When bipolar disorder is treated with lithium, nephrogenic diabetes insipidus (NDI) might occur occasionally. Lithium withdrawal, however, can reverse NDI.
You might not be dreaming if you feel as though you've suddenly gotten more thirsty and need to urinate more frequently.
Your kidneys may not be able to retain water due to a very real illness called nephrogenic diabetes insipidus (NDI), which causes excessive thirst and increased urine production.
Lithium is one of the factors that can produce AVP resistance. Lithium-induced NDI can frequently be resolved by discontinuing lithium treatment.
Continue reading to find out more about how lithium and NDI are related.
Can lithium cause diabetes insipidus?
It is surprisingly common for lithium to cause diabetic insipidus. In one study, NDI was observed in roughly 20–40% of lithium users.
Because lithium interferes with renal collecting tubules, it may be a factor in NDI. The kidneys have these microscopic tubes that allow fluids to be returned to the circulation.
Additionally, it might be a factor in the decrease of aquaporin-2, a protein that aids in the regulation of water balance in the body.
Other possible reasons for both transient and long-term NDI include:
- kidney disease
- urinary tract obstruction
- certain antibiotics, antivirals, antifungals or antineoplastic drugs
- pregnancy
- low levels of potassium in the blood
- low levels of protein in the blood
- high calcium levels
Risk factors
A higher chance of developing diabetes insipidus exists if you:
- have a family history of the condition
- experienced a serious head injury or underwent brain surgery
- take certain drugs, such as diuretics, which might lead to renal issues
- possess metabolic diseases characterized by chronically elevated calcium or potassium levels in the blood
Nephrogenic diabetes insipidus signs and symptoms
Symptoms of NDI can include:
- urinary frequency (more frequent urination than normal)
- polydipsia (extreme thirst)
- polyuria (a lot of light-colored pee being passed)
You might also have symptoms of dehydration, such as weakness, disorientation, or dry skin, in addition to these typical NDI symptoms. Lethargy, limited weight gain, and unexplained fevers are common in infants with NDI.
Is it reversible?
If you stop using lithium, you might be able to reverse NDI; however, some cases persist even after lithium therapy is stopped.
Under certain circumstances, NDI might last for years or forever. There's not much research on this problem, although at least one study has suggested that desmopressin use may be useful in reversing NDI when this occurs.
Diagnosis
Your doctor may recommend a variety of tests if they believe you have NDI due to increased thirst and frequent urination. These may consist of:
- Urinalysis: This can indicate the presence of excess glucose and water in the urine, both of which are indicators of diabetes mellitus.
- Blood tests: These can assess your blood's sodium content in addition to other parameters that could assist in identifying whether diabetes insipidus is the reason for your increased urination.
- Water deprivation test: To determine whether you have diabetes insipidus, doctors will check your blood and urine while you abstain from alcohol for a few hours. During this time, they might also test how you respond to certain drugs.
- MRI: This brain imaging test may be used by physicians to identify whether diabetes insipidus is being caused by hypothalamic or pituitary gland damage.
- Stimulation tests: You might be given a drug by medical personnel to promote the production of vasopressin. After that, your doctor will check your blood for copeptin levels to see if you have primary polydipsia, a distinct disorder, or diabetes insipidus.
Treatment
To determine whether you can stop taking lithium, your doctor may talk to you about other pharmaceutical options if NDI is associated with lithium treatment.
Dietary changes may also be recommended by your doctor to help with symptoms. To lessen the amount of urine your kidneys produce, they could also advise taking extra drugs.
When to contact a doctor
If you develop signs of NDI, such as intense thirst and frequent urination, it's critical to let your doctor know.
Additionally, if you encounter any of the following signs of severe dehydration, you should contact your doctor:
- difficulty concentrating or performing mental tasks
- extreme fatigue
- becoming dizzy when standing up
- nausea
- fainting
The bottom line
NDI can result from the medication lithium, which is occasionally used to treat bipolar disorder. If this happens, you could become extremely thirsty and urinate a lot.
If you experience NDI from lithium, your doctor might advise you to take different medications since quitting lithium therapy could resolve the condition.
Even if you're not taking lithium, it's still vital to see your doctor if you're having excessive thirst and urine as there are other possible causes of non-direct hypotension (NDI).
They can suggest suitable therapies and run tests to help determine whether you have NDI.
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