Lithium-induced nephrogenic diabetes insipidus in older people

Abstract

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.

Do Antidepressants Lower the Prevalence of Lithium-Associated Hypernatremia and Symptomatic Polyuria in the Elderly?

“…Hypernatremia can be life-threatening, as can the overly aggressive correction of it. In 2/7 of our hypernatremic patients and in cases from the literature, (5) relatively low sodium levels (147–149 mmol/L) caused symptoms and necessitated hospitalization. Furthermore, thirty-day mortality has been shown to be significantly higher in hypernatremic elderly when compared to matched controls.…”

“…Hypernatremia has been reported in several cases of lithium-induced NDI, (4,5) with sodium elevations above 147 mmol/L often causing somnolence, confusion, and necessitating hospitalization in the elderly. (5) Symptoms and laboratory abnormalities of NDI are usually reversible with early lithium discontinuation, but become increasingly irreversible, especially after ten years of use. (1) Therefore, prevention and early diagnosis are critical to the reduction of long-term sequelae.…”

“…We studied geriatric patients because there is no data about lithium-induced hypernatremia in this population and these patients are at particularly high risk of sequelae. (4,5) …”

A feasibility and tolerability study of lithium in Alzheimer's disease

“…Variance from the therapeutic window and side effects may be greater in frail elderly people because of co-morbid disease, interacting co-prescribed drugs and a higher incidence of dehydration. In the elderly in particular lithium has been reported to be associated with a wide range of adverse effects, including but not limited to diabetes insipidus (Mukhopadhyay et al, 2001), thyroid toxicity (Oakley et al, 2000), cardiac toxicity (Oudit et al, 2007), calcium-related and other biochemical abnormalities (Wolf et al, 1997) and adverse effects resulting from drug interactions. Prescribing lithium places demands on patients and services and necessitates regular venepuncture for lithium level monitoring.…”

Medication Side Effects: Barriers to the Management of Fluid Intake

“…44 Approximately 2 million adult Americans have bipolar disorder, and about 1 in 1000 people in the general population is using lithium carbonate. 45,46 Numerous other psychotropic agents such as benzodiazepines and those used to treat Parkinson's disease are capable of causing dry mouth and constipation.…”