Lithium
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Possible nephrogenic diabetes insipidus: case report A 46-year-old woman developed possible nephrogenic diabetes insipidus during treatment with lithium for bipolar disorder. The woman, who had stage IV adenocarcinoma of the right lung and a smoking history of 60 packs-year, presented with nausea, abdominal pain, diarrhoea, non-bloody non-bilious vomiting, chills and fevers. She was hospitalised. She was hypotensive, which improved after IV hydration. With the suspicion of sepsis she was treated with empiric unspecified broad spectrum antibiotics. A mediport was suspected as a nidus of infection and was removed. Blood cultures were negative. Chest CT scan showed interval enlargement of a previously noted right lung mass, metastatic hepatic lesions and two new pleural nodules. She also exhibited polyuria and hypernatraemia, which required aggressive IV hydration. Investigations indicated possible nephrogenic diabetes insipidus. The nephrogenic diabetes insipidus was considered possibly due to her previous use of lithium [route, dosage and duration of treatment to reaction onset not stated] for bipolar disorder. The woman was treated with desmopressin and showed partial response. Later, sufficient volume status control was achieved with the treatment of desmopressin, triamterene and hydrochlorothiazide. Despite decrease in urine output, stool output remained high. Later, she was treated with loperamide and diphenoxylate/atropine to regulate her stool output. She was diagnosed to have a paraneoplastic syndrome. Due to progressive metastatic malignancy and refractory pain, she opted for palliative care. It was hypothesised that she might have concomitant neuro-endocrine characteristics on the predominant histopathology of lung adenocarcinoma. Forte M, et al. Uncommon paraneoplastic complication of secretory diarrhea in a patient with metastatic lung adenocarcinoma. American Journal of Respiratory and Critical Care Medicine 199: (plus poster) abstr. A6929, No. 9, May 2019. Available from: URL: http://doi.org/10.1164/ajrccm-conference.2019.199.1_MeetingAbstracts.A6929 [abstract] 803446872
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Reactions 18 Jan 2020 No. 1787
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