SODIUM AND WATER IMBALANCE: DIFFERENTIAL DIAGNOSES

Polydipsia Polyuria Serum ADH Serum Na Urine Na Serum Osm Urine Osm WDT
(0.5-7.6 135 – 145 (Spot and 24 hr: (280-295 (50-1290
pg/ml) mmol/L 40-220 mmol/L) mOsm/kg) mOsm/L)
Psychogenic ✔ ✔ Normal Normal or low Normal or low Normal or low Low or very low Normal
Polydipsia
Nephrogenic ✔ ✔ Normal High Low High Low Abnormal
Diabetes Insipidus
Cranial Diabetes ✔ ✔ Very low High Low High Low Abnormal
Insipidus (>3L/24 hr)
SIADH x x High Low * High Low High -
(>20 or 40) (>100 or 110)
Psychogenic ✔ ✔ High Very low Normal Very low Normal Normal
Polydipsia + SIADH

• mmol/L = mEq/L
• * unless taking diuretics or on a severe salt restriction
• WDT: water deprivation test. Tthis test is performed in absolute liquid deprivation, included coffee and alcohol for at least 6-8 hours, until 18 hours.
The patient is not allowed to smoke during the test. If there is no change in the water loss despite fluid deprivation, desmopressin may be
administered to distinguish between the two types of diabetes insipidus which are central & nephrogenic diabetes insipidus.

Interpretation of WPT

The conditions can be distinguished in the following way:

Ref: Psychogenic polydipsia: a mini review with three case-reports; F. Londrillo, F. Struglia, A. Rossi; Journal of Psychopathology, 2011.