title: Prolonged hypernatremia triggered by hyperglycemic hyperosmolar state with coma: A case report.
abstract: A man with past lithium use for more than 15 years, but off lithium for two years and not carrying the diagnosis of diabetes mellitus or nephrogenic diabetes insipidus (NDI), presented with coma and hyperglycemic hyperosmolar state (HHS). Following correction of HHS, he developed persistent hypernatremia accompanied by large volumes of urine with low osmolality and no response to desmopressin injections. Urine osmolality remained < 300 mOsm/kg after injection of vasopressin. Improvement in serum sodium concentration followed the intake of large volumes of water plus administration of amiloride and hydrochlorothiazide. Severe hyperglycemia may trigger symptomatic lithium-induced NDI years after cessation of lithium therapy. Patients with new-onset diabetes mellitus who had been on prolonged lithium therapy in the past require monitoring of their serum sodium concentration after hyperglycemic episodes regardless of whether they do or do not carry the diagnosis of NDI.
authors.affiliation: Darlene Vigil, Yijuan Sun, Antonios H Tzamaloukas, Karen S Servilla, Nephrology Section, Medicine Service, Raymond G Murphy Veterans Affairs Medical Center, Albuquerque, NM 87108, United States.
authors.forename: Darlene
authors.initials: D
authors.lastname: Vigil
authors.affiliation: Darlene Vigil, Yijuan Sun, Antonios H Tzamaloukas, Karen S Servilla, Nephrology Section, Medicine Service, Raymond G Murphy Veterans Affairs Medical Center, Albuquerque, NM 87108, United States.
authors.forename: Kavitha
authors.initials: K
authors.lastname: Ganta
authors.affiliation: Darlene Vigil, Yijuan Sun, Antonios H Tzamaloukas, Karen S Servilla, Nephrology Section, Medicine Service, Raymond G Murphy Veterans Affairs Medical Center, Albuquerque, NM 87108, United States.
authors.forename: Yijuan
authors.initials: Y
authors.lastname: Sun
authors.affiliation: Darlene Vigil, Yijuan Sun, Antonios H Tzamaloukas, Karen S Servilla, Nephrology Section, Medicine Service, Raymond G Murphy Veterans Affairs Medical Center, Albuquerque, NM 87108, United States.
authors.forename: Richard I
authors.initials: RI
authors.lastname: Dorin
authors.affiliation: Darlene Vigil, Yijuan Sun, Antonios H Tzamaloukas, Karen S Servilla, Nephrology Section, Medicine Service, Raymond G Murphy Veterans Affairs Medical Center, Albuquerque, NM 87108, United States.
authors.forename: Antonios H
authors.initials: AH
authors.lastname: Tzamaloukas
authors.affiliation: Darlene Vigil, Yijuan Sun, Antonios H Tzamaloukas, Karen S Servilla, Nephrology Section, Medicine Service, Raymond G Murphy Veterans Affairs Medical Center, Albuquerque, NM 87108, United States.
authors.forename: Karen S
authors.initials: KS
authors.lastname: Servilla
keywords: Hyperglycemia; Hypernatremia; Hypertonicity; Lithium; Nephrogenic diabetes insipidus