Water Disturbances in Patients Treated with Oral Lithium Carbonate

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Abstract
Patients [48] treated with oral lithium carbonate and 20 control subjects were studied to define the causes of Li-induced water disturbances. Measurement of plasma immunoreactive arginine vasopressin, plasma osmolality and urine osmolality after a period of dehydration separated nephrogenic diabetes insipidus, cranial diabetes insipidus and primary polydipsia, the 3 postulated mechanisms of Li-induced polyuria. Patients [17] had a urinary concentrating defect despite serum Li concentrations in the therapeutic range. Of these patients, 10 had nephrogenic diabetes insipidus, and 1 had results suggestive of cranial diabetes insipidus, but none had evidence of primary polydipsia. Symptoms of thirst and polyuria were poor indicators of the degree of hypo-osmolar urine. No patient had electrolyte abnormalities, and none had sufficiently severe polyuria to stop Li treatment.

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