Intense Thirst Induced by Lithium Use
Lithium, a common treatment for bipolar disorder, may lead to a condition called nephrogenic diabetes insipidus (NDI). This condition affects the kidneys' ability to preserve and concentrate urine, resulting in excessive urination and increased thirst to compensate for fluid loss.
Approximately 70% of people taking lithium may experience excessive thirst and frequent urination. This increased thirst is often one of the first signs of NDI. The risk of developing NDI increases with longer duration of use, increased age, higher dosages, and using more lithium than prescribed.
NDI is considered a progressive condition, with symptoms potentially increasing over time. If left untreated, it could lead to dehydration, a serious complication that may require medical support. Signs of severe dehydration include diarrhea, disorientation, dry mouth, headache, insatiable thirst, nausea or vomiting, shaking hands (tremors), and more. In such cases, immediate medical attention may be required, involving medication and intravenous (IV) fluids.
Screening for NDI may include measuring electrolyte levels and checking renal and thyroid functions twice a year. Early diagnosis and seeking support from a healthcare professional can improve the treatment outlook for NDI.
Treatment options are available for NDI. Triamterene (Dyrenium) has shown effectiveness in managing NDI in an 81-year-old woman with bipolar disorder treated with lithium. Amiloride (Midamor) is another diuretic that can be used to treat mild to moderate cases of NDI, helping to produce urine while keeping potassium levels stable. A supportive dose of amiloride can be used in conjunction with lithium for people with bipolar disorder who respond best to lithium treatment.
Hydrochlorothiazide (Microzide) may also be recommended as a diuretic, but more research is needed on its effectiveness for NDI. Swapping out lithium for another mood stabilizer, such as lamotrigine (Lamictal), may be a solution in the early stages of NDI.
It's important to note that lithium has long been the gold standard for treatment of bipolar disorder. However, NDI is a potential complication that may require additional medical support and frequent monitoring. The exact time when NDI becomes irreversible is inconclusive, but evidence suggests it may take several years into treatment.
In conclusion, while lithium is an effective treatment for bipolar disorder, it's crucial to be aware of the potential complications, such as NDI. Regular screenings, careful monitoring of dosages, and prompt treatment can help manage this condition and ensure the best possible outcomes for those undergoing lithium treatment.
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