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논문분류	춘계학술대회 초록집
제목	Paranoid Adipsia Induced Severe Hypernatremia and Uremia Treated with Hemodialysis
저자	Jae-Hyun Choi, Hee Seung Lee, Sun Moon Kim, Hye-Young Kim, Soon Kil Kwon
출판정보	2013; 2013(1):
키워드	고나트륨혈증, 요독증, 혈액투석/Hypernatremia, Uremia, Hemodialysis
초록	Introduction: Hypernatremia is usually found in elderly patients with cerebral lesion who cannot sense water deficit or people in distressed situation. In the patients with psychiatric illness, senses of water deficiency can be decreased that can show hypernatremia and uremia. We describe here a patient with hypernatremia and uremia caused by paranoid adipsia who had been successfully treated with hydration and hemodialysis. Case: A previously healthy 40-year-old woman was referred to emergency room with altered mentality. She developed paranoid idea that the water contaminated by poison since one month before, and did not take any kind of water. On admission, her blood pressure was 100/60 mmHg, pulse rate was 106/min and skin and mucosa were extremely dehydrated. At blood test, WBC 21,900/mm3, hemoglobin 11.2 g/dl, hematocrit 51%, blood urea nitrogen (BUN) 208 mg/dl, creatinine 4.90 mg/dl, serum osmolality 452 mOsm/L, serum sodium 172 mEq/L and urine specific gravity was above 1.030, urine osmolality 698 mOsm/L, urine sodium/potassium/chloride were 34/85.6/8 mEq/L. Brain CT showed no abnormal finding. We diagnosed with uremic encephalopathy due to prerenal acute kidney injury, started intravenous dextrose, but sodium correction was incomplete. We did hemodialysis to prevent brain damage by uremic encephalopathy, and conducted for two consecutive days. Intravenous dextrose was continued with oral hydration, and sodium level was normalized in three days of hospitalization. The patient was fully recovered without neurologic complication. Conclusion: We experienced a rare case of severe hypernatremia and uremia caused by paranoid adipsia which was successfully treated via hydration and hemodialysis. Although standard treatment of severe hypernatremia is hydration, in case of uremic encephalopathy, hemodialysis can be an additional treatment.
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