Lithium-induced nephrogenic diabetes insipidus after coronary artery bypass.
We present a case of nephrogenic diabetes insipidus that occurred after on-pump coronary artery bypass grafting in a patient taking long-term lithium carbonate. Lithium toxicity (2.79 mmol/L) was identified on postoperative day 9. Serum sodium peaked at 175 mmol/L on postoperative day 21. Serum osmolality peaked at 384 mOsm/kg H2O, with a urinary osmolality of 403 mOsm/kg H2O. The patient was ultimately managed with hemofiltration and high-dose 1-desamino-8-D-arginine-vasopressin. Recommendations are made based on our experience of this case. In patients on long-term lithium therapy, the potentially life-threatening complication of lithium-induced nephrogenic diabetes insipidus should be specifically anticipated and managed.
Leeman
Matthew F
MF
Department of Cardiothoracic Surgery, Papworth Hospital NHS Trust, Cambridgeshire, United Kingdom. mfleeman@nhs.net
Vuylsteke
Alain
A
Ritchie
Andrew J
AJ
D001714:Bipolar Disorder / Q000188:drug therapy*; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery*; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use; D003919:Diabetes Insipidus / Q000139:chemically induced* / Q000628:therapy; D006440:Hemofiltration; D006801:Humans; D016651:Lithium Carbonate / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000139:chemically induced; D016896:Treatment Outcome
D016651:Lithium Carbonate; D003894:Deamino Arginine Vasopressin