Amelioration of Polyuria by Amiloride in Patients Receiving Long-Term Lithium Therapy
Vasopressin-resistant diabetes insipidus is a common side effect of the treatment of affective disorders with lithium. We studied the effect of amiloride on lithium-induced polyuria in nine such patients receiving maintenance lithium therapy who had a vasopressin-resistant defect in urinary concentr...
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| Veröffentlicht in: | The New England journal of medicine 1985-02, Vol.312 (7), p.408-414 |
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| creator | Batlle, Daniel C von Riotte, Alisa B Gaviria, Moises Grupp, Marlene |
| description | Vasopressin-resistant diabetes insipidus is a common side effect of the treatment of affective disorders with lithium. We studied the effect of amiloride on lithium-induced polyuria in nine such patients receiving maintenance lithium therapy who had a vasopressin-resistant defect in urinary concentrating ability. After a mean (±S.E.) of 24±6 days of amiloride administration, the urine volume fell (from 4.7±0.6 to 3.1±0.3 liters per 24 hours; P |
| doi_str_mv | 10.1056/NEJM198502143120705 |
| format | Article |
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2
0; P<0.005) measured after fluid deprivation and the injection of exogenous vasopressin.
We conclude that amiloride mitigates lithium-induced polyuria, at least partly, by blunting the inhibitory effect of lithium on water transport in the renal collecting tubule. Thus, amiloride may provide a specific therapy for polyuria in lithium-treated patients while obviating the need for potassium supplementation in the treatment of this kind of polyuria. (N Engl J Med 1985; 312:408–14.)
POLYURIA is frequent among patients receiving long-term lithium therapy.
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It develops in approximately 20 to 70 per cent of patients receiving maintenance lithium therapy, even when plasma lithium levels are within the therapeutic range.
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The mechanism whereby lithium causes polyuria and thirst has been studied extensively in laboratory animals and in human beings.
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2
3
4
5
6
7
8
Impaired urinary concentrating ability, which is resistant to vasopressin administration, is the chief disturbance underlying most cases of lithium-induced polyuria.
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2
3
4
5
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7
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The finding of elevated levels of plasma arginine vasopressin in the majority of patients with the condition supports the notion that this agent causes nephrogenic diabetes insipidus. . . .</description><identifier>ISSN: 0028-4793</identifier><identifier>EISSN: 1533-4406</identifier><identifier>DOI: 10.1056/NEJM198502143120705</identifier><identifier>PMID: 3969096</identifier><identifier>CODEN: NEJMAG</identifier><language>eng</language><publisher>Boston, MA: Massachusetts Medical Society</publisher><subject>Adult ; Affective disorders ; Amiloride ; Amiloride - therapeutic use ; Bicarbonates ; Biological and medical sciences ; Body Water - metabolism ; Creatinine ; Diabetes insipidus ; Electrolytes - urine ; Excretion ; Female ; Follow-Up Studies ; Humans ; Kidney Concentrating Ability - drug effects ; Kidney Tubules, Collecting - drug effects ; Kidneys ; Lithium ; Lithium - adverse effects ; Male ; Medical sciences ; Middle Aged ; Mood Disorders - drug therapy ; Osmolar Concentration ; Pharmacology. Drug treatments ; Plasma levels ; Polyuria ; Polyuria - chemically induced ; Polyuria - drug therapy ; Potassium ; Pyrazines - therapeutic use ; Sodium ; Supplements ; Urinary system ; Urine ; Vasopressin</subject><ispartof>The New England journal of medicine, 1985-02, Vol.312 (7), p.408-414</ispartof><rights>1985 INIST-CNRS</rights><rights>Copyright Massachusetts Medical Society Feb 14, 1985</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c430t-1781a6f5801ada3a3051220c73a435d1b46f5dd39723c06414cb6701de6fbebb2</citedby><cites>FETCH-LOGICAL-c430t-1781a6f5801ada3a3051220c73a435d1b46f5dd39723c06414cb6701de6fbebb2</cites></display><links><openurl>$$Topenurl_article</openurl><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>776</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=9069712$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/3969096$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Batlle, Daniel C</creatorcontrib><creatorcontrib>von Riotte, Alisa B</creatorcontrib><creatorcontrib>Gaviria, Moises</creatorcontrib><creatorcontrib>Grupp, Marlene</creatorcontrib><title>Amelioration of Polyuria by Amiloride in Patients Receiving Long-Term Lithium Therapy</title><title>The New England journal of medicine</title><addtitle>N Engl J Med</addtitle><description>Vasopressin-resistant diabetes insipidus is a common side effect of the treatment of affective disorders with lithium. We studied the effect of amiloride on lithium-induced polyuria in nine such patients receiving maintenance lithium therapy who had a vasopressin-resistant defect in urinary concentrating ability. After a mean (±S.E.) of 24±6 days of amiloride administration, the urine volume fell (from 4.7±0.6 to 3.1±0.3 liters per 24 hours; P<0.005), and the urine osmolality increased (from 228±35 to 331±34 mOsm per kilogram of H20; P<0.001). The decrease in urine output was sustained during six months of observation in the absence of any significant change in plasma levels of lithium, potassium, or bicarbonate; urinary excretion of sodium or lithium; or creatinine clearance. Amiloride administration was also associated with a significant increase in urine osmolality (from 575±54 to 699±48 mOsm per kilogram of H
2
0; P<0.005) measured after fluid deprivation and the injection of exogenous vasopressin.
We conclude that amiloride mitigates lithium-induced polyuria, at least partly, by blunting the inhibitory effect of lithium on water transport in the renal collecting tubule. Thus, amiloride may provide a specific therapy for polyuria in lithium-treated patients while obviating the need for potassium supplementation in the treatment of this kind of polyuria. (N Engl J Med 1985; 312:408–14.)
POLYURIA is frequent among patients receiving long-term lithium therapy.
1
2
3
It develops in approximately 20 to 70 per cent of patients receiving maintenance lithium therapy, even when plasma lithium levels are within the therapeutic range.
1
2
3
The mechanism whereby lithium causes polyuria and thirst has been studied extensively in laboratory animals and in human beings.
1
2
3
4
5
6
7
8
Impaired urinary concentrating ability, which is resistant to vasopressin administration, is the chief disturbance underlying most cases of lithium-induced polyuria.
1
2
3
4
5
6
7
8
The finding of elevated levels of plasma arginine vasopressin in the majority of patients with the condition supports the notion that this agent causes nephrogenic diabetes insipidus. . . .</description><subject>Adult</subject><subject>Affective disorders</subject><subject>Amiloride</subject><subject>Amiloride - therapeutic use</subject><subject>Bicarbonates</subject><subject>Biological and medical sciences</subject><subject>Body Water - metabolism</subject><subject>Creatinine</subject><subject>Diabetes insipidus</subject><subject>Electrolytes - urine</subject><subject>Excretion</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Kidney Concentrating Ability - drug effects</subject><subject>Kidney Tubules, Collecting - drug effects</subject><subject>Kidneys</subject><subject>Lithium</subject><subject>Lithium - adverse effects</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mood Disorders - drug therapy</subject><subject>Osmolar Concentration</subject><subject>Pharmacology. Drug treatments</subject><subject>Plasma levels</subject><subject>Polyuria</subject><subject>Polyuria - chemically induced</subject><subject>Polyuria - drug therapy</subject><subject>Potassium</subject><subject>Pyrazines - therapeutic use</subject><subject>Sodium</subject><subject>Supplements</subject><subject>Urinary system</subject><subject>Urine</subject><subject>Vasopressin</subject><issn>0028-4793</issn><issn>1533-4406</issn><fulltext>false</fulltext><rsrctype>article</rsrctype><creationdate>1985</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BEC</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kF9LwzAUxYMoc04_gQgBfZPqTZMmzeMY8x9Th2zPJW3TmdE0M2mFfXsrG3sS78t9OL9zLvcgdEngjkDC79-mL69EpgnEhFESg4DkCA1JQmnEGPBjNASI04gJSU_RWQhr6IcwOUADKrkEyYdoOba6Ns6r1rgGuwrPXb3tvFE43-KxNbXzptTYNHjeI7ppA_7QhTbfplnhmWtW0UJ7i2em_TSdxYtP7dVme45OKlUHfbHfI7R8mC4mT9Hs_fF5Mp5FBaPQRkSkRPEqSYGoUlFFISFxDIWgitGkJDnrxbKkUsS0AM4IK3IugJSaV7nO83iErne5G---Oh3abO063_QnM5IKkdCUA-8puqMK70Lwuso23ljltxmB7LfJ7I8me9fVPrvLrS4Pnn11vX6z11UoVF151RQmHDAJXIr-mxG63WHWhqzRa_vv0R9764X1</recordid><startdate>19850214</startdate><enddate>19850214</enddate><creator>Batlle, Daniel C</creator><creator>von Riotte, Alisa B</creator><creator>Gaviria, Moises</creator><creator>Grupp, Marlene</creator><general>Massachusetts Medical Society</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0TZ</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8AO</scope><scope>8C1</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BEC</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>HCIFZ</scope><scope>K0Y</scope><scope>LK8</scope><scope>M0R</scope><scope>M0T</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>M2P</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope></search><sort><creationdate>19850214</creationdate><title>Amelioration of Polyuria by Amiloride in Patients Receiving Long-Term Lithium Therapy</title><author>Batlle, Daniel C ; von Riotte, Alisa B ; Gaviria, Moises ; Grupp, Marlene</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c430t-1781a6f5801ada3a3051220c73a435d1b46f5dd39723c06414cb6701de6fbebb2</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1985</creationdate><topic>Adult</topic><topic>Affective disorders</topic><topic>Amiloride</topic><topic>Amiloride - therapeutic use</topic><topic>Bicarbonates</topic><topic>Biological and medical sciences</topic><topic>Body Water - metabolism</topic><topic>Creatinine</topic><topic>Diabetes insipidus</topic><topic>Electrolytes - urine</topic><topic>Excretion</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Kidney Concentrating Ability - drug effects</topic><topic>Kidney Tubules, Collecting - drug effects</topic><topic>Kidneys</topic><topic>Lithium</topic><topic>Lithium - adverse effects</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mood Disorders - drug therapy</topic><topic>Osmolar Concentration</topic><topic>Pharmacology. Drug treatments</topic><topic>Plasma levels</topic><topic>Polyuria</topic><topic>Polyuria - chemically induced</topic><topic>Polyuria - drug therapy</topic><topic>Potassium</topic><topic>Pyrazines - therapeutic use</topic><topic>Sodium</topic><topic>Supplements</topic><topic>Urinary system</topic><topic>Urine</topic><topic>Vasopressin</topic><toplevel>peer_reviewed</toplevel><creatorcontrib>Batlle, Daniel C</creatorcontrib><creatorcontrib>von Riotte, Alisa B</creatorcontrib><creatorcontrib>Gaviria, Moises</creatorcontrib><creatorcontrib>Grupp, Marlene</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Pharma and Biotech Premium PRO</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>eLibrary</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>SciTech Premium Collection</collection><collection>New England Journal of Medicine</collection><collection>ProQuest Biological Science Collection</collection><collection>Consumer Health Database</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>ProQuest Psychology</collection><collection>Research Library</collection><collection>Science Database</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><jtitle>The New England journal of medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>no_fulltext</fulltext></delivery><addata><au>Batlle, Daniel C</au><au>von Riotte, Alisa B</au><au>Gaviria, Moises</au><au>Grupp, Marlene</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Amelioration of Polyuria by Amiloride in Patients Receiving Long-Term Lithium Therapy</atitle><jtitle>The New England journal of medicine</jtitle><addtitle>N Engl J Med</addtitle><date>1985-02-14</date><risdate>1985</risdate><volume>312</volume><issue>7</issue><spage>408</spage><epage>414</epage><pages>408-414</pages><issn>0028-4793</issn><eissn>1533-4406</eissn><coden>NEJMAG</coden><abstract>Vasopressin-resistant diabetes insipidus is a common side effect of the treatment of affective disorders with lithium. We studied the effect of amiloride on lithium-induced polyuria in nine such patients receiving maintenance lithium therapy who had a vasopressin-resistant defect in urinary concentrating ability. After a mean (±S.E.) of 24±6 days of amiloride administration, the urine volume fell (from 4.7±0.6 to 3.1±0.3 liters per 24 hours; P<0.005), and the urine osmolality increased (from 228±35 to 331±34 mOsm per kilogram of H20; P<0.001). The decrease in urine output was sustained during six months of observation in the absence of any significant change in plasma levels of lithium, potassium, or bicarbonate; urinary excretion of sodium or lithium; or creatinine clearance. Amiloride administration was also associated with a significant increase in urine osmolality (from 575±54 to 699±48 mOsm per kilogram of H
2
0; P<0.005) measured after fluid deprivation and the injection of exogenous vasopressin.
We conclude that amiloride mitigates lithium-induced polyuria, at least partly, by blunting the inhibitory effect of lithium on water transport in the renal collecting tubule. Thus, amiloride may provide a specific therapy for polyuria in lithium-treated patients while obviating the need for potassium supplementation in the treatment of this kind of polyuria. (N Engl J Med 1985; 312:408–14.)
POLYURIA is frequent among patients receiving long-term lithium therapy.
1
2
3
It develops in approximately 20 to 70 per cent of patients receiving maintenance lithium therapy, even when plasma lithium levels are within the therapeutic range.
1
2
3
The mechanism whereby lithium causes polyuria and thirst has been studied extensively in laboratory animals and in human beings.
1
2
3
4
5
6
7
8
Impaired urinary concentrating ability, which is resistant to vasopressin administration, is the chief disturbance underlying most cases of lithium-induced polyuria.
1
2
3
4
5
6
7
8
The finding of elevated levels of plasma arginine vasopressin in the majority of patients with the condition supports the notion that this agent causes nephrogenic diabetes insipidus. . . .</abstract><cop>Boston, MA</cop><pub>Massachusetts Medical Society</pub><pmid>3969096</pmid><doi>10.1056/NEJM198502143120705</doi><tpages>7</tpages></addata></record> |
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| ispartof | The New England journal of medicine, 1985-02, Vol.312 (7), p.408-414 |
| issn | 0028-4793 1533-4406 |
| language | eng |
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| subjects | Adult Affective disorders Amiloride Amiloride - therapeutic use Bicarbonates Biological and medical sciences Body Water - metabolism Creatinine Diabetes insipidus Electrolytes - urine Excretion Female Follow-Up Studies Humans Kidney Concentrating Ability - drug effects Kidney Tubules, Collecting - drug effects Kidneys Lithium Lithium - adverse effects Male Medical sciences Middle Aged Mood Disorders - drug therapy Osmolar Concentration Pharmacology. Drug treatments Plasma levels Polyuria Polyuria - chemically induced Polyuria - drug therapy Potassium Pyrazines - therapeutic use Sodium Supplements Urinary system Urine Vasopressin |
| title | Amelioration of Polyuria by Amiloride in Patients Receiving Long-Term Lithium Therapy |
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