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Age and Ageing 2001; 30: 347-350
© 2001, British Geriatrics Society

Case report

Lithium-induced nephrogenic diabetes insipidus in older people

Diptarup Mukhopadhyay, Lingesan Gokulkrishnan and Kanthaya Mohanaruban

Department of Integrated Medicine, Withybush General Hospital, Haverfordwest SA61 2PZ, UK

Presentation: we report two patients. The first is a 68-year-old woman who presented with a 2-day history of vomiting. She was hypernatraemic and her elevated serum sodium concentration did not improve initially, despite adequate fluid replacement. She subsequently developed polyuria and polydipsia. The second patient, a 77-year-old woman, presented with delirium and severe hypernatraemia after being treated for a chest infection 1 week earlier. Both patients were on long-term lithium treatment.

Investigation: in both the cases, a supervised water-deprivation test done after normalization of the blood biochemistry showed partial nephrogenic diabetes insipidus.

Outcome: lithium was discontinued.

Conclusion: older people on lithium—especially those requiring supportive care—are at risk of severe hypernatraemia after an acute illness or if their fluid intake is restricted.

Keywords: hypernatraemia, lithium, nephrogenic diabetes insipidus


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