Psychogenic Polydipsia

[zenman]

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Admitting a 52 yr old female to psych unit dx with Psychogenic Polydipsia by hospitalist. Original NA 125, now 134. Urine osmolality not back yet. I'm wondering if she's been worked up appropriately by hospitalist. She's definitely anxious, hx ETOH with last drink in Jan on her birthday, although sober since Nov 2011. Lot's of recent stressors with paranoid delusions...thinks cops are wanting to arrest her and people talking about her. OCD behaviors. Smokes 3 PPD. Loads of caffiene. GERD. I was going to start with low dose Risperidone. Attending suggested Haldol 2 mg. May consider Cymbalta and switch Xanax to Klonopin. Xanax and Nexium only regular meds. Hasn't been followed by psych in years. Any suggestions?

 

[vistaril]

Admitting a 52 yr old female to psych unit dx with Psychogenic Polydipsia by hospitalist. Original NA 125, now 134. Urine osmolality not back yet. I'm wondering if she's been worked up appropriately by hospitalist. She's definitely anxious, hx ETOH with last drink in Jan on her birthday, although sober since Nov 2011. Lot's of recent stressors with paranoid delusions...thinks cops are wanting to arrest her and people talking about her. OCD behaviors. Smokes 3 PPD. Loads of caffiene. GERD. I was going to start with low dose Risperidone. Attending suggested Haldol 2 mg. May consider Cymbalta and switch Xanax to Klonopin. Xanax and Nexium only regular meds. Hasn't been followed by psych in years. Any suggestions?

what is her hx though?

 

[whopper]

Wait for labs concerning the polydipsia. This might not be psychogenic, that is unless the documentation from the hospitalist clearly demonstrates this is psychogenic.

A problem is even if there are labs, in patients with polydipsia, there is the notorious habit of staff members to leave the patient alone and they start drinking anything, I mean anything like toilet water, water the flowers were in, water from the tap (nurse: well that's not my fault I didn't serve it to her). In some cases, patients like this need to be put on a one to one.

At the hospital I was previously at, I was on the best unit in the hospital, and if I gave an order, I knew it usually was followed, especially given that I was on the unit most of the day and oversaw what was going on with the more difficult patients. This is not the case in all hospitals.

As for the rest, I'd check her labs out first before I made any medical decisions. There's plenty of ways to go here and not seeing the labs is an important part of the puzzle. The polydipsia could be from psychosis or a form of OCD, this could be xanax-induced psychosis, she may be having med problems causing the polydipsia, etc.