Thirst (polydipsia) is the desire to drink water in large quantities, which is accompanied by subjective sensations of dry mouth. The symptom can occur with various endocrine diseases, increased fluid loss during breathing and sweating, liver and kidney pathologies. To determine the causes of thirst and dry mouth, ultrasound of internal organs, X-ray examination, laboratory tests of blood and urine, hormone tests are performed. To eliminate pathological polydipsia, a medical correction of the underlying disease that caused the manifestations of thirst is necessary.
To maintain the physiological water balance, a person needs to drink about 1.5-2 liters of liquid per day. The periodic desire to take a few sips of water is absolutely normal. When thirst arises caused by pathological causes, there is a constant irresistible urge 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 released in much smaller quantities.
Due to the decrease in saliva production, a person has difficulty talking and eating, it is possible that the tongue “sticks to the palate”. A characteristic feature of pathological thirst is that the desire to drink does not disappear even after consuming large volumes of water, in severe cases people drink up to 10-12 liters of liquid per day, but the dryness of the oral mucosa persists. This condition is often combined with frequent profuse urination. If there is thirst that is not associated with a hot climate or the use of salty dishes, you should contact a specialist to identify the cause of the disorder.
Causes of thirst
Causes of constant thirst
A person may feel the desire to drink throughout the day, sometimes wake up several times in the middle of the night to take a sip of water, constantly feel dry mouth. Such signs are characteristic of serious metabolic disorders and water-electrolyte metabolism. The feeling of constant thirst is provoked by such reasons as:
- Diabetes mellitus: insulin-dependent and insulin-independent type, gestational diabetes.
- Other endocrine diseases: diabetes insipidus, hyperparathyroidism, Itsenko-Cushing syndrome.
- Liver pathology: chronic hepatitis, fatty liver disease, fibrosis and cirrhosis.
- Respiratory water loss: mouth breathing in hypertrophic rhinitis, adenoids in children, chronic bronchitis.
- Mental illnesses: 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 extreme thirst
A short-term need to drink water is observed in absolutely healthy people when exposed to high temperatures, eating certain dishes. Painful polydipsia, developing without a visible etiological factor and accompanied by dry mouth, is a sign of pathological conditions. Common causes of extreme thirst:
- Physiological conditions: being in a hot climate, hard physical work, eating spicy or salty dishes.
- Insufficient fluid intake.
- Intoxication: alcohol and narcotic substances, severe infectious diseases, purulent processes.
- Blood loss: profuse external bleeding, massive hemorrhages in the abdominal and thoracic 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 diseases: tubulointerstitial nephritis, acute glomerulonephritis, Fanconi syndrome.
- Carrying out unloading and dietary therapy.
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 internal organs and the endocrine system. The most informative are:
- Blood glucose test. To exclude diabetes mellitus, fasting glucose levels are measured for all patients with thirst and dry mouth. With an increased sugar content, an oral glucose tolerance test is prescribed to clarify the diagnosis, and the concentration of glycosylated hemoglobin and fructosamine in the blood is measured for a retrospective assessment of glycemia.
- Ultrasound examination. Sonography of the most important endocrine organs (thyroid gland, adrenal glands) is performed with special attention to the presence of bulky formations, an increase in the size of the organ. Be sure to do a targeted ultrasound of the liver, kidney sonography to detect signs of degenerative or inflammatory processes.
- Radiological methods.An overview radiography of the abdominal organs is required to exclude severe organic diseases. If severe thirst is detected with pronounced dry mouth, frequent and copious urination, radiographs of the skull and the area of the Turkish saddle are necessary. CT or MRI scans are performed for detailed visualization of brain structures.
- Laboratory tests. To exclude infectious causes of thirst, serological reactions (IFA, CFT, PCR) are prescribed. Urine tests according to Zimnitsky and Nechiporenko are carried out to assess the work of the kidneys. The levels of hormones of the adrenal cortex and thyroid gland are measured. To determine the severity of blood loss, a standard general blood test is performed.
- Invasive diagnostics. If suspicious thyroid neoplasms are detected, a biopsy and cytomorphological analysis of the resulting tissue are necessarily performed. To detect lymphoproliferative diseases, a lymph node puncture is performed under ultrasound control. If there are difficulties in diagnosing liver diseases, a percutaneous biopsy is performed.
The presence of symptoms of intoxication is an indication for specific blood tests for toxins. When thirst and dry mouth are combined with vegetative dysfunctions, headaches or frequent pre-fainting conditions, a comprehensive neurological examination is necessary. Psychiatric examination is recommended for some patients. You may need to consult other specialists (otolaryngologist, geneticist).
Help before diagnosis
The desire to drink large amounts of water passes on its own, only if it is caused by the influence of a natural cause. On hot days, you should always carry a bottle of water with you to prevent dehydration, which leads to dry mucous membranes. It is undesirable to abuse salty food and smoked meats, especially at night, because it causes severe thirst and difficulty falling asleep. If polydipsia is observed for a long time or a person drinks 5-7 liters of water a day, this is the basis for seeking medical help.
The scheme of drug treatment depends on the cause that caused thirst. First of all, etiotropic therapy drugs are used, which make it possible 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. In the diagnosis of type 2 diabetes mellitus, tablet medications are prescribed that reduce insulin resistance of tissues and reduce blood glucose levels. At the same time, intense thirst disappears, dry mouth, urination and appetite are normalized.
- Insulins. Therapy of polydipsia caused by insulin-dependent diabetes mellitus involves injecting insulin of various duration of action. Treatment regimens are selected individually based on the degree of violation of secretory function, lifestyle of a sick person.
- Inhibitors of hormone biosynthesis. Specific medications can inhibit the production of hormonal substances in the endocrine organs, which makes it possible 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, dry mouth and mucous membranes, deterioration of the general condition, it is recommended to take antipyretics from the NSAID group. The funds block the formation of pro-inflammatory mediators that affect the thermoregulation center.
- Detoxification therapy. Saline and colloidal solutions are administered by infusion in severe intoxication syndrome. The drugs enhance the excretion of toxins through the kidneys, normalize the rheological properties of blood, increase the CBV in blood loss.
- Neuroleptics. If thirst is caused by psychogenic causes, it is necessary to prescribe psychotropic drugs. In schizophrenia and bipolar disorder, neuroleptics are used in combination with tranquilizers, antidepressants. Sedatives may be used.
With abundant external bleeding, ligation of the affected vessel or the imposition of vascular anastomosis is required. With internal bleeding into the abdominal cavity, a laparotomy is performed to detect and eliminate the source of blood loss. Surgical interventions are indicated for large hormonally active formations of the endocrine organs: in the case of diagnosis of a pituitary tumor, its transnasal removal is performed, with tumors of the adrenal cortex, an adrenalectomy is performed. In lymphomas, surgical methods are combined with chemotherapy.