Hyperosmolar nonketotic coma precipitated by lithium-induced nephrogenic diabetes insipidus.
A 45-year-old man, with a 10-year history of manic depression treated with lithium, was admitted with hyperosmolar, nonketotic coma. He gave a five-year history of polyuria and polydipsia, during which time urinalysis had been negative for glucose. After recovery from hyperglycaemia, he remained polyuric despite normal blood glucose concentrations; water deprivation testing indicated nephrogenic diabetes insipidus, likely to be lithium-induced. We hypothesize that when this man developed type 2 diabetes, chronic polyuria due to nephrogenic diabetes insipidus was sufficient to precipitate hyperosmolar dehydration.
Azam
H
H
Department of Diabetes, Ninewells Hospital and Medical School, Dundee, Scotland, UK.
Newton
R W
RW
Morris
A D
AD
Thompson
C J
CJ
D018692:Antimanic Agents / Q000009:adverse effects*; D001714:Bipolar Disorder / Q000188:drug therapy; D018500:Diabetes Insipidus, Nephrogenic / Q000139:chemically induced*; D006801:Humans; D006944:Hyperglycemic Hyperosmolar Nonketotic Coma / Q000209:etiology*; D016651:Lithium Carbonate / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged
D018692:Antimanic Agents; D016651:Lithium Carbonate