title: The McGill Geriatric Lithium-Induced Diabetes Insipidus Clinical Study (McGLIDICS).
abstract: OBJECTIVE
  Despite being a common and potentially serious condition, nephrogenic diabetes insipidus (NDI) remains poorly understood in older lithium users. Our main objective was to compare the prevalence of NDI symptoms and decreased urine osmolality ([UOsm] < 300 milli-Osmoles [mOsm/kg]) among geriatric and adult lithium users. We also assessed NDI symptoms, serum sodium (Na+), and urine specific gravity (USG) as possible surrogate measures of decreased UOsm, and ascertained whether potential etiologic factors independently correlated with decreased UOsm.
  
  
  METHODS
  This was a cross-sectional study of 100 consecutive outpatients treated with lithium from 6 tertiary care clinics, of which 45 were geriatric (aged 65 years and older) and 55 adult (aged 18 to 64 years). Patients completed a symptom questionnaire and underwent laboratory tests, including UOsm, serum Na+, and USG.
  
  
  RESULTS
  Geriatric and adult lithium users had similar rates of decreased UOsm (12.5%, compared with 17.9%, P = 0.74), but geriatric patients reported less symptoms (P < 0.05). Although UOsm did not correlate with symptoms or current serum Na+, USG of less than 1.010 was suggestive of UOsm of less than 300 mOsm/kg. Age, lithium duration, and serum lithium level were independently associated with UOsm.
  
  
  CONCLUSIONS
  The prevalence of decreased UOsm is similar in geriatric and adult lithium users, but older patients are less likely to report urinary and thirst symptoms. Although subjective symptoms do not correlate with UOsm, USG may be a cost-efficient clinical surrogate measure for UOsm. We suggest clinicians increase their vigilance for decreased UOsm, especially in lithium users with advanced age, longer duration of lithium exposure, and higher lithium levels. This may potentially prevent lithium intoxication, falls, hypernatremic events, and renal dysfunction.
authors.affiliation: Resident, Department of Psychiatry, McGill University, Montreal, Quebec.
authors.forename: Soham
authors.initials: S
authors.lastname: Rej
authors.affiliation: Assistant Professor, Division of Geriatric Psychiatry, Department of Psychiatry, Jewish General Hospital, McGill University, Montreal, Quebec.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Segal
authors.affiliation: Assistant Professor, Division of Mood Disorders Psychiatry, Department of Psychiatry, McGill University Health Centre, McGill University, Montreal, Quebec.
authors.forename: Nancy C P
authors.initials: NC
authors.lastname: Low
authors.affiliation: Associate Professor, Division of Nephrology, Department of Medicine, Royal Victoria Hospital, McGill University, Montreal, Quebec.
authors.forename: Istvan
authors.initials: I
authors.lastname: Mucsi
authors.affiliation: Consultant Biostatistician, Boston, Massachusetts.
authors.forename: Christina
authors.initials: C
authors.lastname: Holcroft
authors.affiliation: Professor, Division of Geriatric Psychiatry, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Shulman
authors.affiliation: Associate Professor, Division of Consult-Liaison Psychiatry, Department of Psychiatry, Jewish General Hospital, McGill University, Montreal, Quebec.
authors.forename: Karl
authors.initials: K
authors.lastname: Looper
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000652:urine; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000652:urine; D018500:Diabetes Insipidus, Nephrogenic / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology / Q000652:urine; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D018020:Lithium Compounds / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D012016:Reference Values; D012964:Sodium / Q000097:blood; D013046:Specific Gravity; D055815:Young Adult
chemical_list: D018020:Lithium Compounds; D012964:Sodium