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About 20 years ago I developed an incredible thirst. I was living in Germany at the time. I could drink an entire case of Italian spring water a day. I wanted to guzzle beer and juices and wine and, to the horror of my European friends, tap water. I also had a ravenous appetite. I was spending a forune on food, and I'd wake up in the middle of the night hungry.

What I didn't know was that I had had a viral infection of the pancreas. In just a couple of weeks I had gone from not having any diabetes at all to having full blown type 1, insulin-dependent diabetes. My thirst was just a symptom of severe diabetes. The solution for me was to start taking insulin. Just taking pills wouldn't have been enough. However, not everyone who has raveous thirst has diabetes.

  • Diabetes insipidus can cause people to crave up to 20 liters (5 gallons) of water every day. Unlike "sugar diabetes" (diabetes mellitus), this condition usually is caused by damage to the pituitary gland inside the brain. In adults who have free access to cold water, there can be no other symptoms at all. However, when they don't get water, they become feverish and extremely fatigued. There can be dry skin and hair loss, and, unlike diabetes mellitus, loss of appetite. Nephrogenic diabetes insipidus occurs when the kidneys are unable to concentrate urine. This can be due to a failure of the pituitary gland in the brain to produce a hormone called vasopressin.
  • Excessive use of laxatives or diuretics can lead to severe thirst. Typically overdosing these medications also causes low potassium levels, which manifest themselves as severe fatigue, muscle weakness, and bradycardia (very slow heartbeat).
  • Hypercalcemia, high blood calcium levels, can cause severe thirst. Typically doctors diagnose this disease by "stones, bones, moans, and groans." High bloodstream calcium levels lead to kidney stones. The calcium comes out of the bones, which will tend to break from osteoporosis. Confusion and lethargy and "moans and groans" can be a sign of acute disease, leading quickly to death.
  • Head trauma in toddlers and small children often causes excessive thirst as its most obvious symptom. Head trauma has to be treated as quickly as possible.
  • Heat emergencies, such as heat exhaustion and sunstroke, cause severe thirst. They must be treated quickly, especially when symptoms include dry skin, mental confusion, lack of perspiration, and high fever.
  • Snake bites can cause severe thirst. Even if a snake is non-poisonous, an allergy to the snake's saliva can cause severe problems. Snake bites require urgent medical care.
  • Diabetic hyperglycemic hyperosmolar syndrome occurs when there are extremely high blood sugar levels. It's not unusual for people to discover they have type 2 diabetes for the very first time when they are brought to the ER with this condition. The blood and body fluids can become literally syrupy, interfering with vision, causing sticky urine. This condition is a medical emergency that almost always has to be treated with intravenous fluids and insulin.
  • Hyperparathyroidism, overactivity of the parathyroid glands, which lie at the sides of the thyroid gland, can alter thirst and also cause dry hair, dry skin, itching, and brittle nails.
  • Alcoholic cirrhosis of the liver can induce severe thirst.
  • Cushing syndrome, in which the adrenal glands produce too much of the hormone cortisol, can induce severe thirst. It is often the result of malnutrition or alcoholism.

Severe thirst can also be caused by kidney failure, peritonitis, or sickle cell anemia, all of which typically cause other severe symptoms before they cause thirst. 

Of all the possible causes on this list, the most likely cause of severe thirst, if you aren't suffering heat exhaustion and you have access to fluids, is diabetes. It's the first thing doctors will test for, and the easiest to treat.

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