{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,12]],"date-time":"2025-07-12T01:08:00Z","timestamp":1752282480110,"version":"3.40.3"},"reference-count":0,"publisher":"South African Medical Association NPC","license":[{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["S Afr Med J"],"abstract":"<jats:p>\n\n\n\nWe report a case of profound nephrogenic diabetes insipidus (NDI) in which renal resistance to antidiuretic hormone results in dilute polyuria despite normal circulating concentrations. A 28-year-old man with bipolar mood disorder presented to his local clinic with symptoms suggestive of lithium toxicity. Plasma lithium concentrations and thyroid-stimulating hormone (TSH) were taken, but results were not acted upon. One week later, he presented obtunded, severely dehydrated and in renal failure. His plasma lithium concentration was 4.3 mmol\/L (toxic threshold &gt;1.5 mmol\/L) and TSH &gt;100 mIU\/L. After admission to the intensive care unit, including haemodialysis and 12 days of ventilation, he developed profound polyuria, with a peak output of 15 L\/day. Amiloride with hydrochlorothiazide adequately reduced the polyuria. Management of lithium-induced NDI remains complex, and includes diuretics, which paradoxically reduce polyuria in this setting. Failure to follow up critical results led to profound morbidity, and is a crucial learning point in this case.\n\n\n\n<\/jats:p>","DOI":"10.7196\/samj.2025.v115i3.2651","type":"journal-article","created":{"date-parts":[[2025,4,8]],"date-time":"2025-04-08T05:37:30Z","timestamp":1744090650000},"page":"e2651","source":"Crossref","is-referenced-by-count":1,"title":["Severe lithium-induced nephrogenic diabetes insipidus: The diuresis paradox"],"prefix":"10.7196","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5975-3566","authenticated-orcid":false,"given":"G S","family":"Tatz","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7240-8812","authenticated-orcid":false,"given":"Marc","family":"Blockman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3084-7408","authenticated-orcid":false,"given":"J A","family":"Dave","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5308-7563","authenticated-orcid":false,"given":"I L","family":"Ross","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"4425","published-online":{"date-parts":[[2025,4,1]]},"container-title":["South African Medical Journal"],"original-title":[],"link":[{"URL":"https:\/\/samajournals.co.za\/index.php\/samj\/article\/download\/2651\/1302","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/samajournals.co.za\/index.php\/samj\/article\/download\/2651\/1302","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,8]],"date-time":"2025-04-08T05:37:33Z","timestamp":1744090653000},"score":1,"resource":{"primary":{"URL":"https:\/\/samajournals.co.za\/index.php\/samj\/article\/view\/2651"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,1]]},"references-count":0,"URL":"https:\/\/doi.org\/10.7196\/samj.2025.v115i3.2651","relation":{},"ISSN":["2078-5135","0256-9574"],"issn-type":[{"value":"2078-5135","type":"electronic"},{"value":"0256-9574","type":"print"}],"subject":[],"published":{"date-parts":[[2025,4,1]]}}}