Picture 1 – Polydipsia
Source – www.livestrong.com
Polydipsia is a term of Greek origin that has been derived from the term ‘poly’ meaning much or many, and ‘dipsia’ meaning thirst. The definition of polydipsia can be framed as a medical symptom of various underlying diseases that is characterized by chronic excessive thirst which is quenched by the intake of an excess amount of water or any other fluid. It is usually a result of the loss of essential body fluids or of blood through bleeding. Excessive intake of water can lead to an imbalance in the electrolyte and sodium content in the blood, thereby leading to saline imbalance in the blood.
Polydipsia can be of specialised forms, namely, psychogenic polydipsia and primary polydipsia, which is actually non-psychogenic in nature. Psychogenic or psychological polydipsia is associated with mental disorders. It is also known as polydipsia schizophrenia. In case of primary polydipsia, drying of the mouth is the most primary symptom. When associated with diabetes, it is known as polydipsia diabetes. In fact polydipsia in diabetes is quite common and truly speaking in most cases, polydipsia and diabetes go hand in hand.
High intake of fluid in case of polydipsia may lead to polyuria, which is a condition characterized by an increased frequency in urination. Polyuria and polydipsia are quite related to each other and may occur simultaneously. Polydipsia may turn serious enough if not controlled to cause heart attacks or strokes. Polydipsia in children is a common phenomenon but its nature and extent differs from those of the adults. Along with humans, polydipsia in dogs and cats may also be noticed.
The causes of polydipsia are quite a few which may be listed as the following:-
- Diabetes – Both diabetes mellitus and diabetes insipidus are responsible may cause polydipsia. Such a case either occurs naturally or may be triggered by the side effects of diabetic medications. Within diabetes mellitus, transient neonatal and insulin dependent types and within diabetes insipidus, both nephrogenic and neurogenic types are responsible for causing polydipsia.
- Acid-Base imbalance – Abnormality in the normal acid and base level in the body, resulting in the deviation of the normal plasma Ph level may also lead one to feel increasingly thirsty. This causes dehydration and leads one to drink excessive volumes of water, thereby leading to polydipsia and its associate, polyuria.
- Anxiety – It is also another cause that may induce or reduce the blood pressure, causing one to feel increasingly thirsty.
- Acromegaly – The excessive secretion of the growth hormone by the pituitary glands causing severe body complications may also be responsible for causing polydipsia.
- Acute Peritonitis – Infection or even disruption of the serous membrane may cause its inflammation, giving rise to other problems such as abdominal pain and tenderness, sequestration of body fluids and electrolytes leading to polydipsia, renal failure, etc.
- Adrenal Gland complications – Problems associated with the adrenal glands such as adrenal adenoma or tumour, adrenal gland hyperfunction, hyperadrenalism, adrenal cortex neoplasms, adrenal incidentaloma and adrenal cancers like adrenal cortical cartinoma are also quite responsible to a great extent for causing polydipsia.
- Alsing Syndrome – A syndrome characterized by renal problems, optic complications and skeletal abnormalities may also trigger polyuria and polydipsia, due to the renal complications involved.
- Anorexia – Also known as anorexia nervosa, it is an eating disorder in which case one refuses to eat properly with an apprehension of gaining excess weight. Such a disorder is actually self-perpetuated method of starving. It is more common among the fairer sex rather than among guys and is another basic cause of polydipsia. It leads to psychiatric problems, and a massive loss of weight, which may perpetuate to ultimately lead to death. It is also known as habit polydipsia.
- Apparent Mineralocorticoid Excess Syndrome – This is an autosomal recessive disorder that is also responsible for increasing blood pressure and lowering the potassium level, thereby causing polydipsia.
- Bartter Syndrome – It is a rare inherited syndrome affecting the kidneys which is characterized by low levels of potassium, constipation, along with low blood pressure, polydipsia and polyuria.
- Boichis Syndrome – It is also a rare syndrome that is inherited which involves complete renal failure and hepatic fibrosis as a result of congenital nephronophthsis. A symptom of this syndrome includes polydipsia.
- Conn’s Syndrome – Also known as Aldosterone-Producing Adenoma, this syndrome is related to the over production of aldosterone, thereby leading to various kinds of problems such as heart failure, nephrotic syndrome, hepatic cirrhosis, which also includes polydipsia as a symptom and consequence.
- Cyclic Vomiting Syndrome – Cyclic Vomiting Syndrome is a syndrome that makes a person vomit a number of times which may also include traces of blood or in fact blood, along with other symptoms such as abdominal pain, headaches, and migraines.
- Cushing Syndrome – It is a disorder that results due to the body’s exposure to high levels of cortisol that may either be produced normally or may be induced by steroids. This causes skin problems, sexual problems, and other problems within which fall polydipsia and polyuria.
- DEND Syndrome – It is an inherited disorder that causes delay in the process of physical and mental development of a person and is highly associated with diabetes and epilepsy. Polydipsia may also be attributed to the same.
- Diarrhoea – Diarrhoea may be highly associated with polydipsia or polyuria as it entails heavy loss of body fluids which may lead to dehydration and electrolyte imbalance. Its severity may even lead to the death of a person as the person loses essential body fluids and salts through uncontrolled bowel movements and frequency of urination.
- EAST Syndrome – It is a genetic disorder that is highly associated with ataxia, epilepsy, salt-wasting renal Tubulopathy, and sensorineural deafness. It is usually triggered by abnormal blood pressure, hypokalemia or low potassium levels, low magnesium levels in the blood, a condition known as hypomagnesaemia. This results in polydipsia or polyuria.
- Excessive Perspiration – Sweating beyond a certain limit beyond normalcy rips the body of the essential body salts and minerals, which not only aids polydipsia and polyuria but can also give rise to certain severe complications.
- Hypopituitarism – It refers to the decreased secretion of follicle-stimulating hormone or of luteinizing hormone or more hormones by the pituitary glands. It is signalled by the occurrence of Acromegaly, tumorous growth, headaches, optic nerves and also polydipsia or polyuria.
- Fanconi Syndrome – This syndrome is either caused due to genetically motivated factors or may either pop out of damage to the kidneys. It is one of the basic reasons behind the occurrence of polydipsia in children and the aged.
- Froelich’s Syndrome – Froelich’s Syndrome is a rare disease that is actually triggered by damage caused to the hypothalamus or the formation of tumour in the pituitary glands, thereby leading to endocrine abnormality. Among the very many symptoms of this syndrome, excessive thirst and urination do form a significant part.
- Gitelman Syndrome – A mild variant of Bartter’s Syndrome, Gitelman Syndrome is a renal defect that is ascribed by birth and is characterized by the automatic release of essential minerals and salts through the urine without being absorbed into the bloodstream. This causes one to feel quite very thirsty as one has to go to ease oneself frequently.
- Hypercalcaemia – This disorder is characterized by an elevated amount of calcium in the blood which is signalled by feebleness, constipation, vomiting, polydipsia and polyuria.
- Hypokalemia – Also known as hypopotassemia, it refers to a metabolic disorder characterized by poor levels of potassium in the bloodstream. Excessive thirst, constipation and frequent urination are some of the symptoms of this disorder.
- Polydipsia hyponatremia – It is a metabolic condition that is characterized electrolyte imbalance due to poor sodium content in the blood.
Beyond the ones mentioned above, the other causes of polydipsia may be listed as the following:-
- Anticholinergic poisoning
- Paroxymal Supraventricular Tachycardia
- Injury to the head
- Phenol sulfotransferase
- Langerhans Problems
- Overactive thyroid glands
- Parathyroid cancer
- Sheehan’s and Schroeder Syndrome
- Systemic Capillary Leak Syndrome
- Wolfram and Wohlmann-Caglkar Syndrome
- Side-effects of certain drugs and medications such as methacycline, vasopressin resistant drugs, glucotrol, etc, may also lead to polydipsia.
Although polydipsia is itself a symptom of many a chronic or acute diseases, yet among the symptoms of polydipsia, excessive thirst and frequent urge for urination may be regarded as the most primary symptom of the same.
Normally the ability of the body to trigger thirst and hunger diminishes as one grows old. However, one may suffer from dehydration in most cases.
Nocturia can be one of the symptoms of the disease and polydipsia in children can be signalled by enuresis. Along with these, the symptoms of polydipsia may also include breathing troubles, headache, malaise, loss of weight, loss of appetite but increasing thirst, and nocturia may cause nocturnal polydipsia.
The intracranial pressure that results due to the loss of body fluids results in lowering the blood pressure and may also slow the pulse rate. In cases where polydipsia is associated with diabetes, anaemia or renal failure, one may suffer from optic problems such as papilloedema, cataract formation, vessel formation, visual field defect, and even retinal haemorrhages. Schedule induced polydipsia occurs when one suffers from anorexia. One may also exhibit signs of peripheral neuropathy and palpable kidneys in case of diabetes. Moreover, polyphagia, polyuria and polydipsia are linked together and may occur simultaneously. Serious cases of polydipsia may even precipitate to cause strokes and cardiac arrests.
However, in case of canine polydipsia, psychogenic polydipsia in dogs and cats, polyuria in dogs and cats, the symptoms do differ from the nature of the ones affecting humans.
Polydipsia Differential Diagnosis
Polydipsia is mostly accompanied by polyuria and at times with polyphagia. It actually entails changes in the osmolality of essential and extracellular body fluids, and is mostly associated with diabetes and other similar kind of chronic disorders. So for the purpose of detecting the cause of polydipsia, one has to conduct a differential diagnosis of the same so as to differentiate it from its related disorders.
Blood serum tests are useful in detecting the serum concentration of RBCs, blood urea nitrogen (BUN), sodium, calcium and potassium in the blood. It also aids to measure the Erythrocyte Sedimentation Rate in order to detect inflammation in the body. Anaemia can possibly be detected in case of renal failure and collagen vascular diseases.
One may also have to get a serum protein electrophoresis done in cases associated with myeloma in order to detect the protein content. In case when pituitary tumour is involved, one may have to go through a hormone profile test. An autoantibody screening helps screen for antibodies which may have caused renal infections and damage.
Diabetic patients and those suffering from renal failure may have to through a urinalysis, urine osmolality, and urine electrophoresis for the detection of abnormalities in the albumin-creatinine ratio (ACR). Patients under medications to deal with diabetes may also have to take in a Desmopressin test and water deprivation test.
Moreover, imaging tests such as a Renal biopsy, Ultrasound test, CT scan, an x-ray or an MRI of the renal tract, skull, and brain may be conducted to ascertain the exact cause behind polydipsia.
The treatment of polydipsia depends on the nature of the disorder and its underlying cause which may be confirmed by a diagnosis. The treatment for polydipsia may include administration of insulin, sulfonylurea agents such as Glipzide and Glibenclamide, metformin in case of diabetic patients. Another anti-diabetic and antihyperglycemic medication which helps to deal with polydipsia and polyuria is Pioglitazone.
Desmopressin is a synthetically produced drug which acts as a substitute for vasopressin. It helps in reducing the production of urine, and thereby controls polydipsia and polyuria. It is the most prescribed drug for those suffering from diabetes and nocturnal polydipsia. Other medications prescribed include antibiotics and corticosteroids.
The treatment of psychogenic polydipsia is a bit different from the non-psychogenic one. The treatment entails systemic routinized weight-water protocol. It entails dietary controls, daily weight fluctuations, functioning or extent of damage caused to the urinary system, and comorbid disorders. This must be supplemented with physical restraint and monitoring of urination. The psychotropic drugs such as Carbamazepine ironically causes the drying of the mouth but the nature of this reaction is quite different from the one experienced in case of polydipsia. But it should be noted that primary polydipsia often leads to institutionalization of the disorder, in which case the patient needs to get hospitalized.
Hence, it is very essential for an early diagnosis and immediate treatment of polydipsia and the disorders related to it such as polyuria for the purpose of averting life-threatening disorders or diseases such as cardiac arrest, tumour, and severe neurological problems.