Management of geriatric mania complicated by hyponatremia and psychogenic adipsic hypernatremia

A 70-year-old male presented with first episode mania and hyponatremia, which were later corrected with an infusion of hypertonic saline. His clinical condition deteriorated because of adipsic hypernatremia associated with hypokalemic periodic paralysis. Hypernatremia correction and potassium supplementation were started but could not be achieved because of manic symptoms as the patient's oral intake was poor. He was restarted on sodium valproate and olanzapine. Over the next few days, the patient's manic symptoms improved significantly and oral intake improved, which eventually led to correction of hypernatremia. Clinicians should evaluate the existence of electrolyte imbalance while dealing with a case of geriatric mania.