Proposal for the Introduction of a New ICD-10 Code: Hypodipsia - Drug Induced

Background and Rationale

Hypodipsia, or decreased thirst sensation, can significantly impact patient health, particularly when it leads to dehydration. This condition can exacerbate the risk of kidney malfunction, a notable concern with the use of certain medications, including GLP-1 agonists. GLP-1 agonists, known for their appetite-suppressing effects, may inadvertently suppress thirst due to their interaction with the dopamine system, which plays a crucial role in the rewarding properties of eating and drinking.

The mechanism of thirst regulation involves the lamina terminalis located beneath the third ventricle of the brain, where specific cells lie outside the blood-brain barrier. The act of drinking water is perceived as rewarding well before any detectable change in blood osmolarity occurs, suggesting that the gratification from drinking does not solely depend on physiological needs for water balance but also involves the brain's reward systems, particularly those governed by dopamine. Given that GLP-1 agonists and certain dopaminergic drugs, such as stimulants, can modulate this system, there is a plausible link between these medications and the suppression of thirst.

Proposal

It is proposed to introduce a new ICD-10 code specifically for Drug-Induced Hypodipsia, with subdivisions to account for the different classes of drugs implicated, namely:

1. Hypodipsia - Drug Induced from GLP-1 Agonists: This category would address the specific risk associated with GLP-1 agonist therapy, highlighting the need for healthcare providers to advise patients on the importance of regular fluid intake, regardless of their perceived need to drink.

2. Hypodipsia - Drug Induced from Dopaminergic Drugs (e.g., Stimulants): Given the broader impact of dopaminergic drugs on the reward system and their potential to suppress thirst, this category would encompass a wider range of medications that could lead to hypodipsia, thereby alerting clinicians to monitor hydration status in patients prescribed these drugs.

Clinical Implications and Recommendations

The introduction of these specific ICD-10 codes would facilitate better patient monitoring, targeted interventions, and research into the prevalence and outcomes of drug-induced hypodipsia. It would also serve as a critical reminder for healthcare providers to educate patients about the importance of maintaining adequate hydration, especially those on GLP-1 agonists or dopaminergic medications, who might not experience normal thirst cues. Such proactive measures could significantly mitigate the risk of dehydration and its associated complications, improving patient safety and outcomes in populations vulnerable to drug-induced hypodipsia.

References

Giustina, A., Allora, A., Frara, S., Spina, A., & Mortini, P. (2022). The Hypothalamus. The Pituitary, 301–340. https://doi.org/10.1016/b978-0-323-99899-4.00002-0 

Lee, M. D., & Clifton, P. G. (2010). Role of the serotonergic system in appetite and ingestion control. Handbook of Behavioral Neuroscience, 331–345. https://doi.org/10.1016/s1569-7339(10)70088-6

McKay, N. J., Kanoski, S. E., Hayes, M. R., & Daniels, D. (2011). Glucagon-like peptide-1 receptor agonists suppress water intake independent of effects on Food Intake. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 301(6). https://doi.org/10.1152/ajpregu.00472.2011 

Wysokiński, A., Sobów, T., Kłoszewska, I. et al. Mechanisms of the anorexia of aging—a review. AGE 37, 81 (2015). https://doi.org/10.1007/s11357-015-9821-x