A systematic review of the ability of urine concentration to distinguish antipsychotic- from psychosis-induced hyponatremia

Wanlop Atsariyasing, Morris B. Goldman*

*Corresponding author for this work

Research output: Contribution to journalReview article

14 Scopus citations

Abstract

Life-threatening hyponatremia in psychotic patients is common and typically is attributable to either antipsychotic medication or to acute psychosis in those with the polydipsia-hyponatremia syndrome. The preferred treatment for one situation may worsen the hyponatremia if caused by the other situation. Hence it is critical to distinguish between these two possibilities. Case reports and series were identified through electronic databases. Fifty-four cases of hyponatremia without recognized causes in psychotic patients were divided into those with dilute (<plasma osmolality) or concentrated (>plasma osmolality) urine. The distribution of urine concentration and measures likely to be associated with psychotic illness and its treatment were compared in both groups. Naranjo's scale was utilized to determine the probability hyponatremia was drug-induced. Urine osmolality fit a bimodal distribution (intersection 219. mOsm/kg) better than a unimodal distribution. 'Probable' drug-induced cases occurred 6.8 (95%CI=1.6-28.9) times more often in those with concentrated urine. Acute psychotic exacerbations occurred 4.5 (95%CI=0.4-54.1) times more often in those with dilute urine. These findings, as well as several other trends in the data, indicate that measures of urine concentration can help distinguish between antipsychotic-induced and psychosis-induced hyponatremia.

Original languageEnglish (US)
Pages (from-to)129-133
Number of pages5
JournalPsychiatry Research
Volume217
Issue number3
DOIs
StatePublished - Jul 30 2014

Keywords

  • Reset osmostat
  • SIADH
  • Schizophrenia
  • Vasopressin
  • Water intoxication

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry

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