Cortlandt Forum - A Most Unusual Case (June 25, 1999)

A Thirst for Life

Deanna's story came tumbling out within minutes of our introduction. She was a 58-year-old woman whom I was asked to evaluate following a seemingly routine hysterectomy. She cried softly as she told me about her rocky 37-year marriage to a man she portrayed as domineering and wept again as she described her controlling mother, who restricted her trips from the central Texas town where she lived to her physicians' offices in Houston. "I have no life," she concluded.

She traced the origin of her problems to her diagnosis, 30 years before, of manic-depressive disorder. Over the years, she had taken a variety of psychtropic medications, including lithium and aiprazolam. Recently, she had added venlafaxine and fluvoxamine to her regimen.

Five years after she was diagnosed with manic-depressive disorder, Deanna noticed that she was always thirsty, no matter how much liquid she drank. She dismissed the problem, however, assuming that it stemmed from her emotional turmoil. Her thirst continued unabated for 20 years until finally, five years before our meeting, she came to the alarming realization that she was drinking a gallon of milk and another gallon of other fluids--namely, water, soft drinks, and juices--every day. She was also getting up to urinate five or more times every night. Something was clearly wrong.

Amazingly, although she complained about her constant thirst to every physician she saw, no one tried to determine its cause or offered to refer her for additional studies. Her hysterectomy brought matters to a head. Despite having her fluid intake curtailed preoperatively, her postoperative urine output was 800 cc/hr. with intravenous intake of 150 cc/hr. At that juncture, I was asked to see her. The diagnosis of diabetes insipidus was apparent, and the cause was certainly her lithium therapy. Upon discontinuing lithium and receiving desmopressin acetate, her fluid handling normalized, and she had her first full night's sleep in years.

Perhaps she can now accept the substitute teaching position she had declined because she feared that her frequent bathroom visits would be embariassing. Her new independence might also improve her family relationships. Whatever is in store for Deanna, it will surely be better than the past. To say that her hysterectomy changed her life is an understatement indeed.

This article appeared in the June 25, 1999 Issue of Cortlandt Forum, p. 72.