WHEN THE EXCESSIVE WATER INTAKE IS A PROBLEM: A CLINICAL CASE

Introdution: Hyponatremia, defined as a serum sodium concentration below 135 meq/L, is the most commom disorder of body fluid and electrolyte balance. Hyponatremia results from the intake and subsequent retention of water. It can lead to a wide spectrum of clinical symptoms, from subtle to severe, and it’s associated to increased mortality and morbidity. Case report: A 36-year-old female, married, housekeeper, with a previous history of celiac disease, essential hypertension, obesity, hepatic steatosis, dyslipidemia and right amaurose. On December 2015, the patient arrives at the ER with bilateral lower limbs paresthesiae, without any additional complaints. Her physical exam was normal. Analytically, there was a deployment of sodium of 116 mg/dl; with a 235 osmolarity. She was interned in the gastroenterology unit for normotonic sodium cloride correction and clarification of the etiology of hyponatremia. Primary causes of hyponatremia were excluded, with the consumption of thiazide-like diuretics for hypertension treatment as a possible cause. After discovering that patient‘s daily water intake was superior to 3 liters and psychiatry confirmed dysthymia characteristics, the hypothesis of potomania was considered. During her hospitalization, her natremia was normalized, which was maintained in ambulatory with a daily water consumption of approximately 1,5 liters. Conclusion: Potomania is an exclusion diagnosis in the investigation of a hyponatremia board, which is based essentially on anamnesis and the association with psychiatric pathology is known. This case shows the importance of family doctor know the habits and characteristics of our patients‘ personalities, in order to avoid and prevent the consequences of hyponatremia.