PDF(Pubmed)
Abstract：
BACKGROUND Nephrogenic diabetic insipidus (NDI) poses a challenge in clinical management, particularly when associated with lithium ingestion. Non-selective non-steroidal anti-inflammatory drugs (NSAIDs) have been widely used for the treatment of numerous diseases worldwide, including NDI. However, many studies have reported the diverse adverse effects of long-term use of non-selective NSAIDs. Celecoxib, a selective cyclooxygenase-2 (COX-2) inhibitor, is a better drug to relieve pain and inflammation in terms of long-term safety and efficacy than non-selective NSAIDs. Nevertheless, there are few reports describing the effectiveness of celecoxib in treating NDI. CASE REPORT We report a case of a 46-year-old woman with schizophrenia who presented with severe hypernatremia and refractory polyuria due to lithium-induced NDI. Cessation of lithium ingestion and traditional treatments, including trichlormethiazide and desmopressin, yielded minimal improvement in her hypernatremia and polyuria. Her sodium level needed to be strictly controlled with the infusion of dextrose 5% in water. Given the safety of celecoxib, we decided to initiate celecoxib as the treatment of lithium-induced NDI instead of indomethacin. Notably, the introduction of celecoxib led to a substantial and sustained amelioration of polyuria and hypernatremia without any celecoxib-associated adverse effects. Even after transfer to another hospital, stability in serum sodium levels persisted with celecoxib. CONCLUSIONS We presented a case of lithium-induced NDI successfully treated with celecoxib, a selective COX-2 inhibitor. To the best of our knowledge, this is the first reported case of successful treatment of lithium-induced NDI with celecoxib, and suggests celecoxib is a viable therapeutic option warranting further exploration. Physicians should consider its use when faced with the challenging management of lithium-induced NDI.
摘要：
背景肾源性尿崩症（NDI）在临床管理中提出了挑战，特别是当与锂摄入相关时。非选择性非甾体抗炎药(NSAIDs)已广泛应用于世界范围内多种疾病的治疗,包括NDI。然而,许多研究报道了长期使用非选择性NSAIDs的多种不良反应.塞来昔布,选择性环氧合酶-2（COX-2）抑制剂，在长期安全性和有效性方面，是一种比非选择性NSAIDs更好的缓解疼痛和炎症的药物。然而，很少有报道描述塞来昔布治疗NDI的有效性。病例报告我们报告了一例46岁的精神分裂症妇女，由于锂引起的NDI而出现严重的高钠血症和难治性多尿。停止锂摄入和传统治疗，包括三氯噻嗪和去氨加压素，她的高钠血症和多尿症状改善甚微。她的钠水平需要通过输注5%的葡萄糖水溶液来严格控制。考虑到塞来昔布的安全性,我们决定开始使用塞来昔布代替吲哚美辛治疗锂诱导的NDI.值得注意的是,塞来昔布的引入导致多尿和高钠血症的实质性和持续改善，而没有任何塞来昔布相关的不良反应。即使在转移到另一家医院后，塞来昔布维持血清钠水平的稳定性。结论我们提出了一个锂诱导的NDI成功治疗塞来昔布，选择性COX-2抑制剂。据我们所知,这是塞来昔布成功治疗锂引起的NDI的首例报道，并建议塞来昔布是一种可行的治疗选择，值得进一步探索。面对锂引起的NDI的挑战性管理时，医生应考虑其使用。
