Can Lithium Cause Diabetes Insipidus?

Taking lithium, which often treats bipolar disorder, can sometimes cause nephrogenic diabetes insipidus (NDI). However, stopping lithium can reverse NDI.

If you feel like you’ve suddenly become thirstier and urinating more frequently, you may not be imagining things.

A very real condition called nephrogenic diabetes insipidus (NDI) could be preventing your kidneys from keeping water, leading to increased urine production and extreme thirst.

Also called AVP resistance , lithium can cause this condition. In many cases, stopping lithium therapy will help resolve the NDI that has developed from lithium.

Read on to learn more about the link between lithium and NDI.

Can lithium cause diabetes insipidus?

The phenomenon of lithium causing diabetes insipidus is surprisingly common. According to one study, NDI is seen in about 20 to 40% of people taking lithium.

Lithium may contribute to NDI by interfering with renal collecting tubules. These are tiny tubes in the kidneys that return fluids back to the bloodstream.

It may also contribute to a reduction in aquaporin-2, a protein that helps your body maintain amounts of water in the body.

Other potential causes of temporary and permanent NDI include:

• kidney disease
• urinary tract obstruction
• low levels of potassium in the blood
• low levels of protein in the blood
• high calcium levels
• certain antibiotics, antivirals, antifungals or antineoplastic drugs
• pregnancy

Risk factors

You have an increased risk for diabetes insipidus if you:

• have a family history of the condition
• underwent brain surgery or had a major head injury
• take certain medications that can cause kidney problems, including diuretics
• have metabolic disorders that include persistent high blood calcium or low blood potassium levels

Nephrogenic diabetes insipidus signs and symptoms

Symptoms of NDI can include:

• polydipsia (extreme thirst)
• urinary frequency (needing to pee more than usual)

• polyuria (passing large amounts of light-colored urine)

In addition to these common symptoms of NDI, you may experience signs of dehydration like weakness, confusion, or dry skin. Infants with NDI may experience unexplained fevers, lethargy, and slow weight gain.

Is it reversible?

NDI may be reversible if you stop taking lithium, but there are some cases that continue even after the end of lithium therapy.

In these situations, NDI may continue for years or indefinitely. At least one study has suggested the use of desmopressin might be helpful in reversing NDI when this happens, but there’s limited research on the topic.

Diagnosis

If your doctor suspects NDI because of increased thirst and frequent urination, they may suggest several different types of tests . These can include:

• Urinalysis: This can show whether urine has extra water in it and if there is excess glucose, which would be a sign of diabetes mellitus.
• Blood tests: These can measure the amount of sodium in your blood as well as other factors that may help determine whether diabetes insipidus is the cause of extra urine.
• Water deprivation test: Doctors will monitor your blood and urine while not drinking for several hours to see if you have diabetes insipidus. They may also test your response to different medications during this time.
• MRI: Doctors may use this imaging test of the brain to determine if damage to the hypothalamus or pituitary gland is causing diabetes insipidus.
• Stimulation tests: Healthcare professionals may give you a substance to encourage the production of vasopressin. Your doctor will then measure the levels of copeptin in your blood to determine whether you have diabetes insipidus or a different condition called primary polydipsia.

Treatment

If NDI is related to lithium treatment, your doctor may discuss other medication options with you to see if you can stop taking lithium .

Your doctor may also suggest dietary modifications to help with symptoms. They might also suggest taking additional medications to reduce the amount of urine your kidneys make.

When to contact a doctor

It’s important to notify your doctor if you experience symptoms of NDI like extreme thirst and frequent urination.

You should also reach out to your doctor if you experience symptoms of severe dehydration including:

• becoming dizzy when standing up
• nausea
• difficulty concentrating or performing mental tasks
• extreme fatigue
• fainting

The bottom line

Lithium, a drug sometimes used to treat bipolar disorder, can cause NDI. You may experience excessive urination and thirst if this occurs.

Since stopping lithium therapy may resolve the NDI, your doctor may suggest taking other medications if you develop NDI from lithium.

There are other potential causes of NDI, so even if you’re not taking lithium, it’s important to speak with your doctor if you’re experiencing excessive urination and thirst.

They can perform tests to help confirm whether you have NDI and recommend appropriate treatments.