The cascade to a serendipitous discovery of lithium-induced nephrogenic diabetes insipidus.

Lithium therapy is a common treatment for affective disorders and is widely regarded as a lifesaving drug. However, because its elimination is almost wholly unchanged via the kidneys, both acute and long-term adverse effects relating to toxicity may occur, including declining renal function and nephrogenic diabetes insipidus (DI). DI may be difficult to detect and is frequently preceded by dehydration and which, in our patient, was discovered by chance. We describe a case of an elderly woman on chronic lithium therapy for bipolar affective disorder who initially presented with dehydration from vomiting but possibly developed extra-pontine myelinolysis (EPM) after over-zealous correction of hyponatraemia. Steroids administered appeared to have prevented further progression but a persisting hyperosmolar state then alerted us to the presence of nephrogenic DI. Although both conditions were later successfully reversed with no obvious chronic sequelae, the recovery of the patient was protracted. Clinicians should be vigilant for complications of managing dehydration states in people prescribed with lithium.

Depression and low bone mineral density: The correlation among Chinese.

BACKGROUND: Depression is usually associated with changes in the endogenous hormonal system. The most important hormonal modifications are elevation of the serum cortisol level as well as the reduction of endogenous sex hormone levels. These changes have advanced side effects on a bone metabolism and bone remodelling process, which consequently, lead to the declining in bone mineral density and increase the risk of bone fractures, which is reported by current studies. OBJECTIVE: To evaluate the association of low bone density with depression among Malaysian Chinese. METHODS: 91 Chinese participants with depression were chosen from psychiatric clinics in Penang General Hospital and Penang Adventist Hospital, and 98 Chinese volunteers were employed from the community as controls of both genders, with their ages ranging from 25 to 65 years. Bone mineral density was detected by measuring the T-score and Z-score of the calcaneus bone at the heel; this was measured using the CM200 Furuno ultrasound bone densitometry. RESULTS: The bone mineral density of the depressed group was observed to be significantly lower in terms of the T-score (P=0.020) and insignificantly lower in terms of Z-score as compared with the control group. Participants with depression had 1.5-fold relative risk (RR) of having T-score less than -1.0 (low bone density). Logistic regression was then used to adjust all confounding variables which showed a significant association between depression and low bone mineral density with an odds ratio of 2.28. CONCLUSION: Depression may be associated with low bone mineral density among the Malaysian Chinese.