A 54-year-old man with a medical history significant for bipolar disease presents to his physician..

A 54-year-old man with a medical history significant for
bipolar disease presents to his physician with complaints of polyuria. He
states that he must get up three or four times each night to urinate. He also
notes frequent thirst. He denies polyphagia, urinary urgency, difficulty
initiating urination, and postvoid dribbling. His medical history is notable
only for bipolar disease. He has a longstanding history of noncompliance with
medications for the disease, with frequent hospitalizations for both mania and
depression, but has been stable on lithium for the past 6 months. He denies any
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A 54-year-old man with a medical history significant for
bipolar disease presents to his physician with complaints of polyuria. He
states that he must get up three or four times each night to urinate. He also
notes frequent thirst. He denies polyphagia, urinary urgency, difficulty
initiating urination, and postvoid dribbling. His medical history is notable
only for bipolar disease. He has a longstanding history of noncompliance with
medications for the disease, with frequent hospitalizations for both mania and
depression, but has been stable on lithium for the past 6 months. He denies any
symptoms of mania or depression at this time. He takes no other medications.
His family history is notable for depression and substance abuse but is
otherwise negative. The patient has a history of polysubstance abuse but has
been “clean and sober” for the past 6 months. On examination, the patient’s
vital signs are within normal limits. The head–neck examination reveals
slightly dry mucous membranes. The rectal examination reveals a normal prostate
without masses. The remainder of his examination is unremarkable. Urinalysis
reveals dilute urine without glucose or other abnormalities. Serum electrolytes
reveal a mildly increased sodium level. A diagnosis of diabetes insipidus is
entertained.

Questions

A. Do you suspect central or nephrogenic diabetes insipidus?
Why? How would you confirm the diagnosis?

B. How does lithium cause diabetes insipidus?

C. What is the cause of this patient’s polyuria? His thirst?

D. What might occur if this patient were unable to maintain
sufficient water intake?

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