deamino-arginine-vasopressin and Bipolar-Disorder

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.

Topics: Bipolar Disorder; Coronary Artery Bypass; Coronary Disease; Deamino Arginine Vasopressin; Diabetes Insipidus; Hemofiltration; Humans; Lithium Carbonate; Male; Middle Aged; Postoperative Complications; Treatment Outcome

Hypernatraemia over 160 mmol/L is considered to be severe. This case reports a patient who developed extreme hypernatraemia with a serum sodium concentration of 196 mmol/L. The patient was known to have chronic renal impairment and was admitted with acute deterioration of renal function secondary to dehydration. This was considered to be secondary to poor oral fluid intake (related to depression) and lithium-induced nephrogenic diabetes insipidus with salt-losing nephropathy. The patient had a high urinary sodium excretion but was also in a pure water losing state as evidenced by an inappropriately low urine osmolality for the plasma osmolality and was successfully treated with hypotonic intravenous fluid and desmopressin.

Topics: Bipolar Disorder; Deamino Arginine Vasopressin; Dehydration; Depression; Diabetes Insipidus, Nephrogenic; Female; Humans; Hypernatremia; Hypotonic Solutions; Infusions, Intravenous; Lithium Carbonate; Middle Aged; Renal Insufficiency, Chronic; Treatment Outcome

Topics: Adult; Bipolar Disorder; Deamino Arginine Vasopressin; Dose-Response Relationship, Drug; Drug Administration Schedule; Enuresis; Female; Humans

We investigated the renal function (urine volume, glomerular filtration rate, urinary osmolality and proteinuria) of 50 patients chronically treated with lithium carbonate for major affective disorder. No patient had any alteration in the parameters considered. No relationship was found between any of the parameters studied and duration of illness or lithium levels, both in serum and red blood cells. These results were confirmed by the administration of the DDAVP test to 10 patients of the original sample; no alteration of concentration ability was found. We suggest that the discrepancy between our findings and those of most authors was a result of the serum lithium level of our patient sample, which was lower than that usually used in other studies.

Topics: Adult; Aged; Aged, 80 and over; Bipolar Disorder; Deamino Arginine Vasopressin; Female; Humans; Kidney Function Tests; Lithium; Lithium Carbonate; Long-Term Care; Male; Middle Aged

A minority of patients with affective disorders experience mild elevations of the renal enzyme N-acetyl-beta-glucosaminidase (NAG). Some affectively disordered patients also have reduced concentrating ability and reduced creatinine clearance. Thirty-one affectively disordered patients were compared to 17 healthy controls, to evaluate whether these various renal abnormalities are associated with one another and to further examine the proportion of affectively disordered patients experiencing NAG elevations. Twenty-nine percent of patients had an elevated NAG, whereas none of the controls did (P less than .005). There was a trend for an association between elevated NAGs and reduced creatinine clearance (P less than .08), but no association was found between concentrating ability and either elevated NAG or reduced creatinine clearance.

Topics: Acetylglucosaminidase; Adolescent; Adult; Aged; Bipolar Disorder; Creatinine; Deamino Arginine Vasopressin; Depressive Disorder; Hexosaminidases; Humans; Kidney; Kidney Concentrating Ability; Kidney Function Tests; Middle Aged

Animal studies have revealed two important aspects of vasopressin function which make this peptide a suitable candidate for involvement in complex behavioural syndromes: (1) vasopressin deficiency produces deficits of behaviour which are reversed by vasopressin; (2) well-developed systems exist for the distribution of vasopressin throughout the central nervous system (C.N.S.) via either peptidergic neurons or the cerebrospinal fluid (C.S.F.) and provide the means by which vasopressin may regulate cells controlling behavioural or physiological processes. Among the processes which vasopressin can influence are several of significance in the symptom-complex of affective illness, including alterations in memory, changes in pain sensitivity, synchronisation of biological rhythms, the timing and quality of R.E.M. sleep, and the regulation of fluid and electrolyte balance. In addition, vasopressin is functionally linked to monoamine neurotransmitter systems and, like them, is altered by pharmacological agents which affect mood. Some of the pharmacological and clinical data suggest that vasopressin function is diminished in depression and augmented in mania; sometimes, however, alterations in vasopressin function may be detectable only during crucial periods of the manic-depressive cycle. The hypothesis that vasopressin plays a role in disorders of human behaviour, particularly manic-depressive illness, can now be directly tested by radioimmunoassays of vasopressin in C.S.F. and plasma and by the administration of specific vasopressin analogues and inhibitors.

Topics: Affective Symptoms; Bipolar Disorder; Circadian Rhythm; Deamino Arginine Vasopressin; Depression; Endorphins; Homeostasis; Humans; Memory; Nociceptors; Vasopressins

Topics: Bipolar Disorder; Deamino Arginine Vasopressin; Humans; Vasopressins

Topics: Adult; Aged; Bipolar Disorder; Deamino Arginine Vasopressin; Female; Humans; Lithium; Middle Aged; Polyuria; Thirst; Vasopressins