Managing polyuria during lithium treatment: a preliminary prospective observational study

Show simple item record Kinahan, James C. Ní Chorcoráin, Aoife Cunningham, Sean K. Barry, Siobhan Kelly, Brendan 2019-05-08T11:12:32Z 2019-05-08T11:12:32Z 2019-04-10
dc.identifier.citation Kinahan, J. C., Ní Chorcoráin, A., Cunningham, S., Barry, S. and Kelly, B. D. (2019) 'Managing polyuria during lithium treatment: a preliminary prospective observational study', Irish Journal of Psychological Medicine, pp. 1-8. doi: 10.1017/ipm.2019.9 en
dc.identifier.startpage 1 en
dc.identifier.endpage 8 en
dc.identifier.issn 0790-9667
dc.identifier.doi 10.1017/ipm.2019.9 en
dc.description.abstract Objectives:Lithium-treated patients with polyuria are at increased risk of lithium toxicity. We aimed to describe the clinical benefits and risks of different management strategies for polyuria in community lithium-treated patients.Methods:This is a naturalistic, observational, prospective 12-month cohort study of lithium-treated patients with polyuria attending a community mental health service in Dublin, Ireland. When polyuria was detected, management changed in one of four ways: (a) no pharmacological change; (b) lithium dose decrease; (c) lithium substitution; or (d) addition of amiloride.Results:Thirty-four participants were diagnosed with polyuria and completed prospective data over 12 months. Mean 24-hour urine volume decreased from 4852 to 4344 ml (p = 0.038). Mean early morning urine osmolality decreased from 343 to 338 mOsm/kg (p = 0.823). Mean 24-hour urine volume decreased with each type of intervention but did not attain statistical significance for any individual intervention group. Mean early morning urine osmolality decreased in participants with no pharmacological change and increased in participants who received a change in medication but these changes did not attain statistical significance. Only participants who discontinued lithium demonstrated potentially clinically significant changes in urine volume (mean decrease 747 ml in 24 hours) and early morning urine osmolality (mean increase 31 mOsm/kg) although this was not definitively proven, possibly owing to power issues.Conclusions:Managing polyuria by decreasing lithium dose does not appear to substantially improve objective measures of renal tubular dysfunction, whereas substituting lithium may do so. Studies with larger numbers and longer follow-up would clarify these relationships. en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher Cambridge University Press on behalf of the College of Psychiatrists of Ireland en
dc.rights © 2019, College of Psychiatrists of Ireland. Published by Cambridge University Press. All rights reserved. en
dc.subject Lithium en
dc.subject Polyuria en
dc.subject Renal tubular dysfunction en
dc.subject Nephrogenic diabetes insipidus en
dc.subject Amiloride en
dc.title Managing polyuria during lithium treatment: a preliminary prospective observational study en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother James Conor Kinahan, Occasional Staff, University College Cork, Cork, Ireland. +353-21-490-3000 Email: en
dc.internal.availability Full text available en Access to this article is restricted until 12 months after publication by request of the publisher. en 2020-04-10 2019-04-17T09:32:50Z
dc.description.version Published Version en
dc.internal.rssid 481883336
dc.description.status Peer reviewed en
dc.identifier.journaltitle Irish Journal of Psychological Medicine en
dc.internal.copyrightchecked Yes
dc.internal.licenseacceptance Yes en
dc.internal.IRISemailaddress en
dc.internal.bibliocheck First View - Online Version of Record before inclusion in an issue. Check vol / issue / page range. Amend citation as necessary. en
dc.identifier.eissn 2051-6967

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