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November 23, 1984

The Possible Role of Tobacco Cigarette Smoking in Hyponatremia of Long-term Psychiatric Patients

Author Affiliations

From the Veterans Administration Medical Center, Palo Alto, Calif.

JAMA. 1984;252(20):2864-2865. doi:10.1001/jama.1984.03350200050022

HYPONATREMIA in psychiatric patients is found infrequently, but it may represent a medical emergency with an occasionally lethal outcome.1 Once gastrointestinal tract sodium loss, adrenal gland insufficiency, renal disease, congestive heart failure, hepatic cirrhosis, or use of diuretics are ruled out as causes of true low serum sodium concentration, there is still a group of patients with episodes of hyponatremia for which the causality is elusive. Low levels of serum sodium in these cases are usually ascribed to psychotropic drug—induced syndrome of inappropriate antidiuretic hormone secretion (SIADH) and excessive fluid intake. An SIADH induced by postulated neuroendocrine mechanisms triggered through the emotional stress of psychosis has been described in the literature.

Excessive fluid intake is frequently observed among hospitalized psychiatric patients. A study of 241 such patients identified 41 (17.5%) with polydipsia. Their estimated fluid intake ranged from 4 to 10 L/day, and 24-hour urine volumes from 2,120 to