Abstract
P
An 8-year-old boy with ASD and attention-deficit/hyperactivity disorder (ADHD) had aripiprazole, risperidone, methylphenidate, quetiapine treatment trials for irritability, agitation, and hyperactivity. When the patient's symptoms worsened during the curfew, treatment was changed to olanzapine 10 mg/day. Within 1 week after the initiation of olanzapine, the mother reported that the patient was urinating around six to eight times an hour. Because of the pandemic, information was obtained through video recordings and telephone conversations. Fluid restriction was applied, but no improvement was reported. After olanzapine was tapered and discontinued, polyuria/polydipsia recovered, no reoccurrence was noted at the 4-month follow-up.
A 13-year-old boy diagnosed with ASD and ADHD had been using olanzapine 10 mg/day for 10 months, the only agent that improved his symptoms such as irritability, aggression, and behavioral problems. Since schools were closed during pandemic, his symptoms deteriorated, the dose of olanzapine was increased to 15 mg/day. One day after dose increase, the patient was admitted to the emergency department with seizure, agitation, polyuria/polydipsia, and low serum sodium level (127 mEq/L). Fluid intake was restricted and olanzapine was reduced to previous dose, 10 mg/day. He was discharged on day 3 when sodium level (137 mEq/L) returned to normal and polyuria/polydipsia disappeared.
Discussion
Children with ASD often suffer from behavioral and emotional problems; antipsychotics are among the most preferred agents for treatment. Knowledge about antipsychotic-induced water–sodium imbalance in children with ASD is limited to case reports (Chiang et al. 2013; Anil et al. 2020). Although intrinsic factors in ASD such as hypothalamic-pituitary dysfunction and restricted interest can lead to excessive water drinking, both our cases have no history of polyuria/polydipsia (Terai et al. 1999). Both patients developed polyuria/polydipsia after either the beginning of olanzapine treatment or dose increment.
In terms of antipsychotic-induced polydipsia, the rarity of reported pediatric cases is remarkable. This may be due to the less use of antipsychotics in children, or it may mean that polydipsia, as a side effect, is less common in the pediatric population. One other possibility is that families of ASD children are monitoring their children closely, they may notice excessive fluid intake, undergo fluid restriction at early stages. We believe clinicians treating ASD patients with antipsychotics should be cautious of symptoms such as polyuria/polydipsia and check sodium levels.
Footnotes
Disclosures
No competing financial interests exist.