Recurrent rhabdomyolysis secondary to hyponatremia in a patient with primary psychogenic polydipsia

Abstract

Rhabdomyolysis is characterized by the destruction of skeletal muscle tissue, and its main causes are trauma, toxic substances and electrolyte disturbances. Among the latter is hyponatremia-induced rhabdomyolysis, a rare condition that occurs mainly in patients with psychogenic polydipsia. Psycogenic polydipsia mostly affects patients with schizophrenia, coursing with hyponatremia in almost 25% of the cases. It is also in this context that rhabdomyolysis secondary to hyponatremia occurs most often. In this article, the case of a 49-year-old male with a history of schizophrenia, medicated with clozapine, and brought to the emergency room in a state of coma and seizures is described. Severe hypoosmolar hyponatremia with cerebral edema was found on a computed tomography examination, and a subsequent diagnosis of hyponatremia secondary to psychogenic polydipsia was made. Hyponatremia correction therapy was started, and the patient was admitted to the intensive care unit. After the hyponatremia correction, the patient presented with analytical worsening, showing marked rhabdomyolysis with a creatine phosphokinase level of 44.058UI/L on day 3 of hospitalization. The condition showed a subsequent progressive improvement with therapy, with no occurrence of kidney damage. This case stresses the need for monitoring rhabdomyolysis markers in severe hyponatremia, illustrating the condition of rhabdomyolysis secondary to hyponatremia induced by psychogenic polydipsia, which should be considered in patients undergoing treatment with neuroleptics.

Síndrome polidípsico-poliúrico en trastornos de la conducta alimentaria de la adolescencia

“…La polidipsia primaria o psicogénica se caracteriza por el consumo excesivo de líquidos y poliuria secundaria durante un tiempo prolongado y en ausencia de una causa orgánica (5). Se reporta una incidencia de entre el 6-20 % en pacientes psiquiátricos, entre los que se hallan aquellos pacientes con AN y esquizofrenia (3,(10)(11)(12)(13)(14)(15)(16). Dentro de la patogénesis, se ha descrito una desregulación del eje hipotálamo-hipófisis, sed y un umbral de sed más bajo (3).…”

“…La complicación más frecuente de la polidipsia psicogénica es la hiponatremia hipotónica leve, la cual se asocia a una mayor tasa de rehospitalización y a un aumento de la morbilidad. Sin embargo, la de mayor mortalidad es la hiponatremia severa secundaria a intoxicación por agua, que se caracteriza clínicamente por confusión, letargia, psicosis, convulsiones, edema cerebral y, de forma menos frecuente, rabdomiólisis (3,10,(12)(13)(14)(15)(16). Durante la hospitalización, la paciente cursó con hiponatremia hipoosmolar leve, como parte de su SPP, sin llegar a presentar signos ni síntomas de intoxicación por agua.…”

“…Dentro de lo revisado en la literatura colombiana y latinoamericana no se encontraron reportes de polidipsia primaria o psicogénica asociada a TCA; solo relacionada a esquizofrenia y trastorno esquizoafectivo (12,15,16). Hay que tener en cuenta que al presentar esta entidad es importante descartar patologías psiquiátricas, dado su relación con las mismas para prevenir complicaciones multisistémicas, algunas de las cuales, pueden llevar a desenlaces fatales.…”

Rhabdomyolysis-induced acute kidney injury in a patient with undifferentiated connective tissue disease

“…[27] Rhabdomyolysis is primarily caused by acute muscle injury and results in muscle pain, weakness, tightness, and edema from the release of muscular contents into the bloodstream. [31] This may lead to a series of physiological pathologies, which are characterized by the increasing of serum creatine kinase, myoglobin, uric acid, potassium, and phosphorus, influencing the stability of internal environment, and leading to AKI. [32,33] Many symptoms of rhabdomyolysis are non-specific, including myalgia, swelling, weakness, and so on.…”

Colonoscopia: quando a preparação se torna uma complicação

“…Alguns dos fatores que suscetibilizam à ocorrência desta síndroma são a polidipsia psicogénica, determinadas terapêuticas farmacológicas (nomeadamente diuréticos tiazídicos e inibidores de bomba de protões), distúrbios endocrinológicos e a iatrogenia (após cirurgia prostática ou relatosdecaso preparação de colonoscopia com manitol). 11 No contexto deste caso clínico, a rabdomiólise traduziu-se numa elevação da creatinina quinase, sem lesão renal aguda associada e com evolução favorável durante o internamento, sendo, no entanto, difícil estabelecer uma relação causal. Assume-se, contudo, que a rabdomiólise poderá ser consequente de uma hiponatremia secundária a perdas gastrointestinais resultantes da preparação intestinal, com provável agravamento face ao subsequente traumatismo sofrido pela doente.…”