Snapshot A 45-year-old woman presents to her primary care physician for persistent thirst. She has a past medical history of bipolar disorder and hypertension. She reports that the thirst began 4 weeks ago, along with increased trips to the bathroom. Her young cousin was recently diagnosed with diabetes after similar symptoms, and she is worried that she has diabetes. On physical exam, she has dry mucous membranes. A closer look at her medication list shows a new medication, lithium, started about 8 weeks ago. (Nephrogenic diabetes insipidus) Introduction Clinical definition login to view 2 more bullets Central vs Nephrogenic Diabetes Inspidus (DI)Central DINephrogenic DIDefinitionFailure to produce antidiuretic hormone (ADH)Insensitivity or resistance of the kidneys to ADHEtiologyPituitary tumorOther pituitary injuriesautoimmune diseasetraumasurgeryischemiaDrugslithiumdemeclocyclineamphotericin BCongenital (rare)Electrolyte abnormalitieshypercalcemiahypokalemiaPathogenesis↓ ADH↑ADHVasopressin (DDAVP) challenge↓ Urine volume and ↑ urine osmolalityNo change in urine volume or osmolality Presentation Symptoms login to view 4 more bullets Studies Diagnostic testing login to view 15 more bullets Differential Primary polydipsia login to view 3 more bullets Treatment Management approach login to view 2 more bullets Central DI login to view 6 more bullets Nephrogenic DI login to view 15 more bullets Complications Hypernatremia Dehydration