From the Research
Lithium should be discontinued in patients with nephrogenic diabetes insipidus when serum sodium levels exceed 150 mEq/L or when there are significant symptoms of hypernatremia, regardless of the exact sodium level, as supported by the most recent study 1.
Clinical Considerations
When managing patients with lithium-induced nephrogenic diabetes insipidus, it is crucial to consider the severity of psychiatric illness being treated, as abrupt discontinuation of lithium can lead to relapse of bipolar disorder or other conditions.
- Patients with sodium levels between 145-150 mEq/L with mild symptoms may be managed with increased water intake and dose reduction rather than complete discontinuation.
- Alternative treatments like thiazide diuretics, amiloride, or NSAIDs can help manage polyuria and sodium levels if lithium must be continued despite nephrogenic diabetes insipidus.
Pathophysiology and Monitoring
Lithium causes nephrogenic diabetes insipidus by reducing aquaporin-2 water channels in the collecting ducts, impairing water reabsorption and leading to polyuria and potentially hypernatremia, as noted in 2 and 3.
- Regular monitoring of serum sodium, urine output, and symptoms is crucial for patients on lithium therapy, especially in cases where lithium is continued despite nephrogenic diabetes insipidus.
Treatment Options
The efficacy of desmopressin in combination with thiazide diuretics and non-steroidal anti-inflammatory drugs for managing lithium-induced nephrogenic diabetes insipidus has been demonstrated in recent studies, including 1.
- Consideration of both nephrogenic and central diabetes insipidus is necessary when evaluating polyuria and hypernatremia in patients with long-term lithium use, as highlighted in 4.