychogenic Polydipsia Case Report.

We report a case of a 50-year-old female patient presented to the Emergency Department (ED) in respiratory arrest preceded by an inaugural generalized seizure with traumatic lingual mark and sphincter relaxation. Biological: metabolic acidosis, severe hyponatremia (115 mEq/L), osmolarity 253 mOsm, lactate 2 mmol/L. Acute hyponatremia correction treatment was initiated by reducing infusion solutions, administration of hypertonic sodium molar solution on continuous infusion in 30 minutes (30 ml saline and 20 ml natrium molar solution 58.5 mg/ml), loop diuretic 40 mg iv, cerebral depletive 150 ml and administration of desmopressin. After Foley catheterization, 3-hour diuresis was 6000 ml. The patient was known to have polynodular goiter on thyrozole treatment. Emergency CT scan result- absence of acute intracerebral pathology; presence of a large amount of gastric fluid that depletes including the esophagus. After the insertion of nasogastric tube, we evacuated approximately 4000 mL gastric contents. Toxicology tests were negative. The patient was admitted to the intensive care unit where, after sodium correction and appropriate management, her clinico-biological evolution was favourable. Diagnosis of diabetes insipidus and Syndrome of inadequate antidiuretic hormone secretion (SIADH) were ruled out. After 5 days, the patient was conscious, hemodynamically stable and she kindly told the story about her severe depressive disorder diagnosed one year ago in the US, treated with selective serotonin reuptake inhibitors and about her diet with a water intake of 6-8 litres daily for 6 months. [ABSTRACT FROM AUTHOR]