Diabetes insipidus lithium

After several months of continuous therapy with lithium, diabetes insipidus and goiter may develop. The kidney tubules then become insensitive to the action of antidiuretic hormone, and its administration is ineffective. Either a dose reduction or discontinuation of the lithium corrects this side effect without leaving any residual pathology. In the... 

In nephrogenic diabetes insipidus the kidney s ability to respond to AVP is impaired by different causes, such as drugs (e.g. lithium), chronic disorders (e.g. sickle cell disease, kidney failure) or inherited genetic disorders (X-linked or autosomal NDI). This type of diabetes insipidus can not be treated by exogenous administration of AVP or AVP analogues. Instead, diuretics (hydrochlorothiazide combined or not with amiloride) and NSAI (indomethacin) are administrated to ameliorate polyuria. 

The answer is c. (Katzung, p 493.) Lithium treatment frequently causes polyuria and polydipsia. The collecting tubule of the kidney loses the capacity to conserve water via anti diuretic hormone. This results in significant free-water clearance, which is referred to as nephrogenic diabetes insipidus. 

Lithium reduces the kidney s ability to concentrate urine and may cause a nephrogenic diabetes insipidus with low urine specific gravity and low osmolality polyuria (urine volume greater than 3 L/day). This may be treated with loop diuretics, thiazide diuretics, or triamterene. If a thiazide diuretic is used, lithium doses should be decreased by 50% and lithium and potassium levels monitored. 

The long-term toxic effects of lithium, such as nephrogenic diabetes insipidus, which has been calculated to occur in up to 5% of patients, and the rare possibility of lithium combined with neuroleptics being neurotoxic, has stimulated the research for other drug treatments. However, apart from the neuroleptics, these drugs have not been studied as extensively in the treatment of acute mania, but are worthy of consideration because of their reduced side effects. 

Acquired nephrogenic diabetes insipidus Acquired nephrogenic diabetes insipidus unresponsive to vasopressin has been associated with chronic lithium... 

Stone, K.A. (1999) Lithium-induced nephrogenic diabetes insipidus. J Am Board Earn Pract 12 43—47. 

Neuroleptic malignant syndrome Agranulocytosis—clozapine Nephrogenic diabetes insipidus— lithium... 

Lithium Neurological tremor, ataxia, seizures Endocrine hypothyroidism Cardiovascular T wave changes, sinus node dysfunction Renal polyuria, nephrogenic diabetic insipidus Dermatological hair loss, acne, psoriasis, rash Gastrointestinal nausea, diarrhea Miscellaneous fluid retention, weight gain, weakness... 

Both drugs are used in conjunction with other diuretics like thiazide or loop diuretics to augment natriuresis and reduce loss of potassium. Triamterene may be used in the treatment of congestive heart failure, cirrhosis and the edema caused by secondary hyperaldosteronism. Amiloride is also useful in lithium induced diabetes insipidus. 

Lee RV, Jampol LM, Brown WV. Nephrogenic diabetes insipidus and lithium intoxication complication of lithium carbonate therapy. N Engl J Med 1971 284 93-94. 

Billings PR. Amiloride in the treatment of lithium induced diabetes insipidus (letter). N Engl J Med 1985 312 1575-1576. 

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. 

Bisphosphate nucleotidase Involved in AMP production inhibited by lithium may be target that results in lithium-induced nephrogenic diabetes insipidus... 

Polydipsia and polyuria are common but reversible concomitants of lithium treatment, occurring at therapeutic serum concentrations. The principal physiologic lesion involved is loss of responsiveness to antidiuretic hormone (nephrogenic diabetes insipidus). Lithium-induced diabetes insipidus is resistant to vasopressin but responds to amiloride. 

Two of ten patients taking long-term lithium therapy were thought to have hypothalamic diabetes insipidus, because of a positive response to desmopressin (615). 

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

When a 45-year-old man with severe lithium-induced diabetes insipidus developed hyperosmolar, nonketotic hyperglycemia, it was suggested that poorly controlled diabetes mellitus may have contributed to the polyuria (684). Prior contact with a female patient who had developed hyperosmolar coma secondary to lithium-induced diabetes insipidus (685) allowed physicians 4 years later to treat her safely after a drug overdose and a surgical procedure, by avoiding intravenous replacement fluids with a high dextrose content (despite stopping lithium several years earlier, the patient continued to put out 10 liters of urine daily) (686). 

Guirguis AF, Taylor HC. Nephrogenic diabetes insipidus persisting 57 months after cessation of lithium carbonate therapy report of a case and review of the literature. Endocr Pract 2000 6(4) 324-8. 

Krastins MG, Phelps KR. Nephrogenic diabetes insipidus and hyperparathyroidism in a patient receiving chronic lithium therapy. J Am Geriatr Soc 2002 50 S140. 

Azam H, Newton RW, Morris AD, Thompson CJ. Hyperosmolar nonketotic coma precipitated by lithium-induced nephrogenic diabetes insipidus. Postgrad Med J 1998 74(867) 39 11. 

MacGregor DA, Baker AM, Appel RG, Ober KP, Zaloga GP. Hyperosmolar coma due to lithium-induced diabetes insipidus. Lancet 1995 346(8972) 413-7. 

Also known as water diabetes, diabetes insipidus (DI) is a rare chronic disease that causes excessive urination. If not properly treated, it can result in electrolyte imbalance and dehydration. It may be caused by a number of factors, including lithium use (a psychiatric drug used for bipolar disorder), neurological disease, or an inadequate amount of ADH (anti-diuretic hormone, or vasopressin, which is produced by the pituitary gland). DI caused by insufficient ADH is called central diabetes insipidus. 

Kidney urine Lithium-induced nephrogenic diabetes insipidus Rat model 1H NMR Acetate, lactate, allantoin, TMA, and creatinine (46)... 

Lithium Carbonate Common symptoms of lithium toxicity are nausea, vomiting, and diarrhea followed by tremor, increased muscle tone, and rigidity. Acute kidney problems and nephrogenic diabetes insipidus may be possible hazards. In serious cases, coma and convulsions can be observed along with toxicity. 

Lithium also impairs the function of the peripheral nervous system, reducing motor nerve conduction velocity (Faravelli et al., 1999). It causes many metabolic adverse effects, resulting in hypothyroidism, hyperthyroidism (rare), hyperparathyroidism, and diabetes insipidus (Livingston et al., 2006). 

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