Excessive Water Intake Research Articles

8431 Triphasic response of pituitary stalk post anoxic injury in a mechanically ventilated patient

Abstract Disclosure: P. Henriquez Feliz: None. H. Neizer: None. E. Alshdifat: None. F. Abdulkarim: None. T. Mazhude: None. T. Zahra: None. Introduction: A phenomenon may manifest wherein the pituitary undergoes a triphasic response following an inciting event. Phases include diabetes insipidus (DI) followed by Syndrome of inappropriate Antidiuretic Hormone (ADH), and finally a recurrence of DI. Research has established that this is a common complication to neurosurgical interventions but there are limited reports following anoxic brain injury. This case demonstrates a potential pituitary stalk injury after an anoxic brain injury. Case: Unknown 30 year old male found by EMS with pulseless electrical activity cardiac arrest likely from polysubstance use. Returned of spontaneous circulation after 30 minutes in the emergency department. Total downtime unknown. Managed by Intensive Care Unit. Scans were negative. Initial blood work showed eunatremia with a specific gravity (sg) 1.068 and serum osmolarity (Sosm) 311. Eventually, developed hypernatremia, 163 mmol/L, and a urine osmolarity (Uosm) of 428 mosm, raising concern for central DI (CDI). Responded to hypotonic fluids not requiring desmopressin at that time. On day 10, developed severe hyponatremia 113 mmol/L with a Uosm of 774, suggesting ADH mediated response or excessive free water intake. Sodium normalized after managed with fluid restriction. On day 16, patient developed hypernatremia, 178 mmol/L, and Uosm of 869 mosm. Suggestive of CDI recurrence. Treated with desmopressin and hydrocortisone. Discussion: Changes in water-electrolyte balances may occur after anoxic brain injury. The mechanism is believed to arise from axonal shock due to disruptions in vascular supply leading to unregulated release of ADH from degenerating posterior pituitary, causing oliguria and hyponatremia, and subsequent permanent DI from loss of neurons. These stages may last 5-7 days on initial phase, and the second phase can extend anywhere from 2-14 days. In this case, phases one and two lasted four and three days, respectively. It is important to acknowledge that timelines may vary based on management initiation and recognition of transition between stages. CDI treatment involves hypotonic fluids with desmopressin. Our patient was initially managed with free water due to low suspicion for CDI. During shift towards suspected second phase, Uosm increased, urine output and sodium dropped significantly. However, it is uncertain whether this was due to axonal injury causing SIADH or a consequence of hypotonic fluids causing increased response of ADH. As predicted during triphasic response, patient became oliguric with a net negative fluid balance of >10L and Uosm of 869. Therefore, desmopressin was started with good response. Further follow up was unattainable as neurological status deteriorated preceding to brain death. Most cases reported showed hypoattenuation lesion of posterior pituitary on MRI; MRI would have been required to determine if there was injury to the pituitary in this case. Presentation: 6/2/2024

Ecological compensation mechanism controlled by both river ecological water demand and regional water rights

River ecological protection and rational utilization of water resources provide an important support for the sustainable development for human beings and nature. In view of the lack of ecological compensation research on river ecological water demand and socio-economic water demand, a mechanism and methodology for ecological compensation based on the synergistic control of river ecological water demand and river water rights allocation is proposed. The variable monthly flow method and the improved dynamic calculation method are applied to obtain the river basic and suitable ecological water demands as the river protection threshold. A two-layer decision model for water rights allocation is established, which realizes the cascading allocation of initial water rights from city to counties to sectors, and the socio-economic water usage threshold for each level is obtained based on the model. Developing compensation discrimination guidelines under the dual-threshold synergistic control and using the unilateral water resources value by sub-sector as the compensation standard, realize the quantification and sharing of compensation funds. The Nanyang section of the Bai River basin in China is used as an example. The ecological compensation value for wet year (2011), normal year (2012), and dry years (2014–2013) are 0, 15.09 × 108 and 12.04 × 108 (average value for dry years) RMB. The adoption of suitable ecological water demand thresholds in 2012 increases the ecological protection requirements thus leading to an internal compensation situation between Nanyang County and Xinye County. From 2014 to 2016, river runoff continued to be low, and excessive water intake from upstream lead to a chain of compensation situations in the midstream and downstream. It is essential to establish a basin and regionally nested ecological compensation mechanism. The research results are conducive to improving the eco-compensation theory and provide scientific references for water resources management and high-quality development in the basin.

Emerging Role of Ionic Liquids in the Fabric Industry

Abstract: Profitable interest in the pervasive packaging of ionic liquids has continued to increase due to its several advantages and environmentally pleasant nature. Fabric enterprise is stated to be the most important enterprise as a result of a rapid increase in the populace across the globe. Certain ionic beverages can dissolve textile fibers. Therefore, ionic liquids are doubtlessly appropriate for material production and recycling. The dyeing of fabric substances involves numerous financial and ecological risks, resulting in an excessive intake of water, power, and chemicals. Ionic liquids surpass through their extraordinarily low vapor pressure, which enables them to deal with commonly used natural solvents. Moreover, ionic liquids display excessive temperature-associated dielectric constants, consequently displaying top-notch solvent strength for distinct fabric-associated substances, inclusive of silicones, keratin, and cellulose. This article provides a brief review of the pertinent literature that focuses on historical patterns and practical commercial applications of ionic liquids before moving on to current developments in ionic liquids and the fabric industry.

Neurogenic Pulmonary Edema Associated with Hyponatremia, Primary Polydipsia, and Cannabis Use: A Case Report.

Neurogenic pulmonary edema is a rare and potentially life-threatening condition that can present as severe pulmonary edema after significant neurologic insults. This is the first documented instance that shows a plausible causal link between cannabis consumption, psychogenic polydipsia, and the subsequent development of neurogenic pulmonary edema associated with status epilepticus secondary to acute hyponatremia. We report a case of a 34-year-old female who presented to the emergency department altered and postictal after a witnessed new-onset seizure. She developed significant respiratory distress that required intubation. Her sodium was 121 millimoles per liter (mmol/L), from 137 mmol/L 36 hours prior on routine outpatient labs. Further history revealed excessive water ingestion after eating a cannabis edible prior to the seizure. This case highlights the importance of recognizing neurogenic pulmonary edema in connection with psychogenic polydipsia, severe hyponatremia, and status epilepticus subsequent to cannabis consumption.

A case of hyponatraemia cured by delivery

Hyponatraemia is the most common electrolyte abnormality in pregnancy. In severe cases, it can result in significant maternal and fetal morbidity and mortality. The prevalence of hyponatraemia in pregnancy has been estimated to be 0.27%, with the major causes being hyperemesis gravidarum in the first half and preeclampsia in the latter half of pregnancy. Pregnancy-specific causes of the syndrome of inappropriate antidiuretic hormone release include preeclampsia, prolonged labour, caesarean section, postpartum haemorrhage, cortisol deficiency and oxytocin. Excess water intake can also lead to hyponatraemia during labour, a period of excess antidiuretic hormone secretion. A case of idiopathic severe hyponatraemia with biochemistry consistent with inappropriate antidiuretic hormone secretion progressing during the third trimester with rapid spontaneous resolution post-partum is presented.

Prevalence of Manasikahetu (Psychological factors) in patients suffering from Ajirna (Indigestion)

In Ayurveda, digestive power is compared to fire and is also called Agni. The weakening of digestive power () by various reasons, lead to dyspepsia or indigestion and the state called as . Different symptoms like abdominal distension and hard stools detrimentally affect the lives of patients suffering from , often leading to psychological disturbances.Study focuses on the elucidation of the prevalence of psychological issues in patients suffering from .Descriptive data of 100 pre-diagnosed patients, showing definite relation to causative factors was analyzed using numbers and percentages. Chi square test was also used to correlate the data.: This cross-sectional observational study included the pre-diagnosed patients of Ajirna, from the age group of 20 to 60 years. A structured and pilot-tested 14 item questionnaire was used to collect data.: In our study, 67% of the patients suffered from chronic indigestion, and 33% from acute indigestion. patients were majorly affected by hard stools (89%), abdominal distension (85%), and incomplete defecation or bloating (54%). Other noteworthy factors are 72% of the patients showed excessive water intake per day and restraining from defecation reflex (70%). Almost 90% of the population was sentimental, with 76% was short-tempered and 72% restraining the crying reflex. The frequent emotional breakdown was noticed in 71% of the patients, and 40% suffered from grief regularly.Our study suggests the correlation of chronic digestive problems with psychological factors () in patients. Therefore, treatment of along with associated psychological ailments will be crucial for effective outcome.

Long-Term Effects of Tolvaptan in Autosomal Dominant Polycystic Kidney Disease: Predictors of Treatment Response and Safety over 6 Years of Continuous Therapy.

Tolvaptan, an oral vasopressin V2 receptor antagonist, reduces renal volume expansion and loss of renal function in patients with autosomal dominant polycystic kidney disease (ADPKD). Data for predictive factors indicating patients more likely to benefit from long-term tolvaptan are lacking. Data were retrospectively collected from 55 patients on tolvaptan for 6 years. Changes in renal function, progression of renal dysfunction (estimated glomerular filtration rate [eGFR], 1-year change in eGFR [ΔeGFR/year]), and renal volume (total kidney volume [TKV], percentage 1-year change in TKV [ΔTKV%/year]) were evaluated at 3-years pre-tolvaptan, at baseline, and at 6 years. In 76.4% of patients, ΔeGFR/year improved at 6 years. The average 6-year ΔeGFR/year (range) minus baseline ΔeGFR/year: 3.024 (-8.77-20.58 mL/min/1.73 m2). The increase in TKV was reduced for the first 3 years. A higher BMI was associated with less of an improvement in ΔeGFR (p = 0.027), and family history was associated with more of an improvement in ΔeGFR (p = 0.044). Hypernatremia was generally mild; 3 patients had moderate-to-severe hyponatremia due to prolonged, excessive water intake in response to water diuresis-a side effect of tolvaptan. Family history of ADPKD and baseline BMI were contributing factors for ΔeGFR/year improvement on tolvaptan. Hyponatremia should be monitored with long-term tolvaptan administration.

Scientific approach in justification of monitoring and bioremediation of natural reservoirs in the suburban area

The relevance of the study is explained by the need to form a scientific approach to monitoring and bioremediation of pond reservoirs located in suburban areas. Further climate change, population growth, and excessive water intake lead to a decrease of restoration functions of water bodies and an increase of the HAB (Harmful Algal Bloom) effect. Suburban areas combine features of rural and urban lifestyles. At these territories, pond fish farming is intensively developed, and a space-time continuum with Push-pull strategies is being formed. The fishery complex of the Russian South is on the rise. It constantly requires applying of innovations. The essence of the research hypothesis was to define economic motivators for the development of pond fish farming in a suburban area, and to substantiate scientific approach to monitoring and bioremediation of water bodies. The represented materials reveal the tools for the development and using of automated devices and smart technologies in biosphere monitoring. Also the materials describe the tools for promotion of environmentally friendly technologies (bioremediation in the pond business). It is shown that such key requirements as mobility, efficiency, and using of green technologies, including bioremediation, become more and more significant for the development of pond fish farming in suburban areas. =

Pagophagia-Induced Hyponatremia: An Unusual Case

Hyponatremia occurs when the serum sodium level is below 135 mmol/L. The symptoms include nausea, vomiting, confusion, headache, cardiorespiratory symptoms, profound somnolence or coma, and seizures are observed. Iron deficiency anemia can also cause pagophagia, a Pica subspecies. Although it has been emphasized that electrolyte disturbance may develop due to pagophagia, only a dearth of cases was reported. A 59-year-old male patient was brought to the emergency department with complaints of incoherent speech that started at night, disorientated movements (such as fluttering and climbing), insomnia, restlessness, and confusion. In 2017, he experienced hyponatremia due to pagophagia and a salt-free diet. At the index episode of hyponatremia, he experienced confusion, drowsiness, and sleepiness. It was learned that the patient enjoyed these symptoms.For this purpose, the patient made a habit of eating a completely salt-free diet and consumed plenty of water. Although pagophagia is considered to cause hyponatremia because it causes excessive water intake, there are not enough cases reported. It is to be noted that people develop habits or addiction to things they like.

The Effect of Environmental Disasters on Endocrine Status, Hematology Parameters, Body Composition, and Physical Performance in Young Soccer Players: A Case Study of the Aral Sea Region.

The Aral Sea region (Uzbekistan) is infamous because of the ecological disaster characterized by the disappearance of the Aral Sea due to excessive uncontrolled water intake for agriculture needs. A new desert occurrence, soil and climate aridization led to pesticide and toxic metals environment pollution. The impact of environmental conditions in some areas of Uzbekistan on the health of soccer players is not as noticeable as, for example, the effectiveness of training, so it is not widely discussed in scientific papers. The aim of the present study was to study the features of endocrine status, hematology parameters (e.g., red blood cells (RBC) and hemoglobin (Hb)), and their influence on body composition and physical fitness performance in local young soccer players of the Aral Sea region as the territory of ecological disaster. The study involved 60 male soccer players aged from 18 to 22 years. Participants were divided into two groups: the experimental group (EG), which consisted of 30 soccer players living on the territory of the Aral ecological disaster region, and the control group (CG), which included 30 soccer players, natives of the ecologically favorable region of Uzbekistan. All volunteers had anthropometric measurements, concentrations of insulin-like growth factor-1 (IGF-1), total testosterone (TT), estradiol (E2), cortisol (C), RBC, and Hb count. Moreover, Yo-Yo Intermittent Recovery Test Level 1 (YYIRT1) and professional skills tests such as dribbling shuttle test (DSt) and goal accuracy test (GAt) were assessed. When comparing the CG group to the EG group, it was observed that the EG group exhibited statistically significantly reduced levels of TT and E2 (p < 0.05). No significant statistical difference was observed between the two groups in terms of IGF-1 and C (p > 0.05). Regarding hematological parameters, Hb, Ht, and mean corpuscular volume (MCV) were found to be significantly lower in the EG compared with the CG (p < 0.05). Moreover, the distance covered in the YYIR1 test was found to be significantly lower in soccer players within the EG compared with the CG (p < 0.05). Additionally, it was determined that there was no significant difference between the groups in terms of DSt and GAt values (p > 0.05). Lastly, significant differences were observed between the EG and CG in terms of anthropometric characteristics (diameters, skinfold, and somatotype profile) (p < 0.05). The present study showed that the changes in evaluated characteristics might result from the complex influence of endocrine-disrupting chemicals, the content of which is high in the environment of the Aral Sea region. The results obtained may help monitor the health of athletes living in an environmentally unfriendly environment.

Reaction of Kidney Medullary Laminin to Prolonged Dehydration of Rats

Laminin is the main water-soluble protein in the basement membrane of epithelial tissue. The content of laminin in the renal parenchyma was studied in rats that were on an alternative water diet for 60 h with excessive water intake or a complete lack of drinking water in the food. It has been shown that the osmotic concentration of urine, which develops as a result of water deprivation, is accompanied by a quantitative change in the composition of laminin. It has been established that the amount of laminin beta chain increases in the kidney medulla of dehydrated rats. This effect is observed only in WAG rats with normally expressed vasopressin gene and is absent in mutant Brattleboro rats unable to synthesize the hormone. The increase in the level of beta-laminin also does not extend to the cortical substance. Based on the original and new data, it is assumed that laminin, as a key regulatory element in the basement membrane of the tubular epithelium, participates in the adaptive reaction of the concentrating system of the kidney to conditions of prolonged dehydration. Hyperhydration does not affect the level of laminin in the renal parenchyma.

A family educational therapy for a 15 months-old child with polydipsia

Polydipsia is a condition characterized by excessive water intake and can be caused by several conditions. We present a case report of a child who was admitted in our department for persistent fever, but during the recovery a primary polydipsia was accidentally found through laboratory exams.

Facilitating cooperation among users in water conflicts with a tripartite evolutionary game model: A case study in the Hanjiang Basin, China

Water conflict is evolving into one of the most vital social and environmental issues as the global water crisis intensifies in recent years. Previous studies mostly focus on the game between water users but overlook the fact that water resource institutions (WRIs), which are increasingly involved in water conflicts, are also essential players. In this study, a tripartite evolutionary game model that considers WRIs, demand-side users, and supply-side users is developed. Seven potential evolutionary stable strategies and nine evolutionary scenarios are deduced. The theoretical findings are validated by simulating the water conflict of two provinces (i.e., Hubei and Henan) in the Hanjiang basin, China. The results indicate that non-cooperation among water users and ineffective intervention by WRIs are the long-term outcomes of this water conflict case. To foster cooperation, the game structure needs to be altered by affecting the external variables that determine the net benefits of excess water intake and water rights transfer. Owing to the insufficient long-term incentives for WRIs, cooperation among water users cannot rely on the intervention strategy. Nonetheless, even if external conditions are immature, the intervention strategy can act as auxiliary means to foster cooperation in advance but at the cost of some of the WRIs’ interests. The outcomes of the present study can provide managers of water resources with contributing information for cooperation promoting among water users.

Lack of sex and estrous stage effects on compulsive behavior assessed using a schedule-induced polydipsia procedure in rats.

Preclinical behavior models used for screening pharmacological treatments for mental disorders have generally used only male research subjects, and for studies that have included female subjects, few have utilized sex as a study variable. In fact, many mental disorders vary by prevalence and symptomatology between sexes, creating a need to evaluate established subject models for sex differences. Compulsive behavior is a feature shared across many mental disorders and effective treatments have been examined pre-clinically using the schedule-induced polydipsia procedure in rats. Drugs effective for reducing polydipsia include psychostimulants, such as d -amphetamine. Virtually no studies have examined sex differences using this procedure. For the present study, male and female rats were examined in the schedule-induced polydipsia paradigm. Rats were food-restricted and trained on a fixed-interval food reinforcement schedule and given free access to water during experimental sessions. Estrous stages were assessed during training and test sessions. The psychostimulant d -amphetamine was also tested once stable water consumption occurred. Excessive water intake developed over the course of training. Females required significantly more sessions to reach a stable level of drinking. Treatment with d -amphetamine (1.0 mg/kg, but not 0.25 or 0.5 mg/kg) significantly reduced drinking in both male and female rats. No sex differences were observed across other study variables including comparisons between diestrus and proestrus stages. Overall, these findings suggest that schedule-induced polydipsia procedures that employ similar methods can produce results generalizable across male and female subjects.

Hyponatremia due to excessive water intake in COVID-19 patients: case series study

BackgroundLiteratures revealed syndrome of inappropriate antidiuretic hormone (SIADH) as the most common mechanism of hyponatremia in COVID-19. However, it is important to rule out other etiologies of hyponatremia.MethodsThis is a case series, retrospective study. Four patients were reviewed from the Mesaieed Hospital, Hamad Medical Corporation, Qatar. The patients were admitted during the second wave of pandemic because of mild to moderate COVID pneumonia. The patients received medications according to the protocol; after few days of treatment, their blood laboratory results showed hyponatremia; as compared to the initial readings, hyponatremia workup excluded SIADH. History revealed that the patients were drinking large amounts of water, around 4–5 L/day, due of certain reasons: one patient had dysgeusia, and the other three patients thought that excessive drinking of water is beneficial for COVID-19 infection.ResultsThe hyponatremia level was less than 135 mmol/L, other laboratory tests excluded SIADH, and the provisional diagnosis was dilutional hyponatremia. Male/female ratio was 3/1, age from 29- to 45-year-old patients with no associated comorbidities. Fluid restriction up to 1.5 L/day showed dramatic improvement of their sodium blood level. The patients are discharged in a stable condition.ConclusionsIn COVID-19 patients, hyponatremia not only is secondary to SIADH but can also be due to other etiologies. Hyponatremia can be induced by excessive water drinking and considered an extremely rare reported cases.

Evolution of water resource allocation in the river basin between administrators and managers

AbstractThe reasonable allocation of water resources runs through the main links of regional water resource planning and management, which is a complex decision-making issue, ensures the sustainable development and utilization of water resources, and makes a greater contribution to the sustainable development of social economy. In this paper, evolutionary game theory is applied to the allocation of watershed water resources in a river basin. Also, the analysis of the replication dynamics and evolutionary stability strategies of water resource allocation among water resource manufacturers was done. It was found that the evolutionary game among the water resource manufacturers has only an evolutionary stability strategy. Considering the evolutionary game between water resource managers and water resource manufacturers, the evolutionary stability strategy is analyzed. This study suggests that there are two evolutionary stability strategies ( normal water intake, high level of regulation) and ( excess water intake, low level of regulation) between the water resource manufacturers and the administrative water resource regulators, where the strategy ( normal water intake, high level of regulation) is the expected direction. The evolution factors of the strategy ( normal water intake, high level of regulation) were analyzed. Furthermore, it also suggested that an effective reward and punishment mechanism will help to draw up excessive water, dismantle the conflicts between the water resource manufacturers and the administrative water resource regulators, and increase the benefits of both sides.

The mysterious death of the beer drinking champ: potential role for hyperacute water loading and acute hyponatremia.

ABSTRACTHyponatremia is acute when present for <48 h. Most cases of acute hyponatremia involve both excess free water intake and an at least partial urinary free water excretion defect. By contrast, hyperacute water intoxication may result from a large excess electrolyte-free water intake in such a short time that properly working urinary free water excretion mechanisms cannot cope. A hyperacute decrease in serum sodium may lead to death before medical intervention takes place. Well-documented cases have been published in the military medicine literature. In addition, news reports suggest the existence of cases of voluntary ingestion of excess free water by non-psychiatric individuals usually during ‘dare’ activities. Education of the public is required to prevent harm from these high-risk activities. Adequate training of emergency medical units may prevent lethal outcomes. Spanish media reported the case of a male who died following his triumph in a 20-min beer drinking contest. ‘From a heart attack. Man dies after drinking six litres of beer in a contest’ ran the news. We now review the physiology underlying hyperacute water intoxication and discuss the potential contribution of hyperacute water loading and acute hyponatremia to the demise of this patient.

Abstract- Poster

IntroductionWater intoxication is a rare condition characterized by over consumption of water. In the case outlined below, it emerged as a result of psychogenic polydipsia.Case report informationHere we report an elderly male who presented with polydipsia while being on prolonged lithium therapy for more than 10 years for bipolar affective disorder. Further evaluation showed hyponatremia as a result of water intoxication due to the polydipsia and it confirmed the diagnosis of lithium induced polydipsia which responded to change in the drug and behavioral therapy.Intervention/treatmentProper evaluation of such a patient was done by comparison of serum and urine osmolality before confirming the diagnosis. The hyponatremia was resolved with water intake restriction. Discontinuation of lithium and start of valproate in such a patient was done. And as the manic phase of the patient subsided the symptoms of polydipsia also decreased.ResultHis manic symptoms and, as his symptoms improved, the water restriction was more manageable, and the serum sodium levels also increased, after ensuring water intake less than 1.5L per day, following which his serum osmolality and urine osmolality now were in the normal range.DiscussionPolyuria may occur more frequently with twice daily dosing. Lithium can cause a reduction in urinary concentrating capacity: Nephrogenic diabetes insipidus. Hence the occurrence of thirst and polyuria. This effect is usually reversible in the short to medium term but renal effects may be irreversible after long term treatment: >1.5 years.Psychogenic polydipsia is a disorder that can lead to significant morbidity and mortality and occurs in 6% to 20% of psychiatric patientsConclusionGiven how common psychogenic polydipsia is, we suggest that routine enquiry should be made into excessive water intake, in both inpatient and outpatient settings.

Clinical characteristics and outcomes of hyponatraemia associated with oral water intake in adults: a systematic review

IntroductionExcessive water intake is rarely associated with life-threatening hyponatraemia. The aim of this study was to determine the clinical characteristics and outcomes of hyponatraemia associated with excess water intake.MethodsThis review...

Extreme hyponatraemia due to primary polydipsia and quetiapine-induced SIAD.

SummaryHyponatraemia is the most common electrolyte disturbance in hospitalised patients and is associated with numerous adverse outcomes. Patients with schizophrenia are particularly susceptible to hyponatraemia, in part due to the close association between this condition and primary polydipsia. We report the case of a 57-year-old woman with schizophrenia and primary polydipsia who was receiving inpatient psychiatric care. She became increasingly confused, had multiple episodes of vomiting, and collapsed 1 week after being commenced on quetiapine 300 mg. On examination, she was hypertensive and her Glasgow coma scale was nine. She had a fixed gaze palsy and a rigid, flexed posture. Investigations revealed extreme hyponatraemia with a serum sodium of 97 mmol/L. A CT brain demonstrated diffused cerebral oedema with sulcal and ventricular effacement. A urine sodium and serum osmolality were consistent with SIAD, which was stimulated by the introduction of quetiapine. The antidiuretic effect of vasopressin limited the kidney’s ability to excrete free water in response to the patients' excessive water intake, resulting in extreme, dilutional hyponatraemia. The patient was treated with two 100 mL boluses of hypertonic 3% saline but deteriorated further and required intubation. She had a complicated ICU course but went on to make a full neurological recovery. This is one of the lowest sodium levels attributed to primary polydipsia or second-generation antipsychotics reported in the literature.Learning pointsThe combination of primary polydipsia and SIAD can lead to a life-threatening, extreme hyponatraemia.SIAD is an uncommon side effect of second-generation anti-psychotics.Serum sodium should be monitored in patients with primary polydipsia when commencing or adjusting psychotropic medications.Symptomatic hyponatraemia is a medical emergency that requires treatment with boluses of hypertonic 3% saline.A serum sodium of less than 105 mmol/L is associated with an increased risk of osmotic demyelination syndrome, therefore the correction should not exceed 8 mmol/L over 24 h.