Published date: Sep 27 2023

Journal Title: Sudan Journal of Medical Sciences

Issue title: Sudan JMS: Volume 18 (2023), Issue No. 3

Pages: 370–376

DOI: 10.18502/sjms.v18i3.14090

Aydanur Akbaba1Emergency Department, School of Medicine, Düzce University, Turkey

Mustafa Boganmustafabogan@hotmail.comEmergency Department, School of Medicine, Düzce University, Turkey

Ceren KarakeçiliEmergency Department, School of Medicine, Düzce University, Turkey

Fatma BoğanVocational School of Health Services, Düzce University, Düzce, Turkey

Hasan SultanogluEmergency Department, School of Medicine, Düzce University, Turkey

Hyponatremia occurs when the serum sodium level is below 135 mmol/L. The symptoms include nausea, vomiting, confusion, headache, cardiorespiratory symptoms, profound somnolence or coma, and seizures are observed. Iron deficiency anemia can also cause pagophagia, a Pica subspecies. Although it has been emphasized that electrolyte disturbance may develop due to pagophagia, only a dearth of cases was reported. A 59-year-old male patient was brought to the emergency department with complaints of incoherent speech that started at night, disorientated movements (such as fluttering and climbing), insomnia, restlessness, and confusion. In 2017, he experienced hyponatremia due to pagophagia and a salt-free diet. At the index episode of hyponatremia, he experienced confusion, drowsiness, and sleepiness. It was learned that the patient enjoyed these symptoms.For this purpose, the patient made a habit of eating a completely salt-free diet and consumed plenty of water. Although pagophagia is considered to cause hyponatremia because it causes excessive water intake, there are not enough cases reported. It is to be noted that people develop habits or addiction to things they like.

[1] Hoorn, E. J., & Zietse, R. (2017). Diagnosis and Treatment of Hyponatremia: Compilation of the Guidelines. Journal of the American Society of Nephrology, 28(5), 1340–1349. https://doi.org/10.1681/ASN.2016101139

[2] Rangan, G. K., Dorani, N., Zhang, M. M., Abu-Zarour, L., Lau, H. C., Munt, A., Chandra, A. N., Saravanabavan, S., Rangan, A., Zhang, J. Q. J., Howell, M., & Wong, A. T. (2021). Clinical characteristics and outcomes of hyponatraemia associated with oral water intake in adults: A systematic review. BMJ Open, 11(12), e046539. https://doi.org/10.1136/bmjopen-2020-046539

[3] Nauwynck, E., Van De Maele, K., Vanbesien, J., Staels, W., De Schepper, J., & Gies, I. (2021, February 27). Psychogenic polydipsia in a female adolescent without a psychiatric background: A case report. Clinical Case Reports, 9(4), 1937–1942. https://doi.org/10.1002/ccr3.3910

[4] Benítez-Mejía, J. F., Morales-Cuellar, J., Restrepo-López, J. S., Giraldo-Carmona, E. M., & Cabrera-Gómez, E. (2021). Psycogenic Polydipsia And Severe Hyponatremia In Bipolar Affective Disorder. Actas Españolas de Psiquiatría, 49(6), 288–290.

[5] Bafarat, A. Y., Labban, S. A., Alhatmi, N., Aly, H., Bashah, D. M., & Alshaiki, F. (2023). Hyponatremia-Induced Seizure in a Patient With Psychogenic Polydipsia: A Case Report. Cureus, 15(4), e37710. https://doi.org/10.7759/cureus.37710

[6] Davey, R. J. (2013, August). Iron and ice. Transfusion, 53(8), 1623–1625. https://doi.org/10.1111/trf.12319

[7] Al Nasser, Y., Muco, E., & Alsaad, A. J. (2023 Jan). Pica. [Updated 2022 Nov 17] In StatPearls [Internet]. StatPearls Publishing., Available from https://www.ncbi.nlm.nih.gov/books/NBK532242/

[8] Coltman, C. A., Jr. (1969). Pagophagia and iron lack. Journal of the American Medical Association, 207, 513–516. https://doi.org/10.1001/jama.1969.03150160025005

[9] Barton, J. C., Barton, J. C., & Bertoli, L. F. (2019, July). Pagophagia in men with iron-deficiency anemia. Blood Cells, Molecules & Diseases, 77, 72–75. https://doi.org/10.1016/j.bcmd.2019.04.002

[10] Barton, J. C., Barton, J. C., & Bertoli, L. F. (2010). Pica associated with iron deficiency or depletion: Clinical and laboratory correlates in 262 non-pregnant adult outpatients. BMC Blood Disorders, 10, 9.

[11] Bedanie, G., Tikue, A., Thongtan, T., Zitun, M., & Nugent, K. (2020, July 21). Pica/Pagophagia-Associated Hyponatremia: Patient Presenting With Seizure. Cureus, 12(7), e9330. https://doi.org/10.7759/cureus.9330

[12] Mehra, A., Sharma, N., & Grover, S. (2018, Summer). Tekrarlayan Majör Depresif Bozukluğu Olan Bir Kadin HastadaPagofaji: Bir Olgu Sunumu ve Literatür Derlemesi [Pagophagia in a Female with Recurrent Depressive Disorder:A Case Report with Review of Literature]. Türk Psikiyatri Dergisi, 29(2), 143–145.

[13] Khan, Y., & Tisman, G. (2010). Pica in iron deficiency: A case series. Journal of Medical Case Reports, 4, 86. https://doi.org/10.1186/1752-1947-4-86

[14] Rondon, H., & Badireddy, M. (2023 Jan). Hyponatremia. [Updated 2023 Jan 23] In StatPearls [Internet]. StatPearls Publishing., Available from https://www.ncbi.nlm.nih.gov/books/NBK470386/

[15] Villalvazo, P., Fernandez-Prado, R., Niño, M. D. S., Carriazo, S., Fernández- Fernández, B., Ortiz, A., & Perez-Gomez, M. V. (2022, March). Who killed Bruce Lee? The hyponatraemia hypothesis. Clinical Kidney Journal, 15(12), 2169–2176. https://doi.org/10.1093/ckj/sfac071

[16] Yasir, M., & Mechanic, O. J. (2023 Jan). Syndrome of Inappropriate Antidiuretic Hormone Secretion. [Updated 2023 Mar 6] In StatPearls [Internet]. StatPearls Publishing., Available from https://www.ncbi.nlm.nih.gov/books/NBK507777/