Severe lithium-induced nephrogenic diabetes insipidus: The diuresis paradox
We report a case of profound nephrogenic diabetes insipidus (NDI) in which renal resistance to antidiuretic hormone results in dilute polyuria despite normal circulating concentrations. A 28-year-old man with bipolar mood disorder presented to his local clinic with symptoms suggestive of lithiu...
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South African Medical Association
2025-04-01
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| Series: | South African Medical Journal |
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| Online Access: | https://samajournals.co.za/index.php/samj/article/view/2651 |
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| author | G S Tatz Marc Blockman J A Dave I L Ross |
| author_facet | G S Tatz Marc Blockman J A Dave I L Ross |
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We report a case of profound nephrogenic diabetes insipidus (NDI) in which renal resistance to antidiuretic hormone results in dilute polyuria despite normal circulating concentrations. A 28-year-old man with bipolar mood disorder presented to his local clinic with symptoms suggestive of lithium toxicity. Plasma lithium concentrations and thyroid-stimulating hormone (TSH) were taken, but results were not acted upon. One week later, he presented obtunded, severely dehydrated and in renal failure. His plasma lithium concentration was 4.3 mmol/L (toxic threshold >1.5 mmol/L) and TSH >100 mIU/L. After admission to the intensive care unit, including haemodialysis and 12 days of ventilation, he developed profound polyuria, with a peak output of 15 L/day. Amiloride with hydrochlorothiazide adequately reduced the polyuria. Management of lithium-induced NDI remains complex, and includes diuretics, which paradoxically reduce polyuria in this setting. Failure to follow up critical results led to profound morbidity, and is a crucial learning point in this case.
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| format | Article |
| id | doaj-art-a458eb1529074e5faa18a035d9356b22 |
| institution | DOAJ |
| issn | 0256-9574 2078-5135 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | South African Medical Association |
| record_format | Article |
| series | South African Medical Journal |
| spelling | doaj-art-a458eb1529074e5faa18a035d9356b222025-08-20T03:09:03ZengSouth African Medical AssociationSouth African Medical Journal0256-95742078-51352025-04-0110.7196/SAMJ.2025.v115i3.2651Severe lithium-induced nephrogenic diabetes insipidus: The diuresis paradoxG S Tatz0https://orcid.org/0000-0001-5975-3566Marc Blockman1https://orcid.org/0000-0001-7240-8812J A Dave2https://orcid.org/0000-0003-3084-7408I L Ross3https://orcid.org/0000-0002-5308-7563Division of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South AfricaDivision of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South AfricaDivision of Endocrinology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South AfricaDivision of Endocrinology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa We report a case of profound nephrogenic diabetes insipidus (NDI) in which renal resistance to antidiuretic hormone results in dilute polyuria despite normal circulating concentrations. A 28-year-old man with bipolar mood disorder presented to his local clinic with symptoms suggestive of lithium toxicity. Plasma lithium concentrations and thyroid-stimulating hormone (TSH) were taken, but results were not acted upon. One week later, he presented obtunded, severely dehydrated and in renal failure. His plasma lithium concentration was 4.3 mmol/L (toxic threshold >1.5 mmol/L) and TSH >100 mIU/L. After admission to the intensive care unit, including haemodialysis and 12 days of ventilation, he developed profound polyuria, with a peak output of 15 L/day. Amiloride with hydrochlorothiazide adequately reduced the polyuria. Management of lithium-induced NDI remains complex, and includes diuretics, which paradoxically reduce polyuria in this setting. Failure to follow up critical results led to profound morbidity, and is a crucial learning point in this case. https://samajournals.co.za/index.php/samj/article/view/2651nephrogenic diabetes insipidusarginine vasopressin resistancelithium hypothyroidismlithium-inducedlithium toxicity |
| spellingShingle | G S Tatz Marc Blockman J A Dave I L Ross Severe lithium-induced nephrogenic diabetes insipidus: The diuresis paradox South African Medical Journal nephrogenic diabetes insipidus arginine vasopressin resistance lithium hypothyroidism lithium-induced lithium toxicity |
| title | Severe lithium-induced nephrogenic diabetes insipidus: The diuresis paradox |
| title_full | Severe lithium-induced nephrogenic diabetes insipidus: The diuresis paradox |
| title_fullStr | Severe lithium-induced nephrogenic diabetes insipidus: The diuresis paradox |
| title_full_unstemmed | Severe lithium-induced nephrogenic diabetes insipidus: The diuresis paradox |
| title_short | Severe lithium-induced nephrogenic diabetes insipidus: The diuresis paradox |
| title_sort | severe lithium induced nephrogenic diabetes insipidus the diuresis paradox |
| topic | nephrogenic diabetes insipidus arginine vasopressin resistance lithium hypothyroidism lithium-induced lithium toxicity |
| url | https://samajournals.co.za/index.php/samj/article/view/2651 |
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