J Korean Neuropsychiatr Assoc.  2020 Nov;59(4):319-324. 10.4306/jknpa.2020.59.4.319.

Changes in Urine Osmolal Concentration with Lithium Treatment in Children and Youth with Bipolar Disorder

• Jeong JW
• Choi BS
• Kim DW
• Yu ER
• Huh SY
• Kim SG
• Kim JH

• KMID: 2510512
• DOI: http://doi.org/10.4306/jknpa.2020.59.4.319

Abstract

Objectives
Bipolar disorder has a high rate of recurrence, which can cause problems such as declines in cognitive and social functions. Lithium is the primary medication for preventing recurrence, but the medication compliance is poor owing to side effects that include diarrhea, tremor, polyuria, polydipsia, diabetes insipidus, increased creatinine level, and weight gain. Polyuria and polydipsia also cause voluntary discontinuation of the medication. However, no domestic and international studies have evaluated the direct correlation between lithium therapy and polydipsia in pediatric patients. Therefore, we assessed this relationship by evaluating urine osmolality changes after lithium administration in pediatric patients.
Methods
This study focused on patients admitted to the Department of Psychiatry, Pusan National University Yangsan Hospital. Patients had bipolar disorder types I or II and other specified bipolar disorders based on the DSM-5, criteria at discharge from December 1, 2018, to April 31, 2020. Urine osmolarity changes from admission to discharge in the patients who used lithium for the first time after admission were reviewed.
Results
For 47 patients, the change in osmolality was statistically significant (mean, 203.32±280.68; p<0.001) and significantly higher in those aged <14 years than in those aged ≥14 years (p=0.038). Antipsychotic use and sex-related differences did not affect urine osmolality.
Conclusion
The first-time users of lithium had significantly reduced urine osmolality at discharge. Considering the lithium effect on the kidneys, a prospective study to identify the relationship between lithium use and polydipsia is necessary.

Keyword

Bipolar disorder; Lithium; Polydipsia; Polyuria; Urine osmolality; Kidney function test