Lithium-induced nephrogenic diabetes insipidus after coronary artery bypass

We present a case of nephrogenic diabetes insipidus that occurred after on-pump coronary artery bypass grafting in a patient taking long-term lithium carbonate. Lithium toxicity (2.79 mmol/L) was identified on postoperative day 9. Serum sodium peaked at 175 mmol/L on postoperative day 21. Serum osmolality peaked at 384 mOsm/kg H2O, with a urinary osmolality of 403 mOsm/kg H2O. The patient was ultimately managed with hemofiltration and high-dose 1-desamino-8-D-arginine-vasopressin. Recommendations are made based on our experience of this case. In patients on long-term lithium therapy, the potentially life-threatening complication of lithium-induced nephrogenic diabetes insipidus should be specifically anticipated and managed.