Lithium induced DI

[zenna]

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How do we treat lithium induced DI if there is significant CNS manifestation? Is it amiloride or IV fluids? what is the choice of fluid?

 

[Fuzuli]

The problem in DI is the loss of free water from kindeys, which results in hypernatremia. Therefore, the treatment should be, logically, to replace this lost free water without gaining more sodium. Typically this free water deficit is corrected with IV %5 dextrose solution (D5W).

Treatment of nephogenic DI consists of treatment of the underlying cause, IV D5W and diuretics.

 

[zenna]

Fuzuli I am so impressed how can you answer everything? Hey, and do you know how lithium causes hypercalcemia?

 

[Fuzuli]

Fuzuli I am so impressed how can you answer everything? Hey, and do you know how lithium causes hypercalcemia?

As a twist of irony, I don't know the answer to this question 🙂

According to Harrison's 17th edition: "...lithium can be shown in vitro to shift the PTH secretion curve to the right in response to calcium; i.e., higher calcium levels are required to lower PTH secretion, probably acting at the calcium sensor (see below); this effect can cause elevated PTH levels and consequent hypercalcemia in otherwise normal individuals."