From the Guidelines
Excessive water drinking, known as polydipsia, is most commonly caused by diabetes insipidus, a condition characterized by the inability to regulate fluids in the body, as stated in the most recent study 1.
Causes of Polydipsia
The causes of polydipsia can be divided into several categories, including:
- Medical conditions: diabetes mellitus, diabetes insipidus, and certain medications like diuretics, antipsychotics, and some antidepressants can increase thirst as a side effect 1.
- Psychological factors: psychological conditions such as psychogenic polydipsia, often seen in psychiatric disorders like schizophrenia, can lead to compulsive water drinking.
- Dry mouth conditions: xerostomia from medications, Sjögren's syndrome, or radiation therapy may prompt increased water intake.
- Dehydration: excessive sweating, diarrhea, or vomiting naturally increases thirst.
- Lifestyle factors: high salt intake, spicy foods, alcohol consumption, or smoking can increase thirst sensation.
- Pregnancy: increased thirst due to blood volume changes.
Management of Polydipsia
The management of polydipsia depends on the underlying cause. In the case of diabetes insipidus, treatment with desmopressin or other medications may be necessary 1. In other cases, addressing the underlying medical condition or psychological factor may be sufficient.
Importance of Medical Evaluation
Anyone experiencing persistent excessive thirst should seek medical evaluation, as it could indicate a serious underlying condition requiring treatment 1.
In patients with congenital nephrogenic diabetes insipidus, a rare inherited disorder of water homeostasis, the diagnosis and management are very challenging and require an integrated, multidisciplinary approach 1. The typical emergency in NDI is hypernatraemic dehydration because of excessive water loss and/or the inability to maintain adequate fluid intake, and should be treated with water and dextrose solutions, avoiding salt-containing solutions 1.
From the FDA Drug Label
Patients with habitual or psychogenic polydipsia who may drink excessive amounts of water, may be at increased risk of hyponatremia Desmopressin acetate is contraindicated in patients with the following conditions due to an increased risk of hyponatremia: ... Polydipsia Advise patients to limit fluid intake
Causes of excessive water drinking may include:
From the Research
Causes of Excessive Water Drinking
- Central Diabetes Insipidus: a disorder characterized by hypo-osmotic polyuria secondary to abnormal synthesis, regulation, or renal action of antidiuretic hormone, which can lead to excessive water intake 3.
- Primary Polydipsia: a condition characterized by consumption of excessive quantities of water without any abnormality in regulation or action of antidiuretic hormone, often seen in psychiatric patients and health enthusiasts 4, 5.
- Dipsogenic DI: a condition characterized by an abnormally low thirst threshold, leading to excessive water intake 5.
- Psychotic Disorders: can cause life-threatening water imbalance due to an anterior hippocampal induced stress-diathesis, leading to excessive water drinking 4.
- Manic Symptoms: can be associated with Central Diabetes Insipidus, leading to excessive water intake 6.
Underlying Mechanisms
- Arginine Vasopressin (AVP) deficiency: can lead to Central Diabetes Insipidus, characterized by excessive water intake 7, 3, 5.
- Abnormalities in hypothalamic circuitry: can contribute to primary polydipsia and other disorders characterized by excessive water intake 4.
- Oxytocin deficiency: may be associated with altered quality of life in patients with Central Diabetes Insipidus, although this has not been fully established 3.