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[Intravenous ketoprofen for severe lithium-induced polyuria]
D Tran-Van1, P Avargues, P Labadie
1Département d'anesthésie-réanimation-urgences, HIA Robert Picqué, BP 28, 339898 Bordeaux Armées 33, France. tranvan.c-d@cegetel.net
Presse Medicale (Paris, France : 1983)
|October 7, 2005
Summary
Severe lithium poisoning can cause nephrogenic diabetes insipidus. Intravenous ketoprofen rapidly improved polyuria in a patient, suggesting it as a treatment for this condition.
Area of Science:
- Nephrology
- Pharmacology
- Psychiatry
Background:
- Lithium is a common psychiatric treatment with a narrow therapeutic range.
- Long-term lithium use can lead to nephrogenic diabetes insipidus (NDI), a condition impairing kidney water reabsorption.
- Severe hypotonic polyuria is a rare but serious complication of lithium-induced NDI.
Observation:
- A 42-year-old male patient presented with acute lithium poisoning (plasma lithium 2.6 mmol/L) during chronic treatment.
- The patient developed severe NDI with neurological symptoms.
- Rapid improvement in polyuria was observed after hypotonic solution perfusion and intravenous ketoprofen administration.
Findings:
- Intravenous ketoprofen demonstrated a rapid onset of action in treating severe lithium-induced NDI.
- This contrasts with oral nonsteroidal anti-inflammatory drugs (NSAIDs) like indomethacin, which may have delayed effects.
- NSAIDs may be effective by inhibiting prostaglandin synthesis, which lithium disrupts.
Implications:
- Intravenous ketoprofen is a potential therapeutic option for severe lithium-induced NDI.
- Careful monitoring of rehydration is crucial due to the risk of renal failure associated with NSAIDs.
- This case highlights the importance of considering rapid-acting NSAIDs for managing acute complications of lithium therapy.