Abstract
Lithium (Li) has been associated with several forms of renal injury, the most prevalent being impaired urinary concentrating ability, which is reported in individuals on chronic lithium therapy. Lithium is the most common drug implicated in acquired nephrogenic diabetes insipidus (NDI). Prevalence of NDI correlates with the Li dose and the duration of therapy. Here we report an elderly male, presented with hypotonic polyuria while being on prolonged Li therapy for more than 20 years for bipolar affective disorder. Further evaluation confirmed the diagnosis of Li induced NDI as the aetiology for polyuria which responded to Li dose reduction and Thiazide therapy. Proper evaluation of a patient presenting with hypotonic polyuria with water deprivation followed by a desmopressin challenge is necessary before diagnosis, as therapy differs according to the type of the disease. Usually the concentration defect is at least partially reversible with drug discontinuation. Amiloride minimizes lithium accumulation in collecting tubule cells and is recommended for those patients, in whom Lithium therapy cannot be discontinued. Sri Lanka Journal of Diabetes, Endocrinology and Metabolism 2015; 5: 34-37
Highlights
Lithium is recommended as the first-line therapy for treatment of bipolar disorder for more than 50 years due to excellent therapeutic efficacy despite various adverse effects
Diabetes insipidus (DI) belongs to the spectrum of polyuric and polydipsic diseases, a group of hereditary or acquired disorders mainly associated with an inadequate Arginine Vasopressin (AVP) secretion or renal response to AVP, which clinically results in hypotonic polyuria and a compensatory or underlying polydipsia
Nephrogenic diabetes insipidus (NDI) results from renal resistance to antidiuretic action of Arginine Vasopressin (AVP), which clinically results in hypotonic polyuria and a compensatory polydipsia
Summary
Lithium is recommended as the first-line therapy for treatment of bipolar disorder for more than 50 years due to excellent therapeutic efficacy despite various adverse effects. Psychiatric patients are more prone to develop complications of polyuria, such as dehydration, electrolyte imbalance, neurological problems irrespective of the underlying aetiology. Most importantly all these factors predisposes these patients to Li toxicity, and proper evaluation and prompt correction should be done. There was no past history of diabetes mellitus and he did not have other symptoms of hypercalcaemia He complained of a bilateral hand tremor, but not other symptoms suggestive of Li toxicity. Li induced NDI was suspected and further evaluation was done His serum osmolality was high (304 mOsm/kg H2O) with low urinary osmolality (192 mOsm/kg H2O). With this treatment there was a remarkable improvement in symptoms with reduction of urinary frequency, thirst and resolution of nocturia
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