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Decreased blood urea nitrogen reveals polydipsia in a vegetarian with schizophrenia

Decreased blood urea nitrogen reveals polydipsia in a vegetarian with schizophrenia Received: 4 August 2016 Accepted: 16 September 2016 DOI 10.1111/appy.12263 Of fi cial j ournal of the bs_bs_banner Pacifi c Rim College of Psychiatrists LETTER TO THE EDITOR Decreased blood urea nitrogen reveals polydipsia in a vegetarian with schizophrenia To the Editor: and/or the kidneys, which are responsible for urea excretion. People Primary polydipsia (PP) is not uncommon in psychiatric patients with vegan or vegetarian diets theoretically might have lower BUN (Dundas, Harris, & Narasimhan, 2007). PP can induce dilutional levels (Lin et al., 2010). BUN can be diluted by fluid overload; hyponatremia when the excessive fluid intake overwhelms the therefore, the levels of BUN could be decreased in patients with excretory capacity of the kidney. However, less than half of patients severe PP. Moreover, the patient’s vegetarian diet may have primed with PP develop dilutional hyponatremia (Dundas et al., 2007). his BUN to be more sensitive to fluid overload. Here, we report the case of a man with schizophrenia whose PP was In the outpatient setting, PP is often overlooked until the serum uncovered by the decreased blood urea nitrogen (BUN). levels of sodium have progressed to profound hyponatremia with frank A46‐year‐old vegetarian man with a 20‐year history of neurological symptoms. BUN might be another marker for fluid schizophrenia presented. His family reported that he had stopped overload, particularly in patients with vegetarian or vegan diets. taking his psychotropic drugs 2 months ago and gradually became Hsuan‐Te Chu MD more irritable with overt aggressive acts. Pei‐Shen Ho MD The significant laboratory tests on admission were as follows: Yao‐Wen Liu MD BUN, 2 mg/dL and urine specific gravity, <1.005 g/mL. The other 1,2 Chih‐Sung Liang MD laboratory examinations were negative, including liver enzyme values Department of Psychiatry, Beitou Branch, Tri‐Service General Hospital, and serum levels of sodium and creatinine. Physical examination found National Defense Medical Center, Taipei, Taiwan that he appeared bloated and had some edema in his ankles. The family Graduate Institute of Medical Sciences, National Defense Medical Center, reported that he had a history of PP for 5 years. Taipei, Taiwan After admission, the patient demonstrated compulsive water drinking (around 7‐8 L per day). He weighed 79 kg in the morning and 73 kg evening. Psychotropic drugs were given and a fluid restric- REFERENCES tion program was started. The patient’s BUN and specific gravity grad- Dundas, B., Harris, M., & Narasimhan, M. (2007). Psychogenic polydipsia ually returned to within the normal range over the course of 2 weeks, review: etiology, differential, and treatment. Current Psychiatry Reports, and his body weight remained steady at approximately 73.5 kg. 9(3), 236–241. We found that BUN levels appeared to be a more sensitive indica- Lin, C. K., Lin, D. J., Yen, C. H., Chen, S. C., Chen, C. C., Wang, T. Y., … Lee, tor of fluid overload than sodium levels. BUN measures the amount of M. C. (2010). Comparison of renal function and other health outcomes waste products produced by protein metabolism. BUN could reflect in vegetarians versus omnivores in Taiwan. Journal of Health, Population, the function of the liver, which is responsible for urea production, and Nutrition, 28(5), 470–475. Asia‐Pacific Psychiatry 2017;9:e12263. wileyonlinelibrary.com/journal/appy © 2017 John Wiley & Sons Australia, Ltd 1of 1 https://doi.org/10.1111/appy.12263 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Asia-Pacific Psychiatry Wiley

Decreased blood urea nitrogen reveals polydipsia in a vegetarian with schizophrenia

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References (2)

Publisher
Wiley
Copyright
© 2017 John Wiley & Sons Australia, Ltd
ISSN
1758-5864
eISSN
1758-5872
DOI
10.1111/appy.12263
pmid
28147467
Publisher site
See Article on Publisher Site

Abstract

Received: 4 August 2016 Accepted: 16 September 2016 DOI 10.1111/appy.12263 Of fi cial j ournal of the bs_bs_banner Pacifi c Rim College of Psychiatrists LETTER TO THE EDITOR Decreased blood urea nitrogen reveals polydipsia in a vegetarian with schizophrenia To the Editor: and/or the kidneys, which are responsible for urea excretion. People Primary polydipsia (PP) is not uncommon in psychiatric patients with vegan or vegetarian diets theoretically might have lower BUN (Dundas, Harris, & Narasimhan, 2007). PP can induce dilutional levels (Lin et al., 2010). BUN can be diluted by fluid overload; hyponatremia when the excessive fluid intake overwhelms the therefore, the levels of BUN could be decreased in patients with excretory capacity of the kidney. However, less than half of patients severe PP. Moreover, the patient’s vegetarian diet may have primed with PP develop dilutional hyponatremia (Dundas et al., 2007). his BUN to be more sensitive to fluid overload. Here, we report the case of a man with schizophrenia whose PP was In the outpatient setting, PP is often overlooked until the serum uncovered by the decreased blood urea nitrogen (BUN). levels of sodium have progressed to profound hyponatremia with frank A46‐year‐old vegetarian man with a 20‐year history of neurological symptoms. BUN might be another marker for fluid schizophrenia presented. His family reported that he had stopped overload, particularly in patients with vegetarian or vegan diets. taking his psychotropic drugs 2 months ago and gradually became Hsuan‐Te Chu MD more irritable with overt aggressive acts. Pei‐Shen Ho MD The significant laboratory tests on admission were as follows: Yao‐Wen Liu MD BUN, 2 mg/dL and urine specific gravity, <1.005 g/mL. The other 1,2 Chih‐Sung Liang MD laboratory examinations were negative, including liver enzyme values Department of Psychiatry, Beitou Branch, Tri‐Service General Hospital, and serum levels of sodium and creatinine. Physical examination found National Defense Medical Center, Taipei, Taiwan that he appeared bloated and had some edema in his ankles. The family Graduate Institute of Medical Sciences, National Defense Medical Center, reported that he had a history of PP for 5 years. Taipei, Taiwan After admission, the patient demonstrated compulsive water drinking (around 7‐8 L per day). He weighed 79 kg in the morning and 73 kg evening. Psychotropic drugs were given and a fluid restric- REFERENCES tion program was started. The patient’s BUN and specific gravity grad- Dundas, B., Harris, M., & Narasimhan, M. (2007). Psychogenic polydipsia ually returned to within the normal range over the course of 2 weeks, review: etiology, differential, and treatment. Current Psychiatry Reports, and his body weight remained steady at approximately 73.5 kg. 9(3), 236–241. We found that BUN levels appeared to be a more sensitive indica- Lin, C. K., Lin, D. J., Yen, C. H., Chen, S. C., Chen, C. C., Wang, T. Y., … Lee, tor of fluid overload than sodium levels. BUN measures the amount of M. C. (2010). Comparison of renal function and other health outcomes waste products produced by protein metabolism. BUN could reflect in vegetarians versus omnivores in Taiwan. Journal of Health, Population, the function of the liver, which is responsible for urea production, and Nutrition, 28(5), 470–475. Asia‐Pacific Psychiatry 2017;9:e12263. wileyonlinelibrary.com/journal/appy © 2017 John Wiley & Sons Australia, Ltd 1of 1 https://doi.org/10.1111/appy.12263

Journal

Asia-Pacific PsychiatryWiley

Published: Mar 1, 2017

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