Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2006) 11 P122

ECE2006 Poster Presentations Clinical case reports (128 abstracts)

Is the continuation of lithium treatment safe during peri-operative periods?

A Tan , S Bandyopadhyay & JP Vora


Department of Endocrinology, Royal Liverpool University Hospital, Liverpool, Merseyside, United Kingdom.


Case report: A 40-year old male with a background history of autism, severe learning difficulties and childhood Hirschsprung’s disease had been on long-term lithium carbonate therapy, without any history of polyuria or polydipsia. During admission he underwent a subtotal colectomy for malignant colonic polyps. Pre-operative serum urea and electrolytes, glucose and lithium levels were normal. Pre-operative fluid balance was normal. The post-operative period was turbulent; he required a repeat laparotomy to washout an intra-abdominal collection and was transferred to the intensive care unit. At this stage, urine output rose to six litres per day, serum sodium 165(135–145) mmol/l, serum potassium 2.9(3.5–5.0) mmol/l, urea 4.1(2.5–7.0) mmol/l and creatinine 129(50–130) umol/l. Further investigations revealed plasma osmolality of 341(288–298) mosmol, urine osmolality 141(250–750) mosmol and urine sodium of 7(50–125) mmol/l. Although nephrogenic diabetes insipidus was suspected, a water deprivation test was impossible because of his poor clinical state. Lithium was stopped and desmopressin was commenced at 750 mcg/day. Urine output increased to approximately 20 litres per day. Desmopressin was gradually titrated up to 3 mg. His serum sodium dropped to 140 mmol/l but urine output remained between 8 to 9 litres per day. He was commenced on amiloride (5 mg daily), indomethacin (50 mg tds) and hydrochlorothiazide (2.5 mg daily). His condition improved, serum sodium stayed at around 140 mmol/l and daily urine output decreased to 1.8 litres. Desmopressin and indomethacin were stopped. He was discharged on amiloride (5 mg daily) and bendrofluazide (2.5 mg daily).

Comments: Lithium is known to cause nephrogenic diabetes insipidus. In patients on lithium treatment post-operative precipitation of nephrogenic diabetes insipidus is not a common phenomenon, although it has been previously reported. Temporary cessation of lithium should be considered during hypovolaemic states.

Volume 11

8th European Congress of Endocrinology incorporating the British Endocrine Societies

European Society of Endocrinology 
British Endocrine Societies 

Browse other volumes

Article tools

My recent searches

No recent searches.