A 57-year-old man complained to his physician that he was always thirsty and had frequent and profuse micturition. The man, recently diagnosed with bipolar disorder, had been receiving lithium for 3 weeks. Which of the following was most likely the cause of the patient’s symptoms?
ExplanationPolyuria and polydipsia are common adverse effects of lithium due, at least in part, to inhibition of the vasopressin-induced increase of cAMP in the kidney (lithium inhibits adenylyl cyclase). Circulating levels of vasopressin are normal or elevated, but there is a lack of responsiveness of the collecting tubule (i.e., nephrogenic diabetes insipidus).