Abstract and Introduction
Introduction: Excessive fluid intake can lead to water intoxication, electrolyte abnormalities, exacerbation of heart failure and anatomical changes in the urinary tract that may present diagnostic and therapeutic challenges for patients and physicians. Although the development of nonobstructive hydronephrosis is recognized in patients with central and nephrogenic diabetes insipidus, pregnancy or psychiatric polydipsia, it is rarely a diagnostic consideration in healthy individuals with excessive fluid ingestion. We now present what we believe to be the first report of nonobstructive hydronephrosis associated with social polydipsia.
Case presentation: A 53-year-old African-American woman with moderate back pain was found to have bilateral moderate hydronephrosis and hydroureter by abdominal computed tomography. She underwent ureteral stent placement followed by exploratory laparoscopy with lysis of adhesions and a right oophorectomy, without resolution of the nonobstructive hydronephrosis. A careful assessment revealed a social habit of consuming approximately 5.5L of fluid daily in an effort to remain hydrated in accordance with public health service announcements. It was recommended that the patient reduce her fluid intake. A repeat ultrasound after six weeks revealed complete resolution of the bilateral hydronephrosis and hydroureter.
Conclusion: Recognition of the nonobstructive nature of hydronephrosis caused by polydipsia in healthy individuals is important to prevent unnecessary interventions.
In 1945, the United States Food and Nutrition Board of the National Research Council published dietary recommendations specifying a daily water intake of 2.5 L, concluding that the majority of this quantity is contained in prepared foods. Despite incomplete evidence for the recommendations and general ignorance of the presence of dietary water in prepared foods, the guidelines have prompted six decades of popularizing 'eight 8-ounce glasses of water per day' for health maintenance. These recommendations were amended in collaboration with Health Canada in 2004 with suggested requirements to consume 2.7L of fluid per day for women and 3.7L for men with an upper level for water consumption. The 'stay hydrated' health maintenance concept has encouraged people to consume fluids, often in excess of their natural thirst, and sometimes led to water-balance abnormalities such as life-threatening hyponatremia, respiratory failure and decompensation of heart failure in patients with comorbid conditions. Even healthy athletes have been reported to develop serious health complications with only moderately excess fluid intakes. Although the prevalence of polydipsia ranges from 6% to 17% among chronically ill psychiatric patients, the full extent and range of adverse events associated with excessive fluid intake remain uncertain in healthy populations. We highlight these issues using an unusual case of nonobstructive hydronephrosis (NOH) associated with social polydipsia.
J Med Case Reports. 2012;6(376) © 2012 BioMed Central, Ltd.