Polyuria, lithium-induced

Unlabeled uses Amiloride (10 to 20 mg/day) may be useful in reducing lithium-induced polyuria without increasing lithium levels as is seen with thiazide diuretics. 

Unlabeled Uses Treatment of edema associated with CHF, liver cirrhosis, and nephrotic syndrome treatment of hypertension reduces lithium-induced polyuria, slows pulmonary function reduction in cystic fibrosis... 

Bersudsky Y, Vinnitsky 1, Grisaru N, et al The effect of inositol on lithium-induced polyuria-polydipsia in rats and humans. Human Psychopharmacology 7 403-407, 1992... 

Rosten MD, Forest JN. Treatment of severe lithium-induced polyuria with amiloride. Am J Psychiatry 1986 143 1563-1568. 

Amiloride Blocks epithelial sodium channels in collecting tubules Reduces Na retention and wasting increases lithium clearance Hypokalemia from other diuretics reduces lithium-induced polyuria Orally active duration 24 h Toxicity Hyperkalemic metabolic acidosis... 

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. 

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). 

A comprehensive review of psychoactive drug-induced hyposalivation and hypersalivation included a discussion of lithium-induced dry mouth (common) and sialorrhea (347). A review of dental findings and their management in patients with bipolar disorder briefly mentioned that xerostomia, sialadenitis, dysgeusia, and stomatitis have been attributed to lithium (348). Dry mouth is common and can be due to lithium-induced polyuria, a direct effect on thirst, salivary gland hypofunction, or other drugs (347). Hypersalivation attributable to lithium is rare (349). 

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. 

Factors that put patients at risk of lithium intoxication are those that increase intake (deliberately or accidentally), reduce excretion (kidney disease, dehydration, low sodium intake, drug interactions), or reduce body water (dehydration secondary to fluid restriction, vomiting, diarrhea, or polyuria) (66). Patients with lithium-induced polyuria are at a particular risk of toxicity if their ability to replace fluids is compromised (for example by anesthesia, over-sedation, CNS trauma). 

Movig KL, Baumgarten R, Leufkens HG, van Laarhoven JH, Egberts AC. Risk factors for the development of lithium-induced polyuria. Br J Psychiatry 2003 182 319-23. 

Treatment of lithium-induced polyuria Other complications of lithium administration. Drug interactions ... 

Jackson BA, Edwards RM, DousaTR. Lithium-induced polyuria effect of lithium on adenylate cyclate and adenosine 3 5 monophosphate phosphodisterasein medullary ascending limbof Henle s loop and In medullary collecting tubules. Endocrinol 1980 107(6) 1693-1698. 

Forrest J Jr. Lithium-induced polyuria cellular mechanisms and response to diuretics. In Lithium - controversies and unresolved Issues. Cooper TB, Gershon S, Kline NS (editors). Excerpta Medica, Amsterdam 1979 p. 632-641. 

Hensen and Gross Lithium induced polyuria and renal vasopressin receptor density Nephrol Dial Transplant 1996 11 622-627. 

Treatment of lithium-induced polyuria Effect of lithium on distal nephron acidification Potassium balance... 

We utilized the above principle to treat lithium-induced polyuria [26]. This reduction in urine output could not be ascribed to increased proximal fluid reabsorption and decreased delivery of fluid to the distal nephron as a result of the volume contraction caused by amiloride. Fractional fithium excretion, a marker of proximal sodium reabsorption, did not fall during amiloride heatment, arguing against volume contraction induced by amiloride as possible mechanism [26]. In fithium treated patients, urinary osmolality increased when treated with amiloride (Figure 4). Amiloride at-... 

The management of lithium-induced polyuria includes the use of either thiazide diuretics alone, amiloride alone, or a combination of both The use of thiazide diuretics to treat the polyuria induced by fithium... 

A number of drugs inhibit the antidiuretic actions of vasopressin. Lithium is of particular importance because of its use in the treatment of manic-depressive disorders. Lithium-induced polyuria is usually reversible. Acutely, lithium appears to reduce V -receptor-mediated stimulation of adeny-lyl cyclase. Also, hthium increases plasma levels of parathyroid hormone, a partial antagonist to vasopressin. In most patients, the antibiotic demeclocycline attenuates the antidiuretic effects of vasopressin, probably owing to decreased accumulation and action of cyclic AMP. 

Wilting I, Egberts ACG, Movig KLL, van Laarhoven JHM, Heerdink ER, Nolen WA. The association between concomitant use of serotonergic antidepressants and lithium-induced polyuria. A multicenter medical chart review study. Pharmacopsychiatry 2008 41(4) 129-33. 

Sanches TR, Volpini RA, Massola Shimizu MH, Braganga AC, Oshiro-Monreal F, Seguro AC, et al. Sildenafil reduces polyuria in rats with lithium-induced NDl. Am J Physiol Renal Physiol 2012 302(l) F216-25. 

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