Use of acetazolamide in lithium-induced nephrogenic diabetes insipidus: a case report

Abstract

SummaryLithium-induced nephrogenic diabetes insipidus (Li-NDI) is a rare and difficult-to-treat condition. A study in mice and two recent papers describe the use of acetazolamide in Li-NDI in 7 patients (a case report and a 6 patient series). We describe the case of a 63-year-old woman with bipolar disorder treated with lithium and no previous history of diabetes insipidus. She was hospitalized due to a bowel obstruction and developed severe dehydration after surgery when she was water deprived. After desmopressin administration and unsuccessful thiazide and amiloride treatment, acetazolamide was administrated to control polyuria and hydroelectrolytic disorders without significant side effects. To our knowledge, this is the third publication on acetazolamide use in Li-NDI patients.Learning points:Treatment of lithium-induced nephrogenic diabetes insipidus might be challenging.Vasopressin, amiloride and thiazide diuretics have been used in lithium-induced nephrogenic diabetes insipidus treatment.Acetazolamide might be an option to treat lithium-induced nephrogenic diabetes insipidus patients who fail to respond to standard treatment.The use of acetazolamide in lithium-induced nephrogenic diabetes insipidus must be monitored, including its effects on glomerular filtration rate.

Nephrogenic diabetes insipidus induced by ureter obstruction due to benign prostatic hyperplasia

“…[ 8 , 9 ] Patients with this disease typically produce large quantities of diluted urine (up to 1 L/h in the most severe cases). [ 10 ] The disease has a substantial impact on quality of life, as sleep is frequently interrupted. Treatment of acquired NDI should target the underlying cause, such as relief of any urinary obstruction.…”

Aquaporins and diseases pathogenesis: From trivial to undeniable involvements, a disease‐based point of view

“…According to the pathophysiology of the disease and its severity, excess water consumption, and DDAVP administration contribute to compensate for water deficiency. To harness DI, particularly the nephrogenic one that does not respond to AVP, some new strategies such as thiazides, prostaglandin synthesis inhibitors, AVP V2 receptor agonists, AVPR2 antagonists, specific vasopressin analogues, cyclic GMP phosphodiesterase inhibitors, statins, and acetazolamide have been proposed, each one acting through a different mechanism (Allen et al, 1989;Assadi & Sharbaf, 2015;Bockenhauer & Bichet, 2015;Bonfrate et al, 2015;de Groot et al, 2016;Libber et al, 1986;Macau et al, 2018;Procino et al, 2011Procino et al, , 2014Sinke et al, 2013).…”

Patología psiquiátrica e ingesta de agua: no siempre es polidipsia psicógena

“…Se instaura una dieta baja en solutos (hipoproteica y sin sal), y se educa a la paciente en ingerir agua libremente según la sensación de sed. Revisando la literatura, encontramos varios casos descritos de pacientes con DI nefrogénica tratados con acetazolamida, con buenos resultados [1][2][3] . Decidimos iniciar una prueba terapéutica con 500 mg/día, pero hubo que suspenderla 3 días después debido a que la paciente desarrolló acidosis metabólica, a pesar de que la natremia estaba mejorando (Tabla 1, día +8).…”