{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:42:25Z","timestamp":1791380545226,"version":"4.3.3"},"reference-count":28,"publisher":"MedWorks Media","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Psychopharmacol Bull"],"abstract":"<jats:p>Hyponatremia due to water intoxication is frequently observed in patients with chronic schizophrenia. We herein present a 49-year-old man who developed schizophrenia at the age of 23 and had been admitted to the closed ward of our hospital for 7 years. He was found by a round nurse standing at the bedside, covering both ears with his hands and making groaning noises. He was disoriented and immediately after being returned to bed, a general tonic-clonic seizure occurred. Severe hyponatremia (Na 104 mEq\/L) was noted and intravenous sodium correction was started. A few hours later, due to glossoptosis and massive vomiting, ventilation got worse to the point where he had to be put on a ventilator. On the following day, he developed aspiration pneumonia and antimicrobial treatment was started. In addition, a blood sample taken 36 hours later revealed an extensive elevation of creatine kinase (41,286 U\/L), pointing to a possibility of rhabdomyolysis as a complication. Subsequently, the general condition gradually improved with antimicrobial therapy and sodium correction. He eventually recovered without any complications including central pontine myelinolysis. He had no history of polydipsia before this event but it was later found that esophageal stricture triggered complusive fluid intake, resulting in acute hyponatremia, seizure, aspiration pneumonia and rhabdomyolysis. A brief discussion will be provided on the issues surrounding hyponatremia, rhabdomyolysis and schizophrenia.<\/jats:p>","DOI":"10.64719\/pb.4474","type":"journal-article","created":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T11:39:16Z","timestamp":1761046756000},"page":"39-47","source":"Crossref","is-referenced-by-count":1,"title":["Rhabdomyolysis Complicated with Hyponatremia Due to Water Intoxication and Severe Aspiration Pneumonia: Description of a Patient with Chronic Schizophrenia and Literature Review"],"prefix":"10.64719","volume":"53","author":[{"given":"Shintaro","family":"Watanabe","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshio","family":"Sato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junya","family":"Miyaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takefumi","family":"Suzuki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54175","published-online":{"date-parts":[[2025,8,12]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Ahmadi L, Goldman MB. Primary polydipsia: Update. Best practice & research. Clinical Endocrinology & Metabolism. 2020;34(5):101469. doi: 10.1016\/j.beem.2020.101469. doi:","DOI":"10.1016\/j.beem.2020.101469"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Mercier-Guidez E, Loas G. Polydipsia and water intoxication in 353 psychiatric inpatients: an epidemiological and psychopathological study. European psychiatry. The Journal of the Association of European Psychiatrists. 2000;15(5):306\u2013311. doi: 10.1016\/s0924-9338(00)00399-0. doi:","DOI":"10.1016\/s0924-9338(00)00399-0"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Lambeck J, Hieber M, Dre\u00dfing A, Niesen WD. Central pontine myelinosis and osmotic demyelination syndrome. Deutsches Arzteblatt International. 2019;116(35\u201336):600\u2013606. doi: 10.3238\/arztebl.2019.0600. doi:","DOI":"10.3238\/arztebl.2019.0600"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Rizzieri DA. Rhabdomyolysis after correction of hyponatremia due to psychogenic polydipsia. Mayo Clin Proc. 1995;70(5):473\u2013476. doi: 10.4065\/70.5.473. doi:","DOI":"10.4065\/70.5.473"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Chen LC, Bai YM, Chang MH. Polydipsia, hyponatremia and rhabdomyolysis in schizophrenia. A case report. World J Psychiatry. 2014;4(4):150\u2013152. doi: 10.5498\/wjp.v4.i4.150. doi:","DOI":"10.5498\/wjp.v4.i4.150"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Suzuki T, Uchida H, Watanabe K, Kashima H. A potentially aborted neuroleptic malignant syndrome following seclusion against uncontrollable water intoxication. Psychopharmacology Bulletin. 2008;41(1):164\u2013170.","DOI":"10.64719\/pb.4330"},{"key":"ref7","unstructured":"Japanese Society of Laboratory Medicine. Reference interval and Clinical decision limit. 2023 July 9; (in Japanese) Available from: https:\/\/www.jslm.org\/books\/guideline\/2018\/03.pdf. access."},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Levenson JL. Neuroleptic malignant syndrome. The American Journal of Psychiatry. 2007;142(10):1137\u20131145.","DOI":"10.1176\/ajp.142.10.1137"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"De Leon J, Verghese C, Tracy JI, Josiassen RC, Simpson GM. Polydipsia and water intoxication in psychiatric patients: a review of the epidemiological literature. Biological Psychiatry. 1994;35(6):408\u2013419. doi: 10.1016\/0006-3223(94)90008-6. doi:","DOI":"10.1016\/0006-3223(94)90008-6"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Siegel AJ. Hyponatremia in psychiatric patients: update on evaluation and management. Harvard Review of Psychiatry. 2008;16(1):13\u201324. doi: 10.1080\/10673220801924308. doi:","DOI":"10.1080\/10673220801924308"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Lange-Asschenfeldt C, Kojda G, Cordes J, Hellen F, Gillmann A, Grohmann R, Supprian T. Epidemiology, symptoms, and treatment characteristics of hyponatremic psychiatric inpatients. Journal of Clinical Psychopharmacology. 2013;33(6):799\u2013805. doi: 10.1097\/JCP.0b013e3182a4736f. doi:","DOI":"10.1097\/JCP.0b013e3182a4736f"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Leibowitz SF, Eidelman D, Suh JS, Diaz S, Sladek CD. Mapping study of noradrenergic stimulation of vasopressin release. Experimental Neurology. 1990;110(3):298\u2013305. doi: 10.1016\/0014-4886(90)90042-q. doi:","DOI":"10.1016\/0014-4886(90)90042-q"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Spigset O, Hedenmalm K. Hyponatraemia and the syndrome of inappropriate antidiuretic hormone secretion (SIADH) induced by psychotropic drugs. Drug Safety. 1995;12(3):209\u2013225. doi: 10.2165\/00002018-199512030-00006. doi:","DOI":"10.2165\/00002018-199512030-00006"},{"key":"ref14","unstructured":"Kawakami H, Matsuura Y. Tokyo: Igakushoin; 2010. Polydipsia, Water intoxication, new axis of care and treatment. (in Japanese)"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"Douglas I. Hyponatremia: why it matters, how it presents, how we can manage it. Cleveland Clinic Journal of Medicine. 2006;73(Suppl 3):S4\u2013S12. doi: 10.3949\/ccjm.73.suppl_3.s4. doi:","DOI":"10.3949\/ccjm.73.suppl_3.s4"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"Singh MK, Giles LL, Nasrallah HA. Pain insensitivity in schizophrenia: trait or state marker. Journal of Psychiatric Practice. 2006;12(2):90\u2013102. doi: 10.1097\/00131746-200603000-00004. doi:","DOI":"10.1097\/00131746-200603000-00004"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"Miyabe H, Gocho T, Ando M, Hashiba M, Tshuzuki S, Taguchi M, Uenishi N, Takeyama N. Two cases of severe hyponatremia with polydipsia: response to desmopressin acetate and hypertonic saline. J Jpn Soc Intensive Care Med. 2015;22:523\u20136.","DOI":"10.3918\/jsicm.22.523"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"Adrogu\u00e9 HJ, Tucker BM, Madias NE. Diagnosis and management of hyponatremia: a review. JAMA. 2022;328(3):280\u2013291. doi: 10.1001\/jama.2022.11176. doi:","DOI":"10.1001\/jama.2022.11176"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"Verbalis JG, Goldsmith SR, Greenberg A, Korzelius C, Schrier RW, Sterns RH, Thompson CJ. Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. The American Journal of Medicine. 2013;126(10 Suppl 1):S1\u2013S42. doi: 10.1016\/j.amjmed.2013.07.006. doi:","DOI":"10.1016\/j.amjmed.2013.07.006"},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"Siegel AJ. Hyponatremia in psychiatric patients: update on evaluation and management. Harvard Review of Psychiatry. 2008;16(1):13\u201324. doi: 10.1080\/10673220801924308. doi:","DOI":"10.1080\/10673220801924308"},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"Poels PJE, Gabre\u00ebls FJM. Rhabdomyolysis: a review of the literature. Clinical Neurology and Neurosurgery. 1993;95(3):175\u2013192. doi: 10.1016\/0303-8467(93)90122-w. doi:","DOI":"10.1016\/0303-8467(93)90122-w"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"Sahashi K, Ibi T. Pathogenesis and clinical features of rhabdomyolysis. J Jpn Soc Intensive Care Med. 2009;16:242\u201345.","DOI":"10.3918\/jsicm.16.242"},{"key":"ref23","doi-asserted-by":"publisher","unstructured":"Rangan GK, Dorani N, Zhang MM, Zarour LA, Lau HC, Munt A, Chandra AN, Saravanabavan S, Rangan A, Zhang JQJ, Howell M, Wong AT. Clinical characteristics and outcomes of hyponatraemic psychiatric inpatients: a systematic review. BMJ Open. 2021;11(12):e046539. doi: 10.1136\/bmjopen-2020-046539. doi:","DOI":"10.1136\/bmjopen-2020-046539"},{"key":"ref24","doi-asserted-by":"crossref","unstructured":"Korzets A, Ori Y, Floro S, Tov EI, Chagnac A, Weinstein T, Zevin D, Gruzman C. Case report: severe hyponatremia after water intoxication: a potential cause of rhabdomyolysis. Am J Med Sci. 1996;312:92\u201394.","DOI":"10.1097\/00000441-199608000-00007"},{"key":"ref25","doi-asserted-by":"crossref","unstructured":"Wicki J, Rutschmann OT, Burri H, Vecchietti G, Desmeules J. Rhabdomyolysis after correction of hyponatremia due to psychogenic polydipsia possibly complicated by clozapine. Ann Pharmacother. 1998;32:892\u2013895.","DOI":"10.1345\/aph.18032"},{"key":"ref26","doi-asserted-by":"crossref","unstructured":"Ting JY. Rhabdomyolysis and polydipsic hyponatraemia. Emerg Med J. 2001;18:520.","DOI":"10.1136\/emj.18.6.520"},{"key":"ref27","doi-asserted-by":"publisher","unstructured":"Incecik F, Herguner MO, Yildizdas D, Ozcan K, Altunbasak S. Rhabdomyolysis caused by hypernatremia. The Indian Journal of Pediatrics. 2006;73(12):1124\u20131126. doi: 10.1007\/bf02763063. doi:","DOI":"10.1007\/bf02763063"},{"key":"ref28","doi-asserted-by":"publisher","unstructured":"Packard K, Price P, Hanson A. Antipsychotic use and the risk of rhabdomyolysis. Journal of Pharmacy Practice. 2014;27(5):501\u2013512. doi: 10.1177\/0897190013516509. doi:","DOI":"10.1177\/0897190013516509"}],"container-title":["Psychopharmacology Bulletin"],"original-title":[],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T19:31:59Z","timestamp":1791315119000},"score":1,"resource":{"primary":{"URL":"https:\/\/medworksmedia.com\/pb-article\/rhabdomyolysis-complicated-with-hyponatremia-due-to-water-intoxication-and-severe-aspiration-pneumonia-description-of-a-patient-with-chronic-schizophrenia-and-literature-review\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,12]]},"references-count":28,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,8,12]]}},"URL":"https:\/\/doi.org\/10.64719\/pb.4474","relation":{},"ISSN":["2472-2448"],"issn-type":[{"value":"2472-2448","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,12]]}}}