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Hyperosmolar nonketotic coma precipitated by lithium-induced nephrogenic diabetes insipidus.
  1. H. Azam,
  2. R. W. Newton,
  3. A. D. Morris,
  4. C. J. Thompson
  1. Department of Diabetes, Ninewells Hospital and Medical School, Dundee, Scotland, UK.

    Abstract

    A 45-year-old man, with a 10-year history of manic depression treated with lithium, was admitted with hyperosmolar, nonketotic coma. He gave a five-year history of polyuria and polydipsia, during which time urinalysis had been negative for glucose. After recovery from hyperglycaemia, he remained polyuric despite normal blood glucose concentrations; water deprivation testing indicated nephrogenic diabetes insipidus, likely to be lithium-induced. We hypothesize that when this man developed type 2 diabetes, chronic polyuria due to nephrogenic diabetes insipidus was sufficient to precipitate hyperosmolar dehydration.

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