Nandoshvili Eka, Hyer Steve, Johri Nikhil
Endocrinology, Epsom and Saint Helier University Hospitals NHS Trust Epsom Hospital, Carshalton, UK.
Chemical Pathology, Epsom and Saint Helier University Hospitals NHS Trust Epsom Hospital, Carshalton, UK.
BMJ Case Rep. 2019 Sep 6;12(9):e231093. doi: 10.1136/bcr-2019-231093.
A 40-year-old Caucasian man developed excessive thirst and polyuria particularly at night over the preceding 6 months. He had been taking lithium for 16 years for the treatment of bipolar affective disorder. Investigations revealed subnormal maximum urinary concentrating ability after 8 hours of water deprivation and only a borderline response of urine osmolality to exogenous desmopressin given by intramuscular injection. A plasma copeptin concentration was elevated at 23 pmol/L. These results were consistent with partial nephrogenic diabetes insipidus. He was encouraged to increase his water intake as dictated by his thirst. In addition, he received amiloride with some improvement in his symptoms. Clinicians should be aware of the risk of nephrogenic diabetes insipidus with long-term lithium use and seek confirmation by a supervised water deprivation test augmented with a baseline plasma copeptin. If increased water intake is insufficient to control symptoms, amiloride may be considered.
一名40岁的白种男性在过去6个月里出现了过度口渴和多尿的症状，尤其是在夜间。他因双相情感障碍服用锂盐已有16年。检查发现，禁水8小时后最大尿浓缩能力低于正常水平，肌肉注射外源性去氨加压素后尿渗透压仅有临界反应。血浆 copeptin 浓度升高至23 pmol/L。这些结果与部分性肾性尿崩症相符。鼓励他根据口渴程度增加饮水量。此外，他服用了氨氯吡咪，症状有所改善。临床医生应意识到长期使用锂盐导致肾性尿崩症的风险，并通过在基线血浆 copeptin 基础上进行的有监督的禁水试验来确诊。如果增加饮水量不足以控制症状，可以考虑使用氨氯吡咪。
