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LETTER TO THE EDITOR
Year : 2016  |  Volume : 15  |  Issue : 4  |  Page : 210-211  

Primary polydipsia in a 15-month-old male at paediatric endocrinology clinic University of Nigeria Teaching Hospital


1 Department of Paediatrics, University of Nigeria, Nsukka; Department of Paediatrics, University of Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
2 Department of Paediatrics, Institute of Child Health, University of Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
3 Department of Paediatrics, Federal Teaching Hospital; Department of Paediatrics, Ebonyi State University, Abakaliki, Nigeria
4 Department of Paediatrics, University of Nigeria, Nsukka, Nigeria
5 Department of Paediatrics, Usman Danfodio University, Sokoto, Nigeria
6 Department of Paediatrics, Abia State University, Abia, Nigeria

Date of Web Publication17-Nov-2016

Correspondence Address:
Ugo Nnenna Chikani
University of Nigeria, Nsukka, Enugu Campus, Enugu
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1596-3519.194281

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How to cite this article:
Chikani UN, Tagbo BN, Ibekwe MU, Adimorah GN, Obu H, Eke CB, Ugege MO, Bisi Onyemaechi AI, Ogbonna IF. Primary polydipsia in a 15-month-old male at paediatric endocrinology clinic University of Nigeria Teaching Hospital. Ann Afr Med 2016;15:210-1

How to cite this URL:
Chikani UN, Tagbo BN, Ibekwe MU, Adimorah GN, Obu H, Eke CB, Ugege MO, Bisi Onyemaechi AI, Ogbonna IF. Primary polydipsia in a 15-month-old male at paediatric endocrinology clinic University of Nigeria Teaching Hospital. Ann Afr Med [serial online] 2016 [cited 2017 Jul 24];15:210-1. Available from: http://www.annalsafrmed.org/text.asp?2016/15/4/210/194281



Sir,

Primary polydipsia (PP) is a disorder characterized by excessive intake of water that leads to passage of large volume of hypotonic, dilute, and tasteless urine.[1] It is one of the differential diagnosis of polyuria and polydipsia in children. PP may be classified as thirst driven (dipsogenic) or nonthirst driven as seen in psychiatric illness (psychogenic), psychological disturbances or disordered habits [2] (likely the case in our patient). PP should be differentiated from diabetes insipidus (DI) because the treatment of the latter could be deleterious in patients with PP.

This report describes PP in a toddler a condition rarely discussed in childhood and may be more prevalent than thought.

A 15-month-old male of Igbo tribe in Southeastern Nigeria was brought to pediatric endocrinology clinic of the University of Nigeria Teaching Hospital (UNTH) Enugu with a 3 month history of excessive intake of water. He had an abnormal craving for water and drank about 3.5 L of water daily against his maintenance fluid of about 1100 ml. There was neither associated polyphagia nor weight loss. No history of seizures, fever, diarrhea nor vomiting neither was there head trauma nor surgery. Concurrently, he passed a large volume of urine both day and at night [Table 1]. Hence, mother sought for medical care in UNTH, Enugu.
Table 1: Symptoms/laboratory findings before and after the incidental water deprivation

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Perinatal event and medical history were uneventful; delivery was spontaneous and vertex with a birth weight of 2.8 kg. Immunization was complete for age, and he was not on any medication before the onset of this symptoms. He was exclusively breastfed for 6 months, after which he was fed with about 200–300 ml of cereals enriched with artificial milk 6–8 times in a day in addition to breast milk. He is the second in a monogamous nonconsanguineous family setting with two children. No family history of similar illness. However, there is a positive history of type 2 diabetes mellitus in the father, who is currently on oral hypoglycemic agents with good control.

General and systemic examinations were unremarkable. His length was 75.5 cm (between 3rd and 15th percentile, WHO chart) and a weight of 12 kg (between 85th and 97th percentile). His weight was maintained despite the polyuria and polydipsia, which is a striking feature of PP.

Positive findings of initial investigations done twice within an interval of 1 week were as shown in [Table 1] in addition to low urea level of 0.6 mmol/l, which is usually due to high renal clearance of urea. Fasting blood sugar of 83 mg/dl and 2 h postprandial of 100 mg/dl (5.6 mmol/l). Neither clinico-bacteriological nor radiological evidence of urinary tract infection was noted. There was no glucosuria.

Subsequently, the child developed diarrhea and vomiting for 24 h and was asleep most times of the day (up to 6 h during the day and 8 h at night). He could not demand for water in addition to extra renal losses of fluid. This was regarded as a providential (incidential) water deprivation test, and the following outcomes [Table 1] were observed.

PP mostly likely due to disordered habits was the possible diagnosis in our patient because of the presenting complaints and laboratory findings [Table 1] that normalized after the transient water deprivation. This is similar to the previous cases reported by some authors.[3],[4],[5]

However, prolonged PP can mimic both central and nephrogenic DI by physiologic suppression of antidiuretic hormone and reduction in the renal concentrating ability. Therefore, equivocal results should be interpreted with caution. Evaluating the cause of polydipsia and polyuria in patient is of paramount importance to avoid excessive use of vasopressin therapy.

PP is uncommon but present occasionally and should be considered in the diagnosis of a child or adolescent with polyuria and polydipsia.

Acknowledgment

I wish to thank the patient and the caregiver.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Abhinash S, Majzoub JA, Kappy MS. Posterior pituitary and disorders of water metabolism. In: Kappy MS, Alten DB, Geffner ME, editors. Pediatric Endocrinology. 5th ed. New York: Mc Graw Hill; 2007. p. 195-200.  Back to cited text no. 1
    
2.
Larsen R. Diabetes insipidus. In: Kronenberg KM, Shlomo M, Polonsky KS, Larsen R, editors. Williams Textbook of Endocrinology. 11th ed. Philadelphia: Saunders Elsevier; 2008. p. 607-10.  Back to cited text no. 2
    
3.
Cemeroglu AP, Büyükgebiz A. Psychogenic diabetes insipidus in toddlers with compulsive bottle-drinking: Not a rare entity. Pediatr Endocrinol Metab 2002;15:93-4.  Back to cited text no. 3
    
4.
Linshaw MA, Hipp T, Gruskin A. Infantile psychogenic water drinking. J Pediatr 1974;85:520-2.  Back to cited text no. 4
    
5.
Antoon JW, Bradford KK. Fever of unknown origin in a child. Clin Pediatr (Phila) 2013;52:99-102.  Back to cited text no. 5
    



 
 
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