Hypercalcemia and diabetes insipidus in a patient previously treated with lithium
Walid Khairallah, Ahmad Fawaz, Edward M Brown and Ghada El-Hajj Fuleihan*
Correspondence *Calcium Metabolism and Osteoporosis Program, American University of Beirut Medical Center, Bliss Street, Beirut 113-6044, Lebanon
Email gf01@aub.edu.lb
Background A 65-year-old woman presented with decreased oral intake, a reduced level of consciousness, hypercalcemia and hypernatremia. She had previously received lithium for 20 years for a schizoaffective disorder, but this treatment had been discontinued 3 years before presentation.
Investigations Physical examination, laboratory studies including measurement of serum calcium and parathyroid hormone levels, measurement of urine and serum osmolalities before and after desmopressin administration, blood and urine cultures, and a CT scan of the abdomen.
Diagnosis Urosepsis, dehydration, kidney stone disease, hyperparathyroidism, and nephrogenic diabetes insipidus.
Management Hydration, antibiotics, intravenous pamidronate for rapid control of hypercalcemia, parathyroidectomy, surgical removal of the large kidney stones, a low-protein and low-sodium diet, and initiation of treatment with a thiazide diuretic.
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