Case report: manic episode with psychotic symptoms induced by hyponatremia

Abstract

In the literature, several cases of an association between hyponatremia and psychotic symptoms have been reported. We present the case of a young Caucasian male presenting with rapid, incoherent speech, religious and megalomanic delusions, and emotional lability. The patient was described by his relatives as being healthy until a few days before admission. He had no significant medical or psychiatric history, except a short drug-induced psychotic episode a few years earlier. Somatic workup showed moderate hyponatremia, but no other abnormalities. Tests for narcotics, in particular, were also negative. Antipsychotic treatment with risperidone was initiated. After normalization of sodium levels using intravenous saline, the patient remitted within a few days and risperidone was discontinued on day 3. He was discharged by day 13 without further pharmacological treatment. Dysfunction of voltage-gated ion channels, particularly sodium and calcium channels, has been implicated in the pathogenesis of bipolar disorder. We therefore assume a causal relationship between hyponatremia and manic-psychotic symptoms in our patient. Hyponatremia was most likely induced by excessive water intake during a period of fasting in the context of a wellness practice.

Delirious mania unveiling hyponatremia: A peculiar presentation

“…A PubMed search on May 10, 2023, revealed only five previously published reports of hyponatremia presenting with manic symptoms. [ 1 2 3 4 5 ] The details of the case reports are summarized in Table 1 . However, concurrence of delirium, catatonia, and mania among patients with hyponatremia has not been reported yet.…”

“…However, the role voltage-gated sodium channels in the pathogenesis and treatment of bipolar disorder is known and one can speculate that the manic symptoms in our patient might be caused by the dysfunction in voltage-gated sodium channels in the setting of hyponatremia. [ 4 ]…”