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Managing polyuria during lithium treatment: a preliminary prospective observational study

Published online by Cambridge University Press:  10 April 2019

J. C. Kinahan ,
A. Ní Chorcoráin ,
S. Cunningham ,
S. Barry  and
B. D. Kelly Open the ORCID record for B. D. Kelly [Opens in a new window]
J. C. Kinahan
Affiliation:
College of Medicine and Health, School of Medicine, Brookfield Health Sciences Complex, University College Cork, College Road, Cork, Ireland Department of Psychiatry, Cork University Hospital, Cork, Ireland
A. Ní Chorcoráin
Affiliation:
College of Medicine and Health, School of Medicine, Brookfield Health Sciences Complex, University College Cork, College Road, Cork, Ireland Department of Psychiatry, Cork University Hospital, Cork, Ireland
S. Cunningham
Affiliation:
Department of Pathology and Laboratory Medicine, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
S. Barry
Affiliation:
Cluain Mhuire Community Mental Health Service, Blackrock, Dublin, Ireland
B. D. Kelly*
Affiliation:
Department of Psychiatry, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin 24, Ireland
*
*Address for correspondence: Professor Brendan Kelly, Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin D24 NR0A, Ireland. (Email: brendan.kelly@tcd.ie)
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Abstract

Objectives:

Lithium-treated patients with polyuria are at increased risk of lithium toxicity. We aimed to describe the clinical benefits and risks of different management strategies for polyuria in community lithium-treated patients.

Methods:

This is a naturalistic, observational, prospective 12-month cohort study of lithium-treated patients with polyuria attending a community mental health service in Dublin, Ireland. When polyuria was detected, management changed in one of four ways: (a) no pharmacological change; (b) lithium dose decrease; (c) lithium substitution; or (d) addition of amiloride.

Results:

Thirty-four participants were diagnosed with polyuria and completed prospective data over 12 months. Mean 24-hour urine volume decreased from 4852 to 4344 ml (p = 0.038). Mean early morning urine osmolality decreased from 343 to 338 mOsm/kg (p = 0.823). Mean 24-hour urine volume decreased with each type of intervention but did not attain statistical significance for any individual intervention group. Mean early morning urine osmolality decreased in participants with no pharmacological change and increased in participants who received a change in medication but these changes did not attain statistical significance. Only participants who discontinued lithium demonstrated potentially clinically significant changes in urine volume (mean decrease 747 ml in 24 hours) and early morning urine osmolality (mean increase 31 mOsm/kg) although this was not definitively proven, possibly owing to power issues.

Conclusions:

Managing polyuria by decreasing lithium dose does not appear to substantially improve objective measures of renal tubular dysfunction, whereas substituting lithium may do so. Studies with larger numbers and longer follow-up would clarify these relationships.

Keywords

Lithiumpolyuriarenal tubular dysfunctionnephrogenic diabetes insipidusamiloride
Type
Original Research
Information
Irish Journal of Psychological Medicine , Volume 39 , Issue 1 , March 2022 , pp. 20 - 27
Copyright
© The Author(s), 2019. Published by Cambridge University Press on behalf of The College of Psychiatrists of Ireland

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