Lithium intoxication can result in nephrogenic diabetes insipidus.
Clinical findings:
(1) polyuria
(2) polydipsia
(3) dehydration
(4) altered mental status progressing to coma
(5) seizures
(6) lethargy and weakness
Laboratory findings:
(1) dilute urine (osmolality < 250 mOsm per kg water)
(2) serum hypernatremia
Risk factors:
(1) impaired renal function (creatinine clearance < 60 mL per minute)
(2) multiple daily doses of lithium
(3) elevated trough serum lithium concentration
(4) long-term therapy (> 15 years)
Differential diagnosis:
(1) diabetes mellitus
(2) other forms of diabetes insipidus
The polyuria should improve after decreasing or stopping the lithium dose. However, urine concentration defects may persist if the patient has received long-term therapy.
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