This case study highlights the important contribution of nursing in obtaining an accurate health history. The case discussed herein initially appeared to be neurogenic diabetes insipidus (DI) secondary to a traumatic brain injury. The nursing staff, by reviewing the patient's health history with his family, discovered a history of polydipsia and long-standing lithium use. Lithium is implicated in drug-induced nephrogenic DI, and because the patient had not received lithium since being admitted to the hospital, his treatment changed to focus on nephrogenic DI. By combining information from the patient history, the physical examination, and radiologic and laboratory studies, the critical care team demonstrated that the patient had been self-treating his lithium-induced nephrogenic DI and developed neurogenic DI secondary to brain trauma. Thus successful treatment required that nephrogenic and neurogenic DI be treated concomitantly.
Questions or comments about this article may be directed to DaiWai M. Olson, BSN RN CCRN, by phone at 919/681-4241 or by e-mail at firstname.lastname@example.org. He is a clinical nurse IV at Duke University Hospital North, Durham, NC.
LorieAnn G. Meek, RN CCRN, is a clinical nurse IV at Duke University Hospital North.
John R. Lynch, MD, is an associate professor of neurology at Duke University School of Medicine, Durham, NC.
© 2004 American Association of Neuroscience Nurses