Water intoxication, hyperpyrexia and rhabdomyolysis in a patient with psychogenic polydipsia

Healthy subjects or patients with psychogenic polydipsia can consume large amounts of water without having a marked change in blood osmolality. In the rare reported cases of spontaneous water intoxication in patients with psychogenic polydipsia, it appears that the intoxication resulted from resetting of the osmoreceptors controlling antidiuretic hormone (ADH) secretion. People who maintain abnormally high water intake are vulnerable to water intoxication in conditions leading to an increase in plasma ADH concentration; the source of ADH may be endogenic or exogenic. In the following report we describe a patient with psychogenic polydipsia in whom water intoxication developed in association with hyperpyrexia. We propose that the hyperpyrexia may serve as the stimulus for ADH secretion causing water intoxication.