+Estimation of serum sodium levels from weight gain and suggested interventions Weight gained (% body mass) Estimated serum sodium (mmol/L) Suggested intervention 0-3 140 - 134 No direct intervention, monitoring 3-5 133 - 130 Redirection from water sources 5-7 129–126 Oral NaCl and redirection 7–10 125–120 Oral NaCl and redirection, possibly restraint > 10 < 120 Slow IV saline, seizure precautions Treatment for psychogenic<unk>  depends on severity and may involve behavioural and pharmacological modalities. Acute hyponatraemia If the patient presents with acute hyponatraemia (overhydration) caused by psychogenic<unk> , treatment usually involves administration of intravenous hypertonic (3%) saline until the serum sodium levels stabilise to within a normal range, even if the patient becomes asymptomatic. Fluid restriction If the patient is institutionalised, monitoring of behaviour and serum sodium levels is necessary. In treatment-resistant<unk>  psychiatric patients, regulation in the inpatient setting can be accomplished by use of a weight-water protocol. First, base-line weights must be established and correlated to serum sodium levels. Weight will normally fluctuate during the day, but as the water intake of the<unk>  goes up, the weight will naturally rise. The physician can order a stepped series of interventions as the weight rises. The correlation must be individualized with attention paid to the patient's normal weight and fluctuations, diet, comorbid disorders (such as a seizure disorder) and urinary system functioning. Progressive steps might include redirection, room restriction, and increasing levels of physical restraint with monitoring. Such plans should also include progressive increases in monitoring, as well as a level at which a serum sodium level is drawn. Behavioural Behavioural treatments may involve the use of a token economy to provide positive reinforcement to desirable behaviour. Furthermore, cognitive therapy techniques can be used to address the thought patterns that lead to compulsive drinking behaviour. Success has been seen in trials of this technique, with emphasis on the development of coping techniques (e.g. taking small sips of water, having ice cubes instead of drinks) in addition to challenging delusions leading to excessive drinking. Psychogenic<unk>  often leads to institutionalisation of mentally ill patients, since it is difficult to manage in the community. Most studies of behavioural treatments occur in institutional settings and require close monitoring of the patient and a large degree of time commitment from staff. Pharmaceutical Risperdal (risperidone) tablets A number of pharmaceuticals may be used in an attempt to bring the<unk>  under control, including: * Atypical antipsychotics, such as clozapine, olanzapine and risperidone * Demeclocycline, a tetracycline antibiotic, which is effective due to the side effect of inducing nephrogenic diabetes insipidus. Demeclocycline is used for cases of psychogenic<unk> , including those with nocturnal enuresis (bed-wetting). Its mechanism of action involves direct inhibition of vasopressin at the DCTs, thus reducing urine concentration. There are a number of emerging pharmaceutical treatments for psychogenic<unk> , although these need further investigation: * ACE Inhibitors, such as enalapril * Clonidine, an alpha-2 adrenergic agonist * Irbesartan, an angiotensin II receptor antagonist * Propranolol, a sympatholytic beta blocker * Vasopressin receptor antagonists, such as conivaptan * Acetazolamide, a carbonic anhydrase inhibitor Lithium was previously used for treatment of PPD as a direct competitive ADH antagonist, but is now generally avoided due to its toxic effects on the thyroid and kidneys. It is important to note that the majority of psychotropic drugs (and a good many of other classes) can cause dry mouth as a side effect, but this is not to be confused with true<unk>  in which a dangerous drop in serum sodium will be seen.
Primary polydipsia
Syndrome of inappropriate antidiuretic hormone secretion
Diabetic hypoglycemia
Reactive hypoglycemia
Idiopathic hypoglycemia
Ketosis-prone diabetes
Central diabetes insipidus
Nephrogenic diabetes insipidus