Thirst (polydipsia) is the desire to drink water in large quantities, which is accompanied by subjective sensations of dry mouth. A symptom can occur with various endocrine diseases, increased fluid loss during breathing and sweating, pathologies of the liver and kidneys. To determine the causes of thirst and a feeling of dry mouth, ultrasound of the internal organs, X-ray examination, laboratory blood and urine tests, and hormone tests are performed. To eliminate pathological polydipsia, drug correction of the underlying disease that caused the manifestations of thirst is necessary.
To maintain physiological water balance, a person needs to drink about 1.5-2 liters of fluid per day. The occasional urge to take a few sips of water is completely normal. When thirst arises due to pathological causes, there is a constant irresistible desire to drink huge amounts of water - several glasses at a time. Polydipsia is accompanied by a feeling of dry mouth, patients report that saliva becomes viscous and is excreted in much smaller quantities.
Due to a decrease in saliva production, a person has difficulty speaking and eating, and there may be a feeling that the tongue “sticks to the palate”. A characteristic feature of pathological thirst is that the desire to drink does not disappear even after drinking large volumes of water; in severe cases, people drink up to 10-12 liters of fluid per day, but dryness of the oral mucosa persists. This condition is often combined with frequent copious urination. If you have thirst that is not associated with a hot climate or eating salty foods, you should consult a specialist to identify the cause of the disorder.
Causes of thirst
Causes of Constant Thirst
A person may feel like drinking throughout the day, sometimes waking up several times in the middle of the night to take a sip of water, constantly feeling dry mouth. Similar signs are characteristic of serious disorders of metabolism and water-electrolyte metabolism. The feeling of constant thirst is provoked by such reasons as:
- Diabetes mellitus : insulin-dependent and non-insulin-dependent type, gestational diabetes.
- Other endocrine diseases : diabetes insipidus, hyperparathyroidism, Itsenko-Cushing's syndrome.
- Liver pathology : chronic hepatitis, fatty liver disease, fibrosis and cirrhosis.
- Respiratory water loss : breathing through the mouth with hypertrophic rhinitis, adenoids in children, chronic bronchitis.
- Mental illness : schizophrenia, bipolar disorder, somatized mental reactions.
- Hyperglycemia in genetic syndromes : Down syndrome, Huntington's chorea, porphyria.
- Oncological pathology : Hodgkin's lymphoma, paraneoplastic syndrome.
- Complications of pharmacotherapy : taking diuretics in large doses, tetracycline antibiotics, psychotropic drugs.
- Rare causes : Robson-Mendehall syndrome, Prader-Willi syndrome, glucagonoma.
Causes of intense thirst
A short-term need for drinking water is observed in absolutely healthy people when exposed to high temperatures, eating certain foods. Painful polydipsia, which develops without a visible etiological factor and is accompanied by dry mouth, is a sign of pathological conditions. Common causes of extreme thirst:
- Physiological conditions : staying in a hot climate, hard physical work, eating spicy or salty foods.
- Insufficient fluid intake .
- Fever .
- Intoxication : the use of alcohol and drugs, severe infectious diseases, purulent processes.
- Blood loss : profuse external bleeding, massive hemorrhages in the abdominal and chest cavity, bleeding from the gastrointestinal tract and lungs.
- Pathological fluid loss : with indomitable vomiting and profuse diarrhea, with generalized hyperhidrosis, extensive burns.
- Traumatic brain injury .
- Kidney disease : tubulointerstitial nephritis, acute glomerulonephritis, Fanconi syndrome.
- Carrying out unloading - dietary therapy .
Diagnostics
The primary examination of patients with complaints of an irresistible craving for water consumption and dry mouth is organized by a general practitioner. Since polydipsia is caused by various causes, it is necessary to use an expanded set of diagnostic methods that allow an objective assessment of the functionality of the internal organs and the endocrine system. The most informative are:
- Blood test for glucose . To exclude diabetes mellitus, all patients with a feeling of thirst and a feeling of dryness in the mouth have their fasting glucose levels measured. With an increased sugar content, an oral glucose tolerance test is prescribed to clarify the diagnosis; for a retrospective assessment of glycemia, the concentration of glycated hemoglobin and fructosamine in the blood is measured.
- Ultrasound . Sonography of the most important endocrine organs (thyroid gland, adrenal glands) is performed, paying special attention to the presence of volumetric formations, an increase in the size of the organ. Be sure to do targeted ultrasound of the liver, sonography of the kidneys to detect signs of degenerative or inflammatory processes.
- X-ray methods . Plain radiography of the OBP is required to exclude severe organic diseases. If severe thirst is detected with severe dryness of the mouth, frequent and profuse urination, radiographs of the skull and the area of the Turkish saddle are necessary. For detailed visualization of brain structures, CT or MRI is performed.
- Laboratory Research . To exclude infectious causes of thirst, serological tests (ELISA, RSK, PCR) are prescribed. To assess the work of the kidneys, urine tests are performed according to Zimnitsky and Nechiporenko. The levels of hormones of the adrenal cortex and thyroid gland are measured. To determine the severity of blood loss, a standard complete blood count is done.
- Invasive Diagnostics . If suspicious neoplasms of the thyroid gland are detected, a biopsy and cytomorphological analysis of the resulting tissue are mandatory. To detect lymphoproliferative diseases, a lymph node puncture is performed under ultrasound control. When it is difficult to diagnose liver diseases, a percutaneous biopsy is done.
The presence of symptoms of intoxication is an indication for specific blood tests for toxins. When thirst and dry mouth are combined with autonomic dysfunctions, headaches or frequent pre-syncope, a comprehensive neurological examination is necessary. For some patients, a psychiatric evaluation is recommended. You may need to consult other specialists (otolaryngologist, genetics).
Determination of glucose in urine
Treatment
Help before diagnosis
The desire to drink large quantities of water passes on its own only if it is due to the influence of a natural cause. On hot days, you should always carry a bottle of water with you to prevent dehydration, leading to dry mucous membranes. It is undesirable to abuse salty foods and smoked meats, especially at night, as this causes severe thirst and difficulty falling asleep. If polydipsia is observed for a long time or a person drinks 5-7 liters of water per day, this is the basis for seeking medical help.
Conservative therapy
The scheme of drug treatment depends on the cause that caused thirst. First of all, drugs of etiotropic therapy are used, which allow to eliminate or reduce the manifestations of the underlying disease. In diabetes mellitus of any etiology, a diet is necessarily prescribed, which involves limiting fast carbohydrates, animal fats and controlling the amount of calories consumed. For the treatment of diseases manifested by polydipsia, apply:
- Hypoglycemic agents . When diagnosing type 2 diabetes, tablet preparations are prescribed that reduce tissue insulin resistance and lower blood glucose levels. At the same time, strong thirst, dry mouth disappear, urination and appetite normalize.
- Insulins . Therapy for polydipsia caused by insulin-dependent diabetes mellitus involves the injection of insulins of various durations of action. Treatment regimens are selected individually based on the degree of violation of the secretory function, the lifestyle of a sick person.
- Inhibitors of hormone biosynthesis . Specific drugs can inhibit the production of hormonal substances in the endocrine organs, which allows you to eliminate the symptoms of Itsenko-Cushing's disease, thyrotoxicosis. Medications are prescribed according to strict indications.
- Antipyretic drugs . With an increase in body temperature of more than 38.5 ° C, which is accompanied by excruciating thirst, dryness of the mouth and mucous membranes, deterioration of the general condition, it is recommended to take antipyretics from the NSAID group. Means block the formation of pro-inflammatory mediators that affect the center of thermoregulation.
- Detoxification therapy . Salt and colloidal solutions are administered by infusion in case of severe intoxication syndrome. Means enhance the elimination of toxins through the kidneys, normalize the rheological properties of the blood, increase the BCC during blood loss.
- Antipsychotics . If thirst is caused by psychogenic causes, it is necessary to prescribe psychotropic drugs. In schizophrenia and bipolar disorder, antipsychotics are used in combination with tranquilizers, antidepressants. Sedatives may be used.
Surgery
With heavy external bleeding, ligation of the affected vessel or the imposition of a vascular anastomosis is required. In case of internal bleeding into the abdominal cavity, a laparotomy is performed to locate and eliminate the source of blood loss. Surgical interventions are indicated for large hormonally active formations of the endocrine organs: in the case of a diagnosis of a pituitary tumor, its transnasal removal is performed; in case of tumors of the adrenal cortex, adrenalectomy is performed. In lymphomas, surgical methods are combined with chemotherapy.