The University of Toledo Translation Journal of Medical Sciences 
Internal Medicine Abstract, Department of Medicine Research Symposium UTJMS 2023 May 5; 11(1):e1-e1 

Lithium-Induced Nephrogenic Diabetes 
Insipidus Self-Treated With Beer 
Potomania and Masquerading as Shock: A 
Case Report 
J Badal, MS4*, J Pourturk, DO1, M Elsamaloty, MD2, RA Assaly, MD3, JC Willey, 
MD3

1Department of Anesthesiology, The University of Toledo, Toledo, OH 43614 
2Department of Radiology, The University of Toledo, Toledo, OH 43614 
3Division of Pulmonary and Critical Care Medicine, Department of Medicine, The 
University of Toledo, Toledo, OH 43614 

*Corresponding author: joyce.badal@utoledo.edu

Published: 05 May 2023 

Introduction: Nephrogenic diabetes insipidus (NDI) is a known adverse effect from lithium use, 
commonly presenting as polyuria and polydipsia. Patients are often able to drink enough water to keep 
up with urinary losses. Here we discuss a patient accustomed to drinking 10 beers daily who developed 
rapid volume depletion, shock, and hypernatremia after his access to oral fluids was disrupted.    

Case Description: A 66-year-old male with a past medical history of bipolar disorder and alcohol use 
disorder presented with altered mental status, ataxia, and severe weight loss. Admission labs were 
significant for leukocytosis, hyponatremia, lactic acidosis, and acute kidney injury. Despite empiric 
antibiotics and volume resuscitation for presumed septic shock, on day two, he required pressors for 
hemodynamic instability and intubation for mental status. Repeat labs revealed hypernatremia and an 
elevated lithium level. Diagnosis of NDI was confirmed by a high serum and low urine osmolality, 
without improvement after DDAVP administration. We stopped lithium and initiated hypotonic fluids, 
amiloride, hydrochlorothiazide, and indomethacin. Gradually the patient’s sodium normalized, pressors 
were weaned off, and he was extubated.    

Conclusion: In this case, we describe a delayed presentation of lithium-induced NDI, initially appearing 
as hypovolemic shock and hyponatremia, then manifesting as persistent hemodynamic instability and 
hypernatremia on day two. Ad lib fluids and possibly beer potomania enabled self-correction of sodium 
levels until our patient’s oral intake was restricted. Clinicians should include NDI in the differential for 
patients taking lithium who develop hypotension, hypernatremia, or shock. Rapid identification and 
treatment may help avoid decompensation. 

https://dx.doi.org/10.46570/utjms.vol11-2023-692 

https://dx.doi.org/10.46570/utjms.vol11-2023-692
mailto:joyce.badal@utoledo.edu