Primary polydipsia Alcoholism may cause physiological thirst since ethanol inhibits vasopressin, the hormone primarily responsible for water retention in osmoregulation. The following conditions should also be excluded: DI, cerebral salt wasting, pseudohyponatraemia caused by hyperlipidemia or hyperparaproteinemia, SIADH, mineralcorticoid deficiency, salt-wasting nephropathy, nephrotic syndrome, chronic heart failure and cirrhosis. Tobacco smoking is an often overlooked factor linked to hyponatremia, due to the ADH-releasing effect of nicotine, although this is usually limited to heavy smokers. One study suggested that around 70% of patients with self-induced polydipsia were tobacco smokers. Diagnostic tests for primary polydipsia usually involves the fluid deprivation test to exclude ADH
Symptom such as rash and muscle tremors are objectively observable both by the patient and by anyone else. Some signs belong only to the physical examination, because it takes medical expertise to uncover them. (For example, laboratory signs such as hypocalcaemia or neutropenia require blood tests to find.) A sign observed by the patient last week but now gone (such as a resolved rash) was a sign, but it belongs to the medical history, not the physical examination, because the physician cannot independently verify it today. Symptomatology (also called semeiology) is a branch of medicine dealing with symptoms. Also this study