Hypernatremia nephrogenic

If serum Na+ is not monitored closely, ADH antagonists can cause severe hypernatremia and nephrogenic diabetes insipidus. If lithium is being used for a psychiatric disorder, nephrogenic diabetes insipidus can be treated with a thiazide diuretic or amiloride. 

The authors suggested that the sequence of events was lithium-induced nephrogenic diabetes insipidus resulting in hypernatremia followed by the dural sinus thrombosis. 

A 77-year-old woman who had taken lithium for 10 years developed delirium, hypernatremia, prerenal azotemia, and a serum lithium concentration of 1.4 mmol/1 her condition was attributed to dehydration related to partial nephrogenic diabetes insipidus (381). 

Nephrogenic diabetes insipidus resulted in dehydration and hypernatremia in a 78-year-old man who had taken lithium for 30 years (301). 

A 76-year-old man developed severe intractable diabetes insipidus which was attributed to lithium (395). He was hospitalized for over 2 weeks and eventually died from intestinal hemorrhage. Vigorous efforts were made to treat his polyuria, electrolyte disturbances, hypernatremia, and dehydration. He had been taking chlorpromazine, lithium, and furosemide, along with other medications, and the diagnosis of lithium-induced nephrogenic diabetes insipidus was considered because of a lack of alternative explanations. 

C. Nephrogenic diabetes insipidus (see p 35) is a recognized complication of chronic lithium therapy and may lead to dehydration and hypernatremia. 

In dehydrated patients, replace fluid deficits with intravenous crystalloid solutions. Initial treatment should Include repletion of sodium and water with 1-2 L of normal saline (children 10-20 mL/kg). Once fluid deficits are replaced, give hypotonic (eg, half-normal saline) solutions because continued administration of normal saline often leads to hypernatremia, especially in patients with lithium-induced nephrogenic diabetes insipidus. 

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