Emergency Treatment of Lithium-Induced Diabetes Insipidus with Nonsteroidal Anti-Inflammatory Drugs
| Title: | Emergency Treatment of Lithium-Induced Diabetes Insipidus with Nonsteroidal Anti-Inflammatory Drugs |
|---|---|
| Authors: | Lam, MBBS, S.S.; Kjellstrand, MD, C. |
| Publisher: | Renal Failure |
| Date Published: | January 01, 1997 |
| Reference Number: | 4 |
Thiazides and amiloride are the most often suggested treatment for nephrogenic diabetic insipidus. We found this ineffectual in a patient with acute problems and reviewed the literature to see if there were other more efficient approaches. A 47-year-old woman on lithium had polyuria. When inadvertently fasted for 48 h she became confused, had a seizure, and her sodium was 170 mmol/L. Urinary output was 24 L/day. Large volumes of intravenous fluids were given but sodium remained greater than 170 mmol/L. Treatment with DDAVP, thiazides, and amiloride did not decrease urinary output. Indomethacin 150 mg was started and urine volume immediately fell to one-half. However, because of persistent high urine output the patient was then fluid depleted, with further reduction to normal in urine volume, and Na decreased to 140 mmol/L. Creatinine rose from 135 mumol/L to 173 mumol/L, but decreased to 152 mumol/L when indomethacin was decreased to 75 mg q.d.; urinary output remained stable around 2 L/day. The literature described 22 patients with nephrogenic diabetes insipidus (16 congenital, 6 lithium) treated with nonsteroidal anti-inflammatory drugs. Urine flow was reduced to 1/2, within hours. Rarely, mild renal failure ensued, improving in all but one case when nonsteroidal anti-inflammatory drugs were reduced. Indomethacin (and controlled volume reduction if continued high urine output), while observing renal function, appears the emergency treatment of choice for serious complications of nephrogenic diabetes insipidus.
This translation by the NDI Foundation is to assist the lay reader. To provide a clear, accessible interpretation of the original article, we eliminated or simplified some technical detail and complicated scientific language. We concentrated our translation on those aspects of the article dealing directly with NDI. The NDI Foundation thanks the researchers for their work toward understanding and more effectively treating this disorder.
© Copyright NDI Foundation 2007 (JC)
The authors reviewed the literature on NDI and nonsteroidal anti-inflammatory drugs and found a total of ten reports: five on adult patients with lithium-induced NDI and five on child patients with congenital NDI. The studies showed that when indomethacin was given to the patients, their urine output was reduced an average of 66% within a few hours of taking the drug. Researchers don't know how nonsteroidal anti-inflammatory drugs like indomethacin reduce urine output. Perhaps their inhibiting effect on prostaglandin production enhances the effect of the antidiuretic hormone. Perhaps it is their ability to reduce the rate at which filters in the kidney filter incoming fluids. These drugs may also increase the kidney's ability to reabsorb sodium, and enhance the kidney medulla's ability to concentrate urine.
The authors, on the basis of their literature review and their own experience, conclude that nonsteroidal anti-inflammatory drugs, rather than diuretic drugs, should be used on patients with severe complications from NDI. Using these drugs does involve a chance of acute kidney failure, but the patients recover quickly in response to reduction in the amount of the drug administered. At present the role of these drugs (and diuretic drugs as well) in the long term management of NDI is not clear.