The McGill Geriatric Lithium-Induced Diabetes Insipidus Clinical Study (McGLIDICS)

Soham Rej, Marilyn Segal, Nancy C P Low, I. Mucsi, Christina Holcroft, Kenneth Shulman, Karl Looper

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Objective: Despite being a common and potentially serious condition, nephrogenic diabetes insipidus (NDI) remains poorly understood in older lithium users. Our main objective was to compare the prevalence of NDI symptoms and decreased urine osmolality ([UOsm] <300 milli-Osmoles [mOsm/kg]) among geriatric and adult lithium users. We also assessed NDI symptoms, serum sodium (Na+), and urine specific gravity (USG) as possible surrogate measures of decreased UOsm, and ascertained whether potential etiologic factors independently correlated with decreased UOsm. Method: This was a cross-sectional study of 100 consecutive outpatients treated with lithium from 6 tertiary care clinics, of which 45 were geriatric (aged 65 years and older) and 55 adult (aged 18 to 64 years). Patients completed a symptom questionnaire and underwent laboratory tests, including UOsm, serum Na+, and USG. Results: Geriatric and adult lithium users had similar rates of decreased UOsm (12.5%, compared with 17.9%, P = 0.74), but geriatric patients reported less symptoms (P <0.05). Although UOsm did not correlate with symptoms or current serum Na+, USG of less than 1.010 was suggestive of UOsm of less than 300 mOsm/kg. Age, lithium duration, and serum lithium level were independently associated with UOsm. Conclusions: The prevalence of decreased UOsm is similar in geriatric and adult lithium users, but older patients are less likely to report urinary and thirst symptoms. Although subjective symptoms do not correlate with UOsm, USG may be a cost-efficient clinical surrogate measure for UOsm. We suggest clinicians increase their vigilance for decreased UOsm, especially in lithium users with advanced age, longer duration of lithium exposure, and higher lithium levels. This may potentially prevent lithium intoxication, falls, hypernatremic events, and renal dysfunction.

Original languageEnglish
Pages (from-to)327-334
Number of pages8
JournalCanadian Journal of Psychiatry
Volume59
Issue number6
Publication statusPublished - 2014

Fingerprint

Diabetes Insipidus
Lithium
Geriatrics
Urine
Osmolar Concentration
Specific Gravity
Nephrogenic Diabetes Insipidus
Clinical Studies
Serum
Thirst
Tertiary Healthcare

Keywords

  • Bipolar disorder
  • Geriatrics
  • Lithium
  • Mood disorders
  • Nephrogenic diabetes insipidus
  • Pharmacoepidemiology
  • Renal adverse events
  • Urine osmolality

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Rej, S., Segal, M., Low, N. C. P., Mucsi, I., Holcroft, C., Shulman, K., & Looper, K. (2014). The McGill Geriatric Lithium-Induced Diabetes Insipidus Clinical Study (McGLIDICS). Canadian Journal of Psychiatry, 59(6), 327-334.

The McGill Geriatric Lithium-Induced Diabetes Insipidus Clinical Study (McGLIDICS). / Rej, Soham; Segal, Marilyn; Low, Nancy C P; Mucsi, I.; Holcroft, Christina; Shulman, Kenneth; Looper, Karl.

In: Canadian Journal of Psychiatry, Vol. 59, No. 6, 2014, p. 327-334.

Research output: Contribution to journalArticle

Rej, S, Segal, M, Low, NCP, Mucsi, I, Holcroft, C, Shulman, K & Looper, K 2014, 'The McGill Geriatric Lithium-Induced Diabetes Insipidus Clinical Study (McGLIDICS)', Canadian Journal of Psychiatry, vol. 59, no. 6, pp. 327-334.
Rej, Soham ; Segal, Marilyn ; Low, Nancy C P ; Mucsi, I. ; Holcroft, Christina ; Shulman, Kenneth ; Looper, Karl. / The McGill Geriatric Lithium-Induced Diabetes Insipidus Clinical Study (McGLIDICS). In: Canadian Journal of Psychiatry. 2014 ; Vol. 59, No. 6. pp. 327-334.
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