Polydipsia – Excessive Thirst Causes and Symptoms

The human body is a unique and intricate work of art. When everything is in balance and functioning as it should, people typically have little to no adverse symptoms, and they can live their life comfortably and happily.

However, when there is an imbalance or a problem within the body, we’re often notified by noticeable symptoms. 

Thankfully, these symptoms alert us that something might not be quite right, which can lead to earlier diagnosis and intervention. Being aware of adverse symptoms, such as polydipsia (excessive thirst), can help people take the proper steps to ensure a resolution of symptoms by addressing the root cause of the problem.

What is polydipsia?

Polydipsia is the term for excessive thirst. There are several different causes of polydipsia. Some of the causes aren’t due to an underlying disease, such as simply not drinking enough water, eating a high-salt diet, or exercising heavily.

However, polydipsia can be a sign of more severe problems, such as high blood sugar or an imbalance of hormones.

Polydipsia can cause polyuria or excessive urination. This process tends to continue in a circular pattern, with excessive urination causing excessive thirst. Breaking the cycle requires finding the root cause of the polydipsia.

The body regulates fluids through hormones in the brain and the kidneys. The primary fluid-regulating hormone is called vasopressin or antidiuretic hormone. This hormone helps tell the body when to hold on to fluids and when to release fluid. Disruptions in these hormones can lead to polydipsia and polyuria.

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Types of polydipsia

There are two main types of polydipsia. Primary polydipsia is due to excessive intake of fluids and is the more common type of polydipsia often associated with underlying medical problems. Psychogenic polydipsia, or self-induced water intoxication, is related to psychiatric disorders.

Psychogenic polydipsia is caused by compulsive water drinking and can present in around 6-20% of psychiatric patients. Psychogenic polydipsia often occurs in people with schizophrenia, psychosis, personality disorders, mental retardation, and anxiety. These individuals drink large amounts of fluids, which can then lead to hyponatremia, which can be life-threatening. 

Hyponatremia occurs when levels of sodium in the blood fall too low due to the dilution by excessive water intake. It can cause symptoms varying in severity, from headache and vomiting to seizures and death. Chronic hyponatremia occurs when serum sodium levels gradually fall over 48 hours, whereas intermittent hyponatremia may be shorter.

Causes of polydipsia

Both medical and non-medical reasons cause polydipsia. Non-medical reasons include circumstances such as:

  • Not drinking adequate fluids.

  • Excessive loss of fluids causing dehydration, such as through excessive sweating, prolonged vomiting, diarrhea, etc.

  • Anxiousness or nervousness, leading to boredom drinking.

  • Increased salt intake.

However, polydipsia can also be a symptom of a more serious health issue, such as:

  • Diabetes mellitus: increased blood sugars (hyperglycemia) leads to increased urine output to reduce blood sugar levels, which causes increased thirst and increased urine output (polyuria).

  • Diabetes insipidus: a rare disorder that causes a fluid imbalance in the body, leading to polyuria and polydipsia. There are four main types of diabetes insipidus: central diabetes insipidus, nephrogenic diabetes insipidus, dipsogenic diabetes insipidus, and gestational diabetes insipidus. 

  • Central diabetes insipidus. Damage to the pituitary gland or hypothalamus from surgery, a tumor, a head injury, or an illness can cause central diabetes insipidus. It affects the usual production, storage, and release of ADH. An inherited genetic disease can also cause this condition.

  • Nephrogenic diabetes insipidus. Nephrogenic diabetes insipidus occurs when there’s a defect in the kidney tubules — the structures in your kidneys that cause water to be excreted or reabsorbed. This defect makes your kidneys unable to properly respond to ADH.

    The defect may be due to an inherited (genetic) disorder or a chronic kidney disorder. Certain drugs, such as lithium or antiviral medications such as foscarnet (Foscavir), also can cause nephrogenic diabetes insipidus.


  • Gestational diabetes insipidus. Gestational diabetes insipidus is rare. It occurs only during pregnancy when an enzyme made by the placenta destroys ADH in the mother.

  • Primary polydipsia. Also known as dipsogenic diabetes insipidus, this condition can cause the production of large amounts of diluted urine. The underlying cause is drinking an excessive amount of fluids.

  • Use of certain medications, such as corticosteroids and diuretics (water pills).

Increased thirst and diabetes

Increased thirst is often one of the first noticeable signs of diabetes. Diabetes causes high blood glucose (sugar) levels. When blood sugar levels are high, the body tries to excrete the sugar via the urine. Excessive urination can lead to dehydration, which causes polydipsia. 

Often increased thirst and urination are the most common symptoms bringing people to their medical provider, where they may be diagnosed with high blood sugar or diabetes mellitus for the first time.

Blood sugar levels are considered high when they are greater than 99 mg/dL when fasting (no food or beverage other than water for 8-12 hours) and when they are greater than 140 mg/dL within two hours of starting a meal.

Diabetes is diagnosed when fasting blood sugar is 126 mg/dL or higher, or when random blood sugar is greater than 200 mg/dL. It can also be diagnosed with a hemoglobin A1c test, which measures average blood sugars over the past 60-90 days. An A1c of 6.5% or greater is indicative of diabetes. 

Polydipsia can be present when blood sugar levels are elevated, but the blood sugar threshold at which polydipsia occurs is dependent on the individual. Some people with a known diagnosis of diabetes can tell when their blood sugar levels are higher than normal simply by their increased thirst.

If a patient with diabetes notices increased thirst, they should monitor their blood sugars and notify their healthcare professional if the readings are consistently higher than their goal.

Symptoms of polydipsia

The main symptom of polydipsia is increased thirst. However, there are other symptoms associated with polydipsia, such as:

  • Increased urine output (greater than 5 liters per day).

  • Persistent dry mouth.

Other symptoms that can accompany polydipsia in the case of diabetes include:

  • Increased hunger

  • Blurry vision

  • Exhaustion

  • Abnormal weight loss

  • Increase in sores or infections

  • Slowly healing wounds

  • High blood sugar

Symptoms that can accompany polydipsia in the case of hyponatremia include:

  • Headaches

  • Dizziness or disorientation

  • Muscle cramps or spasms

  • Unexplained seizures

Treatment of polydipsia

Treatment of polydipsia depends on its cause. For non-medical reasons such as inadequate fluid intake or increased sodium intake, the remedy can be as simple as staying adequately hydrated or cutting back on sodium intake.

In order to properly treat the cause of polydipsia, your healthcare provider may order certain diagnostic tests, such as blood tests, collecting urine samples, and/or conducting a fluid deprivation test.

The fluid deprivation test looks at factors like urine osmolality, serum sodium levels, and monitor weight loss. Individuals with diabetes insipidus tend to lose more weight when deprived of fluid than people without it.

  • Polydipsia caused by diabetes insipidus can be treated with a man-made hormone called desmopressin, which can be taken in the form of a nasal spray, oral tablets, or an injection. Another medication used for diabetes insipidus is hydrochlorothiazide. Some forms of diabetes insipidus can be treated with a low-salt diet and adequate fluid intake to prevent dehydration.

  • Polydipsia caused by increased blood sugar can be treated in many ways. For borderline hyperglycemia, such as prediabetes, lifestyle modifications are often the recommended course of action. Being physically active, eating foods that promote stable blood sugar (such as the plate method), and practicing good sleep hygiene are good lifestyle modifications to help improve hyperglycemia.

There are many medications available for the treatment of diabetes. Insulin is typically the only medication used for type 1 diabetes and is often used to treat type 2 diabetes. Insulin comes in several forms, including long-lasting/basal, intermediate-acting, and short-acting/mealtime.

There are several other treatment options available for use in type 2 diabetes. Some of the more popular medications include:

  • Metformin: Helps to reduce the amount of sugar released by the liver and improves insulin sensitivity

  • Sulfonylureas: Stimulate the pancreas to secrete more insulin

  • GLP1 receptor agonists: Promote insulin production, decrease glucose release from the liver and slows stomach emptying to increase satiety

  • DPP-4 inhibitors: Promote insulin production, decrease glucagon (a hormone that increases blood sugar) production, and delays gastric emptying.

  • For polydipsia caused by psychological issues, treatment may include cognitive-behavioral therapy (CBT) or certain medications.

Prevention of polydipsia

For non-medical causes of polydipsia, prevention includes:

  • Drinking adequate amounts of fluids to prevent dehydration

  • Avoiding excessive sodium intake – aim for fewer than 2,300 milligrams of sodium per day.  

  • Stay hydrated while exercising and/or when it’s hot and humid outside.

When it comes to polydipsia from high blood sugar/diabetes, prevention includes:

  • Keeping blood sugar levels under control. Fasting blood sugars should be less than 100 mg/dL and should be less than 140 mg/dL within two hours of starting a meal.

  • Keeping hemoglobin A1c below 7% in those with existing diabetes and less than 6.5% in those without diabetes.

  • Aiming for 150 minutes per week of moderate to vigorous physical activity.

  • Eating a healthy diet low in added sugars and moderate in carbohydrates. 

Diabetes insipidus is a rare condition that isn’t preventable. The different types of diabetes insipidus (central, nephrogenic, gestational & dipsogenic) all occur due to defects within the body’s ability to regulate fluid levels in the body.

When to see a doctor

Before you contact medical attention for your increased thirst, ask yourself a few questions such as:

  • How often do you feel thirsty?

  • How long are you thirsty at one time?

  • Do you notice any other symptoms when you feel thirsty?

  • Do you only feel extremely thirsty after doing certain activities?

  • Do you still feel extremely thirsty after drinking 64 ounces or more of water throughout the day?

Your answers to these questions can help you decide if your polydipsia can be easily treated at home, or if you need medical attention. Your answers to these questions will also help your healthcare provider diagnose you if you do seek medical attention.

If you’re checking your blood sugar regularly, it’s important to seek medical attention if your blood sugar levels are consistently greater than 200 mg/dL. High blood sugar can cause polydipsia, but it can be a sign of another problem in the body.

Conclusion

Polydipsia is the term for increased thirst. Symptoms of polydipsia include feeling thirsty, but other symptoms are possible, such as increased urine output (>5 liters per day) and chronic dry mouth.

Polydipsia can be caused by simple things such as not drinking enough fluids, eating too much salt, or exercising vigorously. In these cases, medical treatment isn’t usually necessary. Replacing lost fluids, cutting back on sodium, and practicing healthy hydration habits can prevent these causes of polydipsia.

Other times, polydipsia is caused by mental health issues, such as schizophrenia. In these cases, mental health support in the form of therapy and medications may help.

Polydipsia is a sign of high blood sugar, so it is often one of the first signs of undiagnosed diabetes. Keeping blood sugar levels in a healthy range can help prevent polydipsia. For those people with diabetes, checking blood sugar levels regularly and keeping them within their goal range is one of the best ways to prevent high blood sugar and related polydipsia. 

Finally, polydipsia can be caused by a rare condition called diabetes insipidus. There is no way to prevent diabetes insipidus because it occurs when the fluid regulation system is disrupted in the body. Treatment of diabetes insipidus depends on the kind, so medical attention is always required.

If you’re worried that you may have polydipsia, try to pay attention to your symptoms and possible causes. Polydipsia may easily be treated at home with healthy lifestyle habits. However, if symptoms persist, it’s best to seek medical attention to determine if there is another underlying cause.

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Sources

  1. Bhatia MS, Goyal A, Saha R, Doval N. Psychogenic Polydipsia – Management Challenges. Shanghai Arch Psychiatry. 2017;29(3):180‐183. doi:10.11919/j.issn.1002-0829.216106
  2. Gill, M, McCaule, M. (2015). Psychogenic Polydipsia: The Result, or Cause of, Deteriorating Psychotic Symptoms? A Case Report of the Consequences of Water Intoxication. Hindawi. 1 (2), p1
  3. https://www.jdrf.org/t1d-resources/about/symptoms/extreme-thirst/

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