Polydipsia
Polydipsia refers to excessive thirst, a common symptom associated with endocrine disorders and certain drugs. It may reflect decreased fluid intake, increased urine output, or excessive loss of water and salt.
History
Obtain a history. Find out how much fluid the patient drinks each day. How often and how much does he typically urinate? Does the need to urinate awaken him at night? Determine if he or anyone in his family has diabetes or kidney disease. What medications does he use? Has his lifestyle changed recently? If so, have these changes upset him?
Physical assessment
If the patient has polydipsia, take his blood pressure and pulse when he’s in supine and standing positions. A decrease of 10 mm Hg in systolic pressure and a pulse rate increase of 10 beats/minute from the supine to the sitting or standing position may indicate hypovolemia. If you detect these changes, ask the patient about recent weight loss. Check for signs of dehydration, such as dry mucous membranes and decreased skin turgor. Infuse I.V. replacement fluids as needed.
Medical causes
Diabetes insipidus
Diabetes insipidus characteristically produces polydipsia and may also cause excessive voiding of dilute urine and mild to moderate nocturia. Fatigue and signs of dehydration occur in severe cases.
Diabetes mellitus
Polydipsia is a classic finding with diabetes mellitus — a consequence of the hyperosmolar state. Other characteristic findings include polyuria, polyphagia, nocturia, weakness, fatigue, and weight loss. Signs of dehydration may occur. (See Associated disorder: Diabetes mellitus, page 514.)
CULTURAL CUE:Diabetes is the fourth leading cause of death in Black, Native American, Hawaiian, and Filipino women. Also, Blacks are at greater risk for developing diabetes than Whites.
Hypercalcemia
As hypercalcemia progresses, the patient develops polydipsia, polyuria, nocturia, constipation, paresthesia and, occasionally, hematuria and pyuria. Severe hypercalcemia can progress quickly to vomiting, decreased level of consciousness, and renal failure. Depression, mental lassitude, and increased sleep requirements are common.
Hypokalemia
An electrolyte imbalance — hypokalemia — can cause nephropathy, resulting in polydipsia, polyuria, and nocturia. Related hypokalemic signs and symptoms include muscle weakness or paralysis, fatigue, decreased bowel sounds, hypoactive deep tendon reflexes, and arrhythmias.
Renal disorders (chronic)
Chronic renal disorders, such as glomerulonephritis and pyelonephritis, damage the kidneys, causing polydipsia and polyuria. Associated signs and symptoms include nocturia, weakness, elevated blood pressure, pallor and, in later stages, oliguria.
Sickle cell anemia
As nephropathy develops in patients with sickle cell anemia, polydipsia and polyuria occur. They may be accompanied by abdominal pain and cramps, arthralgia and, occasionally, lower extremity skin ulcers and such bone deformities as kyphosis and scoliosis.
Other causes
Drugs
Diuretics and demeclocycline may produce polydipsia. Phenothiazines and anticholinergics can cause dry mouth, making the patient so thirsty that he drinks compulsively.
Special considerations
Carefully monitor the patient’s fluid balance by recording his total intake and output. Weigh the patient at the same time each day, in the same clothing and using the same scale. Regularly check blood pressure and pulse in the supine and standing positions to detect orthostatic hypotension, which may indicate hypovolemia. Because thirst is usually the body’s way of compensating for water loss, give the patient ample liquids.
Pediatric pointers
In children, polydipsia usually stems from diabetes insipidus or diabetes mellitus. Rare causes include pheochromocytoma, neuroblastoma, and Prader-Willi syndrome. However, some children develop habitual polydipsia that’s unrelated to any disease.
Patient counseling
Teach the patient about his underlying disorder and its treatment. Discuss such self-care measures as diet, exercise, and home blood glucose monitoring. Explain the importance of reporting any significant weight gain or loss to his health care provider.
Pictures
Book Source Details
- Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Thirst
Read excerpts from these other book chapters related to Thirst:
Medical Books Excerpts
- POLYDIPSIA
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- THIRST
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- Polydipsia
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Polydipsia
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Polydipsia
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Polydipsia
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2008 Williams & Wilkins.
More About Causes of Thirst
» Next page:
Polyuria and Polydipsia (The Diagnostic Approach to Symptoms and Signs in Pediatrics)
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