Hyponatremia and belligerent behaviour

[Flowers4eden]

I am doing a care plan for tomorrows class and I was wondering about hyponatrmia and belligerent behaviour. Does hyponatremia disturb the thought process because of the electrolyte imbalance? I am somewhat confused as to why a patient would be acting belligerent and was wondering if it pertains to his hyponatremia.

Thanks for any info that would help me. It would be appreciated.

[Daytonite, BSN, RN]

In hyponatremia sodium is low because of low sodium intake, large sodium losses, large water losses or the third spacing of water inside body cavities (this is considered fluid loss). These four situations result in these successively worsening symptoms:

• Increased pulse (tachycardia)
  
• Weak, thready peripheral pulses
  
• Flat neck veins
  
• Increased respiratory rate
  
• Decreased blood pressure (hypotension)
  
• Decreased body weight
  
• Thick, slurred speech
  
• Anorexia
  
• Nausea/Vomiting/abdominal cramps
  
• Oliguria
  
• Anuria
  
• Lethargy/Malaise
  
• Headache
  
• Confusion
  
• Muscular twitching
  
• Seizures
  
• Coma
  
• Respiratory arrest
  

[Mr Ian]

Psychogenic polydipsia is an uncommon disorder characterized by excessive water-drinking in the absence of a physiologic stimulus to drink. If untreated, the syndrome may eventually lead to complications of water intoxication such as hyponatremia, reduced renal concentrating ability, mental status changes, seizures, coma, and even death.1 Approximately 80% of psychiatric patients who manifest psychogenic polydipsia suffer from schizophrenia.2 The disorder may also occur in children, either as a symptom of emotional difficulties or as an isolated phenomenon in a child who simply enjoys drinking. While fluid restriction and behavioral interventions remain the cornerstones of treatment, pharmacologic agents have also been used, including the atypical neuroleptic medication clozapine,3,4 the angiotensin-receptor blocker (ARB) losartan,5 the β-adrenergic blocker propranolol,6-8 the combination of lithium and phenytoin,9 captopril,10 and demeclocycline.11 In the following case, the β-adrenergic and serotonin 5-HT1A autoreceptor antagonist, pindolol, was used successfully in the treatment of psychogenic polydipsia.12

A 47-year-old man had a 26-year history of undifferentiated schizophrenia with prominent ideas of reference, irrelevant speech, inappropriate affect, and belligerence. His symptoms had resulted in hospitalizations approximately 2-3 times/year. For the 3 years prior to his current admission, the patient had developed increasingly problematic psychogenic polydipsia with at least 4 hospitalizations for related complications including delirium and seizures.

http://www.primarypsychiatry.com/aspx/articledetail.aspx?articleid=335

Pindolol For Psychogenic Polydipsia